武汉大学社会学系, 武汉 430072
Weight stigma: Discrimination and bias against obesity
Department of Sociology, Wuhan University, Wuhan 430072, China
收稿日期: 2017-04-27 网络出版日期: 2018-06-10
Received: 2017-04-27 Online: 2018-06-10
体重污名指个体因超重或肥胖受到的社会污名, 主要表现为公众对这一群体的歧视、偏见、消极态度, 其测量主要从公众和被污名群体自身展开。它会对被污名个体的心理、行为、身体产生消极影响, 且这些影响之间存在递进关系。现有体重污名干预研究主要聚焦于减少公众污名、降低体重以及缓解体重污名消极心理影响三个方向。未来研究可以在体重污名影响机制、测量工具和行之有效的干预策略方面进一步扩展。
体重污名指个体因超重或肥胖受到的社会污名, 主要表现为公众对这一群体的歧视、偏见、消极态度, 其测量主要从公众和被污名群体自身展开。它会对被污名个体的心理、行为、身体产生消极影响, 且这些影响之间存在递进关系。现有体重污名干预研究主要聚焦于减少公众污名、降低体重以及缓解体重污名消极心理影响三个方向。未来研究可以在体重污名影响机制、测量工具和行之有效的干预策略方面进一步扩展。
Weight stigma refers to the social stigma to overweight or obese individuals, including discrimination, prejudice and stereotype, which is mainly evaluated by the public and the stigmatized groups themselves. Weight stigma exerts negative and interconnected impacts on individuals’ body, mind and behavior. Currently, there are three main dimensions of weight stigma interventions (i.e., reducing public stigma and conducting physical and psychological intervention on overweight and obese individuals). More theoretical and practical researches in future should be done to reveal the mechanism of effects of weight stigma and develop effective measurements and intervention strategies
Weight stigma refers to the social stigma to overweight or obese individuals, including discrimination, prejudice and stereotype, which is mainly evaluated by the public and the stigmatized groups themselves. Weight stigma exerts negative and interconnected impacts on individuals’ body, mind and behavior. Currently, there are three main dimensions of weight stigma interventions (i.e., reducing public stigma and conducting physical and psychological intervention on overweight and obese individuals). More theoretical and practical researches in future should be done to reveal the mechanism of effects of weight stigma and develop effective measurements and intervention strategies
DUAN Wenjie, FENG Yu.
超重和肥胖是指可损害健康的异常或过量脂肪累积(World Health Organization, 1998)。常采用身体质量指数(Body Mass Index, BMI)来衡量人们的肥胖程度, 具体计算方法是用体重(kg)除以身高(m)的平方, 即体重/身高2(kg/m2)。随着国内学者对肥胖问题的日益关注, 中华人民共和国卫生和计划生育委员会(2013)确定了适用于中国成年人的超重、肥胖行业标准, 将成人身体质量指数大于或等于24定义为超重、大于或等于28定义为肥胖。2016年, 一项最新调查研究对比了186个国家的数据, 发现全球的肥胖人口从1975年的1.05亿增加到了2014年的6.41亿。全球肥胖人数快速增长的同时, 中国肥胖人口形势也不容乐观。中国的肥胖人口已经居世界首位, 肥胖总人数达8960万人, 其中男性4320万、女性4640万, 分别占全球肥胖人口的16.3%和12.4% (Di et al., 2016)。肥胖问题俨然是中国公众健康与卫生的重要议题。与此同时, 社会对超重和肥胖群体的歧视越来越严重, 体重污名已成为一种普遍的社会现象。有关肥胖的刻板印象广泛传播, 肥胖者通常被视为懒惰、没有动力、无能、马虎、缺乏自律和意志力(Puhl & Heuer, 2009)。因为超重或肥胖体型受到的污名统称为体重污名(Weight Stigma)。在美国, 体重污名的发生率在10年时间里增加了66%, 甚至超过美国国内的种族歧视(Puhl & King, 2013)。
目前, 相对于其它类型污名研究而言, 国内对体重污名的研究较少。现有文献对艾滋病、精神疾病污名等热点议题关注较多, 且有学者对相关领域研究进行系统回顾, 如刘颖和时勘(2010)从归因理论、社会文化理论、道德理论分析艾滋病污名形成原因、负面影响和干预措施; 王晓刚、尹天子和黄希庭(2012)从测量方法、主要研究领域评述了国内外心理疾病内隐污名的研究; 而李强、高文珺和许丹(2008)则从理论角度评述功能主义和生物文化两个派别的心理疾病污名成因。也有研究把目光聚焦于其他较少关注的污名群体, 如姜兆萍和周宗奎(2012)根据已有研究定义了老年歧视概念, 梳理了老年歧视发展的特点、成因、影响以及干预方式。目前, 国内缺乏有关体重污名的理论和实证研究, 在国外体重污名研究的基础上, 本文厘清了体重污名的不同定义、在各领域的表现、测量工具, 从身体、心理、行为分析体重污名的影响, 从减少公众污名、降低体重、减缓污名心理影响归纳现有干预策略, 并指出现有研究在探讨理论机制、编译中文版测评工具、开发有效干预策略三个方面存在的不足, 以期丰富体重污名的理论研究并为今后实证干预指明方向。
污名(Stigma)概念最早由戈夫曼提出, 他在《污名：受损身份管理札记》中把污名定义为个体获得的非社会赞许的“受损身份”。依据他的观点, 体重污名属于第一类, 即由于身体缺陷或特征而受到的污名(Goffman, 1963)。体重污名是指对肥胖个体的消极态度、观点和歧视行为(Puhl & Heuer, 2009)。Brewis (2014)认为体重污名是把某些随意的道德判断与身体体型联系起来的过程, 最终导致社会诋毁、排斥与边缘化。与之相似, Tomiyama (2014)将体重污名定义为对超重和肥胖群体的社会贬低和诋毁, 并导致对这些人的偏见、消极刻板印象和歧视。体重污名分为知觉到的体重污名和内化污名两种类型。前者常指被污名的体验, 这种体验来自外部环境, 公众会施加给超重和肥胖群体消极的评价和标签; 后者则指被污名群体认同这种标签和刻板印象, 接受自己就是这样的人(Papadopoulos & Brennan, 2015), 他们认为自己身上具有懒惰、不努力等“不良特征”。体重污名还包括一种动态的过程和结果, 即把负面的刻板印象和评价与超重、肥胖群体联系起来, 导致社会对这一群体的歧视、偏见, 最终致使他们处于社会弱势地位的结果。
Puhl和Heuer (2009)曾指出体重污名的现象广泛存在于职场、医疗、教育等领域中, 并根据以往的实证研究进行了一个系统的归纳。在此基础上, 学者分别从研究方法、研究视角上进行深化。
医疗领域的一直是体重污名研究重要方向, 主要表现在医生、护士、健康专家等表现出的消极评价、态度甚至歧视。基于体重的歧视和偏见在医疗领域普遍存在, 其发生率接近69% (Ferrante, Piasecki, Ohman-Strickland, & Crabtree, 2009)。Forhan和Salas (2013)根据过去20年的文献指出肥胖病患者在寻求治疗过程中面临医疗人员持续的歧视、偏见。对待肥胖病人的态度需要改变, 认为肥胖病人缺乏智慧和毅力的污名观点需要改变(Johnston, 2012), 医疗环境下的体重偏见会导致肥胖患者就诊时间缩短、医疗服务减少(Forhan & Salas, 2013)。
超重和肥胖的学生会经历被取笑、戏弄、欺凌等遭遇, 外界对其学业、社交、自我管理等方面评价都低于正常体重学生, 这种评价会影响他们获取学术资源。Burmeister, Kiefner, Carels和Musher-Eizenman (2013)发现学生在完成面试后, 肥胖学生的BMI值越高, 他们收到心理学研究生录取通知的可能性越小。在控制了性别、年龄、个人社交能力、年级这些变量后, 研究分析得出超重和肥胖的小学生获得更少的同龄接纳和朋友, 且更容易受到的校园欺凌(Krukowski et al., 2009)。
体重污名除了在职场、医疗、教育等领域存在, 也表现在人际交往、新闻媒体等领域中, 这些歧视、偏见出现在社会生活的方方面面, 却受到社会的接纳认可, 成为合理的社会现象。
基于上述体重污名概念界定, 体重污名的测量主要有两个方向, 即公众(非肥胖群体)和肥胖群体两个角度。反肥胖态度测试(Anti-Fat Attitudes Test, AFAT)是使用频率最高的问卷, 由美国学者Lewis, Cash, Jacobi和Bubb-Lewis (1997)编制, 主要是调查公众对肥胖的态度。它包括社会/角色轻视(对肥胖者的个人情感反应), 体型/浪漫无魅力(对肥胖者个性和身体吸引力的看法), 体重控制/指责(饮食习惯和影响体重的因素)3个因子。此外, 对待肥胖态度问卷(Antifat Attitudes Questionnaire, AAQ) (Crandall, 1994)、对肥胖者态度量表(The Attitudes Toward Obese Persons Scales, ATOP)、对肥胖者观念量表(The Beliefs About Obese Persons scales, BAOP) (Dedeli, Bursalioglu, & Deveci, 2014)也应用广泛。这些量表都具有较好的内部一致性、信效度, 能较大程度反映公众的显性态度、观点。
除了来自公众的偏见, 超重和肥胖群体也可能对自身持有偏见。为此, 学界设计出用于肥胖和超重群体自测的内化污名问卷, 如体重偏见内化问卷(Weight Bias Internalization Scale, WBIS) (Hilbert et al., 2014), 该问卷具有良好信效度, 能较好测量超重和肥胖群体对自己的看法。无论是哪个测量工具, 都将体重污名概念化为消极的态度、偏见、歧视。
在某些情境中, 人们会隐藏他们的消极态度, 理智上他们也认为这种态度不合理, 这种潜在态度被称为内隐污名(Implicit stigma)。体重内隐污名是个体不能精确识别的反肥胖态度。为了准确识别这种态度, 内隐联想测试(Implicit Association Test, IAT)被开发出来并逐渐受到认可。内隐联想测试由Greenwald在1998年首先提出, 已应用于测量内隐精神疾病污名等(Ruggs, King, Hebl, & Fitzsimmons, 2010)。它是一种测量设计, 根据不同研究需要进行编制。虽然内隐联想测试能更准确地反映公众对肥胖态度, 但与问卷调查相比, 它花费更多时间。更关键地的是, 有研究指出公众的内隐和外显污名没有显著差异(Ruggs et al., 2010)。如Phelan, Burgess和Puhl等(2015)调查了1795个医学生对肥胖的内隐和外显污名, 运用IAT测量被试对肥胖者和体重正常者的观念, 结果发现内隐污名和外显污名都存在, 但内隐污名程度更高。因此, 大多数研究可采用问卷调查, 辅之以联想测试检验内隐和外显污名之间是否存在较大差异。此外, 研究者也可借鉴其他污名研究测量方法, 一般情况下最好使用认可度较高的专业化问卷, 基于该问卷得出的结论普及性更强。
现有研究采用严格的实证方法分析体重污名的消极影响。自我报告的体重污名经历与较差的生理、心理健康有关(Hunger & Major, 2015)。有学者从具体领域总结体重污名的影响, 如Phelan, Burgess和Yeazel等(2015)系统回顾了出现在医疗领域的体重污名对医护人员、肥胖病人以及医疗环境的影响。目前大多数实证研究尚未划分肥胖群体, 但学者们一致认同体重污名对个体身心的不利影响。Puhl和Suh (2015)发现体重污名会导致暴食行为、减少身体锻炼频率, 直接危害身体健康; Vartanian和Porter (2016)厘清了近些年的相关实证研究, 主要按照研究选取的样本群体特征、研究方法来组织体重污名对饮食行为的危害。我们认为, 体重污名对个体影响一般体现在心理健康、健康行为和身体健康三个方面。
超重和肥胖者经常遭遇到来自陌生人公开的目光审视、言语辱骂及社会整体的消极判断, 这会导致个体抑郁、沮丧, 产生不安全感, 并对自己能力、形象产生怀疑(Blackstone, 2016)。现有研究从两个角度论证。一是体重污名会降低个体自尊、自我认同、自我效能感、幸福感等正向心理指标。Schafer和Ferraro (2011)发现知觉到的体重歧视会减少自我身份认同。Major, Eliezer和Rieck (2012)通过理论模型推断体重污名担忧的情境会导致身份认同危机, 进而增加压力、减少自控力。Graham和Edwards (2013)为了探讨自尊与医疗人员的反肥胖态度是否存在关联, 选取了108个BMI值在40以上的肥胖病人作为样本, 分析说明自我污名是自尊的关键预测因素, 非洲裔的美国肥胖青年病患自尊较低。另一项基于全美调查数据的分析证明, 知觉到的体重污名与幸福感有关, 与同龄人相比, 超重和肥胖学生的社会支持更少、孤独感更强(Phelan, Burgess, Puhl et al., 2015)。
二是体重污名导致负性情绪状态增加。Durso, Latner和White等人(2012)通过实证研究证明肥胖病人内化体重偏见会增加抑郁。同样地, 在意大利的研究分析得出BMI值与超重、肥胖病人的抑郁症状有关, 知觉到的医护歧视是重要的调节因素(Innamorati et al., 2017)。Preiss, Brennan和Clarke (2013)检索了46篇不同分析方法、不同地区、不同年龄群体的实证研究, 都证明体重污名与抑郁成正相关。Major等人(2012)发现与BMI值在正常范围内的女性相比, 高BMI值的女性在体重污名的情境下会知觉到更多的压力。在危地马拉的研究证明, 体重污名在低收入的发展中国家是一个重要的压力来源, 可能会加重肥胖女性的抑郁症状(Hackman, Maupin, & Brewis, 2016)。Himmelstein, Incollingo Belsky和Tomiyama (2015)通过实验操作法对比两组发现体重污名会增加皮质醇, 这是压力生理反应的主要指标。
Almeida, Savoy和Boxer (2011)发现与环境压力、心理功能、消极应对等因素相比, 体重污名对肥胖病人和大学生的暴食行为发挥独特作用。污名程度越高, 暴食行为的频率更高, 患上暴食混乱症的可能性更大(Ashmore, Friedman, Reichmann, & Musante, 2008)。因体重受到取笑的经历与女性青少年的体重控制行为、暴食频率相关, 而且受到取笑的频率越高, 这种关联越强(Olvera, Dempsey, Gonzalez, & Abrahamson, 2013)。另一项相关分析利用网络调查, 包括男性和女性样本, 表明体重歧视和暴食行为之间存在显著相关关系(Durso, Latner, & Hayashi, 2012)。其他研究还证明, 童年时期经历的体重取笑与以后生活中的暴饮暴食、饮食问题、代偿行为、饮食失调等也有关(Quick, McWilliams, & Byrd-Bredbenner, 2013)。
越来越多的研究已经开始探讨体重歧视对身体活动的影响, 尤其是对年轻人的影响。学校体育活动中, 因体重受到的取笑是肥胖学生常有的体验(Puhl & Suh, 2015)。决策和行为的定性、定量研究都显示那些因为身体体型受到审视的人, 他们身体活动的积极性较低, 他们会做出规避在学校、游泳馆等公共场所锻炼的决定(Vartanian & Smyth, 2013)。体重污名与超重、肥胖的大学生/成年人的运动回避是联系在一起的, 内化体重污名会调节这种关系(Vartanian & Novak, 2011)。其他研究发现这种效应也出现在儿童、青少年身上(Vartanian & Smyth, 2013)。在学校或者体育活动中受到的体重取笑无疑会打击青少年的运动积极性。对140个超重青少年的实验研究显示, 被随机分配到刻板印象威胁的实验组学生比控制组学生在体育游戏活动中表现更糟(Li, Lwin, & Jung, 2014)。
体重污名对身体健康的消极作用会体现在一些生理指标上。针对BMI值大于25以上群体的研究证明, 体重歧视调节BMI值与健康的重要指标C反应之间的关系。此外, 知觉到的体重歧视也会增加个体系统炎症的可能性(Sutin, Stephan, Luchetti, & Terracciano, 2014)。
鉴于体重污名对健康行为的有害影响, 研究已经开始将肥胖视为污名的潜在结果。一项有关成年人的纵向数据表明体重歧视与肥胖(Jackson, Beeken, & Wardle, 2014)和体重增加(Hansson & Rasmussen, 2014)之间存在明显联系。通过从非营利减肥组织中选取的1013个女性和68个男性调查对象, Farrow和Tarrant (2009)发现内化肥胖刻板印象并不会使超重和肥胖个体减少体重, 反而会增加BMI值。在年轻人中, 体重歧视会增加女性64%~66%的超重和肥胖风险(Haines, Kleinman, Rifas-Shiman, Field, & Austin, 2010; Quick, Wall, Larson, Haines, & Neumark-Sztainer, 2013)。根据英国全国老龄化调查组的纵向数据分析, 体重歧视会导致BMI、腰围指数上升(Jackson et al., 2014)。
近些年来对体重污名的结果机制进行探讨的研究越来越多, 体重污名对身心的消极影响是交织在一起的, 影响间存在递进关系。Puhl和Heuer (2010)认为体重污名会挫伤运动积极性、增加暴食行为, 进而导致体重增加, 这是受到广泛认可的。另一种心理机制理论提出被污名的体验会增加个体压力, 压力会导致体重的上升。Tomiyama (2014)提出的COBWEBS (Cyclic Obesity/Weight-based Stigma Model)模型解释体重污名不是一个静态结构, 而是一个恶性循环系统。这种循环系统体现在污名会使压力上升, 然后饮食增多, 最终导致体重增加。这个理论在澳大利亚的一个纵向研究中被证实, 高水平的压力状态能够预测5年内BMI值增加0.2 kg/m2 (Harding et al., 2014)。Hunger, Major, Blodorn和Miller (2015)的新近研究进一步深化该机制, 认为体重污名是一种社会身份威胁因素, 导致个体产生压力上升, 增强个体污名回避动机和减少自我控制能力, 这会影响个体健康有关行为, 最终影响身心健康水平。
体重污名干预的系统理论无论是国内还是国外尚未形成, 该问题的研究主要围绕三个方向开展。如何减少体重污名一直是污名领域研究难点; 而如何有效地帮助超重、肥胖个体减重则被视为解决问题的根本; 但近来的研究重点已经转向如何建立有效的积极干预策略增强个体应对体重污名的能力。
减少公众偏见和歧视是污名研究一直关注和探讨的关键点。传统的体重污名应对方法主要是教育和提高个体意识, 强化公众有关肥胖成因复杂性的认知, 肥胖成因可能包括遗传、代谢和社会因素等(Williams, Mesidor, Winters, Dubbert, & Wyatt, 2015)。O'Brien, Puhl, Latner, Mir和Hunter (2010)给实验组成员提供一组关于肥胖成因的信息并向他们强调体重的不可控, 结果显示接收信息的被试会减少对肥胖群体的偏见。Swift等(2013)通过教育电影向医疗工作者展示了超重、肥胖个体面临的医疗歧视和消极后果, 干预后医护人员对肥胖的外显歧视有所改善, 但是内隐反肥胖态度并无显著变化。这些干预方案短期内难以取得效果, 推广难度较高, 个人对超重和肥胖群体的消极看法是根深蒂固, 稳定的认知结构很难在短期内被改变, 因此利用短期的干预策略减少公众污名是无法立竿见影的。
一直以来, 有关肥胖、体重污名认知存在一定偏差, 公众认为对体重的不满会强化个体控制体重的意愿, 体重污名经历会挫伤肥胖者饮食欲望, 同时促使其努力锻炼减轻重量(Heinberg, Thompson, & Matzon, 2001)。健康专家设计了专业化的减肥项目, 并认为体重减少后他们会受到更少的歧视、偏见, 这在一些实证研究中得到验证。如Puhl和Brownell (2001)发现肥胖职员通过减少体重, 向雇主表现出更健康的生活方式, 表明他们更愿意投资人力资本, 这意味着未来工作生产力的预期改善。Brown等(2015)开展健康、康复营养与运动(Nutrition and Exercise for Wellness and Recovery, NEW-R)训练项目, 8周的干预过后, 参与者平均减掉3磅体重, 6个月后平均减掉10磅体重。然而, Crawford, Jeffery和French (2000)通过一个社区的体重预防项目数据, 分析发现超过一半(53.7%)的参与者在干预后的12个月内减去的体重又会反弹, 24.5%参与者在3年内避免了增加体重, 只有4.6%成功地减去和维持体重。
积极心理学(Positive Psychology)是美国心理学界兴起的一个新的研究领域, 主要研究积极的情绪和体验、积极的个性特征、积极的心理过程等(Sheldon & King, 2001)。积极心理干预(Positive Psychology Intervention)是以积极心理学为理论基础的干预范式, 以促进积极感受、行为或认知为目的的治疗方法或有目的的活动。然而, 值得注意的是, 旨在修复、补救或治疗病态/缺陷的问题而不是建立优势的项目、干预或治疗是不符合积极心理干预的定义。积极心理干预包括感恩训练、乐观疗法、积极思考锻炼、正念、放松等在内的可以促进个体产生积极感受、行为及认知的干预措施(Sin & Lyubomirsky, 2009)。
积极心理干预运用在不同群体如癌症患者、抑郁症患者都有很好效果, 其运用于肥胖群体也具有可行性。比如利用接纳和承诺疗法改善肥胖者的生活质量, 该理论认为减少回避行为和增加韧性会减少被污名者的心理不幸感, 从而提升他们对负面评价的容忍度和应对能力, 改善他们的生活质量(Lillis, Hayes, Bunting, & Masuda, 2009)。此外, Lattimore等人(2017)针对饮食混乱的女性采用正念疗法, 发现干预在一定程度上可以缓解女性的心理症状和饮食障碍。Johnson, Burke, Brinkman和Wade (2016)也证实学校基础的正念干预可以预防肥胖青少年抑郁, 减少他们的压力和暴食行为。目前, 国内外研究较少关注干预策略, 尽管数据显示肥胖人口数量不断上升, 体重污名的发生率越来越高。但是如何进行有效的干预来及时遏制这种现象的研究不多, 也较少有研究重点关注如何改善被污名群体的身心健康状态。
随着肥胖人数日益增长, 体重污名逐渐成为国内外研究热点, 其研究具有重要现实意义。尽管已经取得了一定的成果, 但该领域仍存在部分问题有待探讨。
一是研究内容需要进一步深化和拓展。近些年, 体重污名研究已经由现象描述转向结果探讨, 深入挖掘结果产生的机制, 但是有关机制研究主要停留在较浅层面, 缺乏精度与深度。因肥胖受到取笑和欺凌为什么会导致青少年暴食行为?为什么体重污名会抑制锻炼和运动的积极性?体重污名是否必然会引起个体的消极反应(Puhl & Suh, 2015)?哪个群体最容易受到体重污名的影响, 或者说是根据年龄、性别、种族或其他因素划分的群体中哪一类更容易受到体重污名的影响?是否存在一些因素调节体重污名与消极影响之间的关联 (Vartanian & Porter, 2016)?既往的许多研究指出因为体重污名产生的压力等心理不幸感会引起超重者的不当饮食行为, 这是否意味着负性情绪减少会导致体重的减轻?此类问题并没有得到合理的解释, 关于体重污名、心理健康之间的关系还没有研究透彻。只有准确把握这些影响机制, 学者们才能在此基础上进行下一步的研究。当然, 也有研究在这方面做了有益探讨, 如目前学术界较为认可的用社会身份威胁理论来解释体重污名的消极影响(Hunger et al., 2015), 未来还需要对该理论进行数据上的补充和验证。
二是缺乏中文版体重污名测评工具。测量公众和肥胖群体的态度、观点是体重污名研究的基础。目前体重污名测量工具已有较大发展, 如反肥胖态度问卷、对待肥胖态度测试、对肥胖者态度量表等, 但是国内还缺乏汉化版的问卷。目前, 仅有朱大乔等(2013)学者翻译和修订成中文版ATOP量表, 中文版ATOP量表具有良好信效度, 可用于测评医疗工作者群体。除了ATOP量表, 其他体重污名量表则是直接将英文转化为中文, 未经过严谨的汉化程序和信效度检验。此外, 已有的体重污名问卷可能无法准确测量以实现研究目的, 需要根据其他污名问卷改编, 如知觉到的体重歧视问卷(Perceived Weight Discrimination) (Hatzenbuehler, Keyes, & Hasin, 2009)是根据知觉到的种族歧视问卷改编。然而这些直接更换调查对象, 忽视不同群体特殊性的问卷, 其信效度如何存在疑问。事实上, 对肥胖者态度量表就是参照对残疾人态度(Attitudes Towards Disabled Persons, ATDP)量表发展出的。该量表在全美肥胖促进会成员、心理学专业研究生等群体中经过检验, 具有良好信效度才能被认可、推广。因此, 未来研究需要总结现有文献中体重污名测量工具, 发掘其中高效准确问卷, 并采用严谨的实证方法将其汉化和检验。
三是大量文献记录各种领域体重污名表现、影响, 相对缺乏研究探讨减缓污名的心理策略。理论上, 消除体重污名最好方法是降低体重; 事实上, 肥胖不能简单归因于饮食和生活习惯, 有些肥胖是不可控的。对大多数肥胖者而言, 减少体重不是一个持续有效的方法, 通过极端方式减掉的重量又会在几年后反弹。因此有专家建议生活质量、污名导致的不幸感才是肥胖治疗应该关注的重点(Brownell, Puhl, Schwartz, & Rudd, 2005)。对体重污名的干预研究尚且较少, 无法推论出哪些干预策略是最有效的, 哪些特定策略或者联合使用一些方法对部分特殊群体更有效(O'Brien et al., 2010)。除了继续探讨如何减少公众对肥胖群体的刻板印象、偏见、歧视态度, 未来应该增加和注重干预研究和实证研究, 探索哪些干预方法可以缓解体重污名带来的消极体验。专业的心理健康工作者也应把目光转向这一人数众多却被忽视的群体, 减少污名对其身心负面影响, 建立合理的应对污名干预方案, 帮助其回归正常的生活状态。
2016年, 中共中央、国务院印发了《“健康中国2030”规划纲要》, 纲要提出健康是促进人全面发展的必然要求, 必须确定健康优先发展的重要战略地位。建立健全居民营养监测制度, 对重点区域、重点人群实施营养干预, 重点解决微量营养素缺乏、部分人群油脂等高热能食物摄入过多等问题, 逐步解决居民营养不足与过剩并存问题。到2030年, 居民营养知识素养明显提高, 全国人均每日食盐摄入量降低20%, 超重、肥胖人口增长速度明显放缓。帮助肥胖群体减少体重, 同时降低社会污名对他们的消极影响有助于国人体质健康长远发展。
艾滋病污名主要包括实际污名、感知污名和自我污名，这些不同形式的污名给艾滋病患者带来了精 神上的痛苦、社会资源的剥夺等一系列的负面影响。归因理论、社会文化理论和道德理论分别从社会心理学、社会不平等和文化道德的角度阐述了艾滋病污名的形成 机制。从这些机制出发，减少艾滋病污名可以结合接触假设、知识传播以及认知行为疗法，并注意改变艾滋病患者的自身观念。未来的艾滋病污名研究应更多地从社 会文化以及道德的角度进行跨文化的量化研究。
目的 引入对肥胖者态度(attitudes toward obese persons,ATOP)量表,并分析其信度和效度.方法 对ATOP量表进行翻译和文化调适,修订形成中文版量表.采用专家小组评价法检验中文版ATOP量表的内容效度.采用整群抽样法抽取407名护理大学生(护生),用中文版ATOP量表进行问卷调查,收集数据,进行结构效度(包括项目分析、探索性因素分析和验证性因素分析)、效标关联效度、内部一致性信度分析;随机选取样本中20名受试者,间隔2周重复测评,用组内相关系数(ICC)分析重测信度.结果 中文版ATOP量表各条目的平均内容效度指数为0.97.经项目分析和探索性因素分析,提取到3个因子(12个条目),可解释变异量的52.45％.验证性因素分析支持量表的三因子结构(x2=93.75,df=51,x2/df=1.84,RMSEA=0.06,NNFI=0.91,CFI=0.93,IFI=0.93,GFI=0.93,AGFI=0.89).量表及其因子与体重心理控制源的外控性因子得分呈正相关.量表及各因子的Cronbach's α系数为0.59～0.71,重测信度ICC为0.52～0.83.护生的体质指数与其自尊因子得分呈弱负相关;自感超重的护生对自尊因子的评分更低,但对个体差异因子评分更高.结论 中文版ATOP量表具有较好的信度和效度,可用于测评护生对肥胖人群的态度.
The role of weight stigmatization in cumulative risk for binge eating,
Abstract Previous research supports a positive association between weight stigmatization experiences and binge eating. However, the extent to which weight stigmatization accounts for binge eating in the context of other risk factors requires further investigation. Using a cumulative risk model, we examine previously studied risk factors (environmental stress, psychological functioning, negative coping, body dissatisfaction) as well as weight stigmatization as predictors of binge eating bariatric patients and undergraduate students. Results show a unique contribution of weight stigmatization. Analyses by sample indicated that this was only the case for the undergraduate student sample. Results support weight stigmatization as a meaningful predictor of binge eating and highlight the need for further work investigating how these experiences work to promote eating pathology. 2010 Wiley Periodicals, Inc. J Clin Psychol 00:1-15, 2010.
Weight-based stigmatization, psychological distress, & binge eating behavior among obese treatment-seeking adults,
Stigma and the perpetuation of obesity,
Abstract Even as obesity rates reach new highs, the social stigmatization of obesity seems to be strengthening and globalizing. This review identifies at least four mechanisms by which a pervasive environment of fat stigma could reinforce high body weights or promote weight gain, ultimately driving population-level obesity. These are direct effects through behavior change because of feeling judged, and indirect effects of social network changes based on stigmatizing actions and decisions by others, psychosocial stress from feeling stigmatized, and the structural effects of discrimination. Importantly, women and children appear especially vulnerable to these mechanisms. The broader model provides an improved basis to investigate the role of stigma in driving the etiology of obesity, and explicates how individual, interpersonal, and structural dimensions of stigma are connected to variation in health outcomes, including across generations. Copyright 2014 Elsevier Ltd. All rights reserved.
A pilot study of the Nutrition and Exercise for Wellness and Recovery (NEW-R): A weight loss program for individuals with serious mental illnesses,
Abstract This purpose of this study was to evaluate the Nutrition and Exercise for Wellness and Recovery (NEW-R) weight loss intervention. Using a pretest/posttest design, 18 participants recruited from a community-based mental health program were assessed at baseline, immediately following the intervention (8 weeks), and at 6-month follow-up. The intervention was delivered by an occupational therapist and occupational therapy graduate students and consisted of 8 weekly sessions lasting 2 hr. Outcomes included changes in weight, and levels of knowledge about nutrition and exercise. Participants lost an average of 3 pounds at immediate postintervention, and lost an average of 10 pounds at the 6-month follow-up. Participants also demonstrated significant increases in their knowledge about nutrition and physical activity. The results of this study provide preliminary support for the impact of the NEW-R intervention on weight loss and knowledge about diet and exercise. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
Weight bias in graduate school admissions,
Abstract Objective: Whether weight bias occurs in the graduate school admissions process is explored here. Specifically, we examined whether body mass index (BMI) was related to letter of recommendation quality and the number of admissions offers applicants received after attending in-person interviews. Design and Methods: Participants were 97 applicants to a psychology graduate program at a large university in the United States. They reported height, weight, and information about their applications to psychology graduate programs. Participants' letters of recommendation were coded for positive and negative statements as well as overall quality. Results: Higher BMI significantly predicted fewer post-interview offers of admission into psychology graduate programs. Results also suggest this relationship is stronger for female applicants. BMI was not related to overall quality or the number of stereotypically weight-related adjectives in letters of recommendation. Surprisingly, higher BMI was related to more positive adjectives in letters. Conclusions: The first evidence that individuals interviewing applicants to graduate programs may systematically favor thinner applicants is provided here. A conscious or unconscious bias against applicants with extra body weight is a plausible explanation. Stereotype threat and social identity threat are also discussed as explanations for the relationship between BMI and interview success.
Prejudice against fat people: Ideology and self-interest,
Can anyone successfully control their weight? Findings of a three year community-based study of men and women,
Abstract This study examined the prevalence, distribution and correlates of successful weight loss and successful weight maintenance over three years in a community-based sample of 854 subjects aged 20-45 at baseline. More than half (53.7%) of the participants in the study gained weight within the first twelve months, only one in four (24.5%) successfully avoided weight gain over three years, and less than one in twenty (4.6%) lost and maintained weight successfully. The findings underscore the importance of current public health efforts to prevent weight gain, and suggest that without much greater efforts to promote and support weight control the prevalence of obesity will continue to rise.
Validity and reliability of the Turkish version of the attitudes toward obese persons scale and the beliefs about obese persons scale,
Object : The 20-item Attitudes toward Obese Persons Scale (ATOP) and the 8-item Beliefs about Obese Persons Scale (BAOP) are used in English speaking countries to measure attitudes and beliefs about obese persons. The purpose of this study was to test the validity and reliability of the ATOP and the BAOP in Turkish language. Methods: It is a methodological study. The study was conducted in Celal Bayar University. The study subjects comprised of 103 School of Health, 105 Faculty of Economics and Administrative Sciences, 94 School of Physical Education, and Sports students. The data were collected by a questionnaire consisting of socio-demographic characteristics, the level of obesity knowledge and the Turkish version of the ATOP (T-ATOP) and the Turkish version of the BAOP (T-BAOP). The psychometric properties of both scales were examined by exploratory and confirmatory factor analysis, internal consistency, intra-rater reliability. Cronbach alpha coefficients and Spearman Brown split-half were used to assess internal consistency reliability of the scales. Intra-rater reliability of the scales was examined by intraclass correlation coefficients (ICC). Results: Three factors (i.e., Different Personality, Social Difficulties, and Self-Esteem) of the T-ATOP were established by exploratory factor analysis, and confirmatory factor analysis demonstrated three-factor structure. Internal consistency was supported by Cronbach alpha (0.86), Spearman Brown split-half value (0.75 for the first half) and (0.72 for the second half), and intra-rater reliability (ICC=0.78). The results of the exploratory and confirmatory factor analysis demonstrated that the T-BAOP has a structure of the one factor. As for internal consistency of T-BAOP, it was supported by Cronbach alpha (0.84), Spearman Brown split-half value (0.79 for the first half and 0.74 for the second half) and intra-rater reliability (ICC=0.80). Conclusions: The T-ATOP and the T-BAOP showed initial evidence of the reliability and validity that can be used in Turkish speaking countries in order to measure attitudes and beliefs about obese persons.
Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19.2 million participants,
Background Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries. Methods We analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18·5 kg/m2 [underweight], 18·5 kg/m2 to <20 kg/m2, 20 kg/m2 to <25 kg/m2, 25 kg/m2 to <30 kg/m2, 30 kg/m2 to <35 kg/m2, 35 kg/m2 to <40 kg/m2, ≥40 kg/m2 [morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue. Findings We used 1698 population-based data sources, with more than 19·2 million adult participants (9·9 million men and 9·3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21·7 kg/m2 (95% credible interval 21·3–22·1) in 1975 to 24·2 kg/m2 (24·0–24·4) in 2014 in men, and from 22·1 kg/m2 (21·7–22·5) in 1975 to 24·4 kg/m2 (24·2–24·6) in 2014 in women. Regional mean BMIs in 2014 for men ranged from 21·4 kg/m2 in central Africa and south Asia to 29·2 kg/m2 (28·6–29·8) in Polynesia and Micronesia ; for women the range was from 21·8 kg/m2 (21·4–22·3) in south Asia to 32·2 kg/m2 (31·5–32·8) in Polynesia and Micronesia. Over these four decades, age-standardised global prevalence of underweight decreased from 13·8% (10·5–17·4) to 8·8% (7·4–10·3) in men and from 14·6% (11·6–17·9) to 9·7% (8·3–11·1) in women. South Asia had the highest prevalence of underweight in 2014, 23·4% (17·8–29·2) in men and 24·0% (18·9–29·3) in women. Age-standardised prevalence of obesity increased from 3·2% (2·4–4·1) in 1975 to 10·8% (9·7–12·0) in 2014 in men, and from 6·4% (5·1–7·8) to 14·9% (13·6–16·1) in women. 2·3% (2·0–2·7) of the world's men and 5·0% (4·4–5·6) of women were severely obese (ie, have BMI ≥35 kg/m2). Globally, prevalence of morbid obesity was 0·64% (0·46–0·86) in men and 1·6% (1·3–1·9) in women. Interpretation If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women ; severe obesity will surpass 6% in men and 9% in women. Nonetheless, underweight remains prevalent in the world's poorest regions, especially in south Asia.
Perceived discrimination is associated with binge eating in a community sample of non-overweight, overweight, and obese adults,
Abstract OBJECTIVE: The present study examined the relationship between experiences of discrimination and occurrence of binge eating among overweight and obese persons, a population which has previously shown elevated rates of binge eating. METHODS: Internet-based questionnaires were used to measure frequency and impact of discrimination, binge eating frequency, and emotional eating. RESULTS: Pearson correlation analyses demonstrated significant positive relationships between the measures of discrimination and measures of eating behaviors (r = 0.12-0.37). Regression models significantly predicted between 17 and 33% of the variance of emotional eating scores and frequency of binge eating; discrimination measures contributed significantly and independently to the variance in emotional eating and binge eating. Weight bias internalization was found to be a partial mediator of the relationship between discrimination and eating disturbance. CONCLUSION: Results demonstrate the relationship of discrimination to binge eating. Weight bias internalization may be an important mechanism for this relationship and a potential treatment target. Copyright 2012 S. Karger GmbH, Freiburg
Internalized weight bias in obese patients with binge eating disorder: Associations with eating disturbances and psychological functioning,
Abstract Objective: Widespread bias against obese individuals may lead to the internalization of weight bias in obese persons. This study examined correlates of internalized weight bias (IWB) in obese patients with binge eating disorder (BED). Method: One hundred treatment-seeking obese patients with BED were administered with the eating disorders examination interview and questionnaires assessing IWB, fat phobia, depression, and self-esteem. Results: The mean IWB score in this group of patients with BED was significantly greater than the mean IWB score observed previously in a community sample of overweight adults. IWB was positively associated with eating disorder psychopathology, fat phobia, and depression, and negatively associated with self-esteem. IWB made significant independent contributions to the variance in eating disorder psychopathology even after accounting for fat phobia, depression, and self-esteem. Discussion: Treatment-seeking obese patients with BED demonstrate high levels of IWB. IWB may contribute to the variance in eating disorder psychopathology in BED patients, beyond the contributions of fat phobia, depression, and self-esteem. 2011 by Wiley Periodicals, Inc. Int J Eat Disord 2012
Weight-based discrimination, body dissatisfaction and emotional eating: The role of perceived social consensus,
Abstract OBJECTIVE: Discrimination can have a negative impact on psychological well-being, attitudes and behaviour. This research evaluates the impact of experiences of weight-based discrimination upon emotional eating and body dissatisfaction, and also explores whether people's beliefs about an ingroup's social consensus concerning how favourably overweight people are regarded can moderate the relationship between experiences of discrimination and negative eating and weight-related cognitions and behaviours. RESEARCH METHODS AND PROCEDURES: 197 undergraduate students completed measures about their experiences of weight-based discrimination, emotional eating and body dissatisfaction. Participants also reported their beliefs concerning an ingroup's attitude towards overweight people. RESULTS: Recollections of weight-based discrimination significantly contributed to emotional eating and body dissatisfaction. However, the relationships between experiencing discrimination and body dissatisfaction and emotional eating were weakest amongst participants who believed that the ingroup held a positive attitude towards overweight people. DISCUSSION: Beliefs about ingroup social consensus concerning overweight people can influence the relationships between weight-based discrimination and emotional eating and body dissatisfaction. Changing group perceptions to perceive it to be unacceptable to discriminate against overweight people may help to protect victims of discrimination against the negative consequences of weight-based stigma.
Family physicians' practices and attitudes regarding care of extremely obese patients,
Abstract Despite the growing epidemic of extreme obesity in the United States, weight management is not adequately addressed in primary care. This study assessed family physicians' practices and attitudes regarding care of extremely obese patients and factors associated with them. A cross-sectional, self-administered survey was mailed to 500 family physicians in New Jersey (NJ) during March-ay 2008. Measures included knowledge, weight management approaches, attitudes toward managing obesity, challenges with examinations, availability of supplies, and strategies to improve care. Response rate was 53% ( N = 255). Bariatric surgery and weight loss medications were infrequently recommended, particularly in physicians with higher volume of extremely obese patients (odds ratio (OR) 0.38; 95% confidence interval (CI) 0.23, 0.62 and OR 0.51; 95% CI 0.31, 0.85 for surgery and medications, respectively). Higher knowledge was associated with increased frequency of recommendations of weight loss medications ( P < 0.0001) and bariatric surgery ( P < 0.0001). There was a high prevalence of negative attitudes, particularly in younger physicians and those with lower patient volume. Increased knowledge of weight-loss diets was associated with less dislike in discussing weight loss ( P < 0.0001), less frustration ( P = 0.0001), less belief that treatment is often ineffective ( P < 0.0001), and less pessimism about patient success ( P = 0.0002). Many providers encountered challenges performing examinations on extremely obese patients. More education of primary care physicians, particularly on bariatric surgery, specific examination techniques, and availability of community resources for obese persons is needed. Further research is needed to determine if interventions to increase knowledge of physicians will lead to less negative attitudes toward weight loss and extremely obese patients.
Is fat a feminist issue? Exploring the gendered nature of weight bias,
Obesity and discrimination: The next ‘big issue’?,
Inequities in healthcare: A review of bias and discrimination in obesity treatment,
Cette revue s'appuie sur une exploration de la littérature publiée au cours des 20 dernières années en matière de préjugés, de honte et de discrimination liés au poids, et leur lien avec le traitement de l'obésité. Les organisations nationales et internationales sur l'obésité ont considéré la honte de l'obésité comme l'obstacle majeur à une lutte efficace contre l'épidémie d'obésité et ont fait appel aux interventions fondées sur la théorie pour la réduire. Le Réseau canadien en obésité ( http://www.obesitynetwork.ca/french ) et l'Obesity Society ( http://www.obesity.org ) ont des orientations stratégiques, des énoncés de mission et des collaborations qui s'opposent fortement aux préjugés liés au poids et reconnaissent les répercussions négatives qu'a le potentiel de ces préjugés sur le traitement de l'obésité. Des revues exhaustives de la littérature en ce qui concerne les préjugés liés au poids ont été publiées et ont subséquemment fait prendre conscience des répercussions potentielles de la discrimination et des préjugés liés au poids sur la santé et le bien-être des individus atteints d'obésité. Le but de cette revue est de mettre l'accent sur les déterminants des préjugés liés au poids et de discuter de leurs répercussions sur le traitement de l'obésité.
Stigma: Notes on the management of spoiled identity
The psychological burden of obesity: The potential harmful impact of health promotion and education programmes targeting obese individuals,
Despite evidence that individual fitness levels rather than body weight are more closely linked to health outcomes, stereotypes held about overweight and obese people have resulted in pervasive levels of discrimination. It is of little wonder that overweight and obese people have been found to be unhappy. The current investigation explored the psychological burden being experienced by overweight and obese people while also examining their perceived ability to engage in exercise. Depression, anxiety and stress levels were all found to be unacceptably high for the current sample, while exercise self-efficacy or perceived ability to engage in exercise was low. Given these characteristics, messages exhorting obese people to eat less and exercise more may do little except increase the stigmatisation and levels of despair experienced by them. Those designing public health promotion and education campaigns aimed at decreasing obesity need to be cognisant of the harm that a focus on obese and overweight individuals can potentially cause. A public health focus on greater fitness for all, regardless of weight, would serve the entire population while minimising the risk of perpetuating discriminatory stereotypes about overweight and obese individuals.
Weight- related stigma is a significant psychosocial stressor in developing countries: Evidence from Guatemala,
Weight-related stigma is established as a major psychosocial stressor and correlate of depression among people living with obesity in high-income countries. Anti-fat beliefs are rapidly globalizing. The goal of the study is to (1) examine how weight-related stigma, enacted as teasing, is evident among women from a lower-income country and (2) test if such weight-related stigma contributes to depressive symptoms. Modeling data for 12,074 reproductive-age women collected in the 2008–2009 Guatemala National Maternal-Infant Health Survey, we demonstrate that weight-related teasing is (1) experienced by those both underweight and overweight, and (2) a significant psychosocial stressor. Effects are comparable to other factors known to influence women’s depressive risk in lower-income countries, such as living in poverty, experiencing food insecurity, or suffering sexual/domestic violence. That women’s failure to meet local body norms—whether they are overweight or underweight—serves as such a strong source of psychological distress is particularly concerning in settings like Guatemala where high levels of over- and under-nutrition intersect at the household and community level. Current obesity-centric models of weight-related stigma, developed from studies in high-income countries, fail to recognize that being underweight may create similar forms of psychosocial distress in low-income countries.
Examination of shared risk and protective factors for overweight and disordered eating among adolescents,
OBJECTIVE: To identify shared risk and protective factors for purging, binge eating, and overweight. DESIGN: Prospective cohort study. SETTING: Population-based questionnaires of children and adolescents residing across the United States. PARTICIPANTS: Girls (n = 6022) and boys (n = 4518), aged 11 to 17 years in 1998, in the ongoing Growing Up Today Study. MAIN EXPOSURES: Putative risk and protective factors within the psychological, behavioral, and socioenvironmental domains. MAIN OUTCOME MEASURES: Overweight, use of laxatives or purging (vomiting), and binge eating. Because of the low prevalence of purging, we did not examine shared factors for this behavior among boys. RESULTS: In 1998, a total of 219 girls (3.7%) and 30 boys (0.7%) reported purging behaviors, 426 girls (7.1%) and 90 boys (2.0%) reported binge eating, and 1019 girls (17.4%) and 1040 boys (24.6%) were overweight. From 1999 through 2001, 331 girls (7.8%) initiated purging behaviors, 503 girls (11.8%) and 132 boys (4.5%) initiated binge eating behaviors, and 424 girls (10.0%) and 382 boys (13.6%) became overweight. Concern for weight was directly associated with all 3 weight-related problems among boys and girls. Among girls, dieting, parental weight-related teasing, and family meal frequency had a shared effect on the weight-related problems examined. CONCLUSIONS: Factors within the psychological, behavioral, and socioenvironmental domains may have a shared effect on purging, binge eating, and overweight. Further research is needed to determine if an intervention designed to address these shared risk and protective factors is effective in simultaneously reducing these weight-related problems.
Association between perceived health care stigmatization and BMI change,
Abstract BACKGROUND/AIMS: This study examined the association between experiences of health care stigmatization and BMI changes in men and women with normal weight and obesity in Sweden. METHODS: The participants were drawn from a population-based survey in Sweden (1996-2006), and data on their perceived health care stigmatization were measured in 2008. They were categorized in individuals with normal weight (n = 1,064), moderate obesity (n = 1,273), and severe obesity (n = 291). The main outcome measure was change in BMI. RESULTS: Individuals with severe obesity experiencing any health care stigmatization showed a BMI increase by 1.5 kg/m2 more than individuals with severe obesity with no such experience. For individuals with moderate obesity, insulting treatment by a physician and avoidance of health care were associated with a relative BMI increase of 0.40 and 0.75 kg/m2, respectively, compared with their counterparts who did not experience stigmatization in these areas. No difference in experience of any form of health care stigmatizing associated BMI change was observed for men and women with normal weight. CONCLUSION: In this large, population-based study, perceived health care stigmatization was associated with an increased relative BMI in individuals with severe obesity. For moderate obesity, the evidence of an association was inconclusive.
Psychosocial stress is positively associated with body mass index gain over 5 years: Evidence from the longitudinal AusDiab study,
Abstract OBJECTIVE: Emerging evidence suggests that psychosocial stress may influence weight gain. The relationship between stress and weight change and whether this was influenced by demographic and behavioral factors was explored. DESIGN AND METHODS: A total of 5,118 participants of AusDiab were prospectively followed from 2000 to 2005. The relationship between stress at baseline and BMI change was assessed using linear regression. RESULTS: Among those who maintained/gained weight, individuals with high levels of perceived stress at baseline experienced a 0.20 kg/m(2) (95% CI: 0.07-0.33) greater mean change in BMI compared with those with low stress. Additionally, individuals who experienced 2 or 3 stressful life events had a 0.13 kg/m(2) (0.00-0.26) and 0.26 kg/m(2) (0.14-0.38) greater increase in BMI compared with people with none. These relationships differed by age, smoking, and baseline BMI. Further, those with multiple sources of stressors were at the greatest risk of weight gain. CONCLUSION: Psychosocial stress, including both perceived stress and life events stress, was positively associated with weight gain but not weight loss. These associations varied by age, smoking, obesity, and multiple sources of stressors. Future treatment and interventions for overweight and obese people should consider the psychosocial factors that may influence weight gain. Copyright 2013 The Obesity Society.
Associations between perceived weight discrimination and the prevalence of psychiatric disorders in the general population,
Abstract Despite the increased prevalence of weight discrimination, few studies have examined the association between perceived weight discrimination and the prevalence of current psychiatric disorders in the general population. This study utilized a subsample of overweight and obese individuals ( N = 22,231) from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a cross-sectional nationally representative study of noninstitutionalized US adults. Perceived weight discrimination is associated with substantial psychiatric morbidity and comorbidity. These results remained significant after adjusting for a potential confound, perceived stress. Moreover, social support did not buffer against the adverse effects of perceived weight discrimination on mental health. Controlling for BMI did not diminish the associations, indicating that perceived weight discrimination is potentially harmful to mental health regardless of weight. These results highlight the urgent need for a multifaceted approach to address this important public health issue, including interventions to assist overweight individuals in coping with the mental health sequelae of perceived weight discrimination.
Body image dissatisfaction as a motivator for healthy lifestyle change: Is some distress beneficial?
Hypothesizes that body image dissatisfaction is not always a negative process. It is argued that some degree of dissatisfaction may be helpful and necessary to motivate individuals to engage in healthy behaviors such as exercise and restricting fats and calories. The assumption that dissatisfaction with weight is universally deleterious is questioned. It is suggested that to further analyze the role of body image dissatisfaction in eating disorders, one might examine how body dissatisfaction interacts with motivation and participation in healthy behaviors. Theoretical background and empirical support for these hypotheses are offered. The following issues are reviewed: the relationship between body image dissatisfaction and dieting behavior; the public health problem of obesity, body image, and dieting behavior in overweight and obese populations; the research examining the possible beneficial aspects of body image dissatisfaction in predicting weight loss and exercise behavior; and theories from the health psychology literature supporting the notion that distress may serve as a motivating factor for engaging in health behaviors. Implications for this reconceptualization of the hazards of body image dissatisfaction are offered and research directions are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Weight bias internalization scale: Psychometric properties and population norms,
Objective Internalizing the pervasive weight bias commonly directed towards individuals with overweight and obesity, co-occurs with increased psychopathology and impaired quality of life. This study sought to establish population norms and psychometric properties of the most widely used self-report questionnaire, the Weight Bias Internalization Scale (WBIS), in a representative community sample. Design and Methods In a survey of the German population, N = 1158 individuals with overweight and obesity were assessed with the WBIS and self-report measures for convergent validation. Results Item analysis revealed favorable item-total correlation of all but one WBIS item. With this item removed, item homogeneity and internal consistency were excellent. The one-factor structure of the WBIS was confirmed using confirmatory factor analysis. Convergent validity was shown through significant associations with measures of depressive and somatoform symptoms. The WBIS contributed to the explanation of variance in depressive and somatoform symptoms over and above body mass index. Higher WBIS scores were found in women than in men, in individuals with obesity than in individuals with overweight, and in those with lower education or income than those with higher education or income. Sex-specific norms were provided. Conclusions The results showed good psychometric properties of the WBIS after removal of one item. Future research is warranted on further indicators of reliability and validity, for example, retest reliability, sensitivity to change, and prognostic validity.
The weight of stigma: Cortisol reactivity to manipulated weight stigma,
Objective Rates of weight-based stigmatization have steadily increased over the past decade. The psychological and physiological consequences of weight stigma remain understudied. Methods This study examined the effects of experimentally manipulated weight stigma on the stress-responsive hypothalamic–pituitary–adrenal axis (HPA) in 110 female undergraduate participants (BMI: M 65=6519.30, SD65=651.55). Objective BMI and self-perceived body weight were examined as moderators of the relationship between stigma and HPA reactivity. Results Results indicated participants' perceptions of their own body weight (but not objective BMI) moderated the effect of weight stigma on cortisol reactivity: F (1,102)65=6513.48, P 652</sup>p65=650.12 (interaction 95% CI range [612.06 to 611.44, 611.31 to 610.99]). Specifically, participants who perceived themselves as heavy exhibited sustained cortisol elevation post-manipulation compared with individuals who did not experience the weight-related stigma. Cortisol change did not vary by condition for participants who perceived themselves as average weight. Conclusions In the first study to examine physiological consequences of active interpersonal exposure to weight stigma, experiencing weight stigma was stressful for participants who perceived themselves as heavy, regardless of their BMI. These results are important because stress and cortisol are linked to deleterious health outcomes, stimulate eating, and contribute to abdominal adiposity.
Weight stigma mediates the association between BMI and self-reported health,
Weight stigma is pervasive in the United States. We tested the hypothesis that stigma may be a mechanism through which obesity negatively affects self-reported health. Two studies examined whether perceived weight-based discrimination and concerns over weight stigma mediated the association between BMI and self-reported psychological health (Study 1) and physical health (Study 2).In 2 online studies, adult community members completed measures of stigma-relevant mediators (perceived weight discrimination, weight stigma concerns) and provided their height and weight. In Study 1 (N = 171) participants also completed measures of psychological health (depression, self-esteem, quality of life), whereas participants in Study 2 (N = 194) also completed a measure of self-reported physical health. Process modeling was used to simultaneously test for mediation through perceived discrimination and stigma concerns independently as well as for serial mediation through both variables.Across both studies, we hypothesized and found support for serial mediation such that BMI was indirectly related to poorer self-reported health through its effect on perceived discrimination and concerns about stigma. Additionally, concerns about stigma mediated the association between BMI and health independent of perceived discrimination.Weight stigma is an important mediator of the association between BMI and self-reported health. Furthermore, results indicate that concerns about facing stigma in the future mediate the link between perceived past experiences of discrimination and psychological and physical health.
Weighed down by stigma: How weight-based social identity threat contributes to weight gain and poor health,
Abstract Weight stigma is pervasive, and a number of scholars argue that this profound stigma contributes to the negative effects of weight on psychological and physical health. Some lay individuals and health professionals assume that stigmatizing weight can actually motivate healthier behaviors and promote weight loss. However, as we review, weight stigma is consistently associated with poorer mental and physical health outcomes. In this article, we propose a social identity threat model elucidating how weight stigma contributes to weight gain and poorer mental and physical health among overweight individuals. We propose that weight-based social identity threat increases physiological stress, undermines self-regulation, compromises psychological health, and increases the motivation to avoid stigmatizing domains (e.g., the gym) and escape the stigma by engaging in unhealthy weight loss behaviors. Given the prevalence of overweight and obesity in the US, weight stigma thus has the potential to undermine the health and wellbeing of millions of Americans.
Weight bias internalization scale discriminates obese and overweight patients with different severity levels of depression: The Italian version of the WBIS,
We have investigated the psychometric properties of the Italian version of the weight bias internalization scale (WBIS) in overweight and obese patients who were attending weight loss programs. Participants were 386 overweight and obese patients admitted in two medical centers specializing in the treatment of obesity. All the patients were administered the WBIS, and measures of binge eating, depression, self-esteem, and body dissatisfaction. Confirmatory factor analysis failed to confirm the fit of the original 11-item unidimensional model. Item analysis and exploratory factor analysis indicated that 9 items included in the original measure (the items 1 and 9 were excluded because low item-total correlations) formed a reliable unidimensional measure of internalized weight bias (WBIS-9). The WBIS-9 was significantly correlated with convergent measures and was able to categorize individuals with different severity levels of depression (sensitivity of 0.72 and specificity of 0.70). The WBIS-9 may be useful in clinical practice to discriminate patients with more severe psychopathology, comorbid disordered eating patterns, and risk for poor outcomes.
Perceived weight discrimination and changes in weight, waist circumference, and weight status,
To examine associations between perceived weight discrimination and changes in weight, waist circumference, and weight status.Data were from 2944 men and women aged ≥50 years participating in the English Longitudinal Study of Ageing. Experiences of weight discrimination were reported in 2010-2011 and weight and waist circumference were objectively measured in 2008-2009 and 2012-2013. ANCOVAs were used to test associations between perceived weight discrimination and changes in weight and waist circumference. Logistic regression was used to test associations with changes in weight status. All analyses adjusted for baseline BMI, age, sex, and wealth.Perceived weight discrimination was associated with relative increases in weight (+1.66 kg, P65<650.001) and waist circumference (+1.12 cm, P65=650.046). There was also a significant association with odds of becoming obese over the follow-up period (OR65=656.67, 95% CI 1.85-24.04) but odds of remaining obese did not differ according to experiences of weight discrimination (OR65=651.09, 95% CI 0.46-2.59).Our results indicate that rather than encouraging people to lose weight, weight discrimination promotes weight gain and the onset of obesity. Implementing effective interventions to combat weight stigma and discrimination at the population level could reduce the burden of obesity.
Effectiveness of a school-based mindfulness program for transdiagnostic prevention in young adolescents,
Anxiety, depression and eating disorders show peak emergence during adolescence and share common risk factors. School-based prevention programs provide a unique opportunity to access a broad spectrum of the population during a key developmental window, but to date, no program targets all three conditions concurrently. Mindfulness has shown promising early results across each of these psychopathologies in a small number of controlled trials in schools, and therefore this study investigated its use in a randomised controlled design targeting anxiety, depression and eating disorder risk factors together for the first time. Students ( M age 13.63; SD =.43) from a broad band of socioeconomic demographics received the eight lesson, once weekly.b (“Dot be”) mindfulness in schools curriculum ( N =132) or normal lessons ( N =176). Anxiety, depression, weight/shape concerns and wellbeing were the primary outcome factors. Although acceptability measures were high, no significant improvements were found on any outcome at post-intervention or 3-month follow-up. Adjusted mean differences between groups at post-intervention were .03 (95% CI:61.06 to 61.11) for depression, .01 (61.07 to 61.09) for anxiety, .02 (61.05 to 61.08) for weight/shape concerns, and .06 (61.08 to 61.21) for wellbeing. Anxiety was higher in the mindfulness than the control group at follow-up for males, and those of both genders with low baseline levels of weight/shape concerns or depression. Factors that may be important to address for effective dissemination of mindfulness-based interventions in schools are discussed. Further research is required to identify active ingredients and optimal dose in mindfulness-based interventions in school settings.
The impact of weight-based discrimination in the health care setting,
ABSTRACT Considerable attention has been given to the behaviors that need to be changed in individuals who are overweight and obese. Much less attention has been given to the behaviors that need to be changed in health care professionals who treat these individuals. Specifically, health care professionals, similar to the general population, have been shown to engage in weight-based discrimination. The impact this may have on patients is discussed.
Overweight children, weight-based teasing and academic performance,
Background. School performance of overweight children has been found to be inferior to normal weight children; however, the reason(s) for this link between overweight and academic performance remain unclear. Psychosocial factors, such as weight-based teasing, have been proposed as having a possible mediating role, although they remain largely unexplored. Methods. Random parental telephone surve...
'I can't accept that feeling': Relationships between interoceptive awareness, mindfulness and eating disorder symptoms in females with, and at-risk of an eating disorder,
Mindfulness based therapies (MBTs) for eating disorders show potential benefit for outcomes yet evidence is scarce regarding the mechanisms by which they influence remission from symptoms. One way that mindfulness approaches create positive outcomes is through enhancement of emotion regulation skills. Maladaptive emotion regulation is a key psychological feature of all eating disorders. The aim of the current study was to identify facets of emotion regulation involved in the relationship between mindfulness and maladaptive eating behaviours. In three cross-sectional studies, clinical (n=39) and non-clinical (n=137 and 119) female participants completed: 1) the Eating Disorder Inventory (EDI) eating specific scales (drive-for-thinness and bulimia) and the EDI psychological symptom scales (emotion dysregulation and interoceptive deficits); and 2) mindfulness, impulsivity, and emotion regulation questionnaires. In all samples mindfulness was significantly and inversely associated with EDI eating and psychological symptom scales, and impulsivity. In non-clinical samples interoceptive deficits mediated the relationship between mindfulness and EDI eating specific scales. Non-acceptance of emotional experience, a facet of interoceptive awareness, mediated the relationship between mindfulness and eating specific EDI scores. Further investigations could verify relationships identified so that mindfulness based approaches can be optimised to enhance emotion regulation skills in sufferers, and those at-risk, of eating disorders.
Prejudice toward fat people: The development and validation of the antifat attitudes test,
Abstract Although the stigma of obesity in our society is well documented, the measurement of antifat attitudes has been a difficult undertaking. Two studies were conducted to construct and validate the Antifat Attitudes Test (AFAT). In study 1, college students (110 men and 175 women) completed the preliminary 54-item AFAT and specific indices of body image and weight-related concerns. Psychometric and factor analysis revealed a 47-item composite scale and three internally consistent factors that were uncorrelated with social desirability: Social/Character Disparagement, Physical/Romantic Unattractiveness, and Weight Control/Blame. Several body images correlates of antifat prejudice were identified, and men expressed more negative attitudes than women. Study 2 experimentally examined the effects of information about the controllability of weight on the antifat attitudes of 120 participants. Exposure to information on behavioral vs. biogenetic control led to greater blame of persons who are fat for their body size. The implications of the findings and the potential utility of the AFAT are discussed.
Wii, myself, and size: The influence of proteus effect and stereotype threat on overweight children's exercise motivation and behavior in exergames,
Exercise-based videogames, or exergames, provide a promising and novel way to improve exercise attitudes and behavior among overweight children. These digital interventions often allow for customizations of player characters and weave in narratives and goals. Theoretically, the presence of visual identity cues (e.g., avatars) and social category cues (e.g., stereotypes) within the virtual gaming environment are likely to motivate a player's exercise attitudes and behavior in various ways. This study examined the effects of both visual cues (via the Proteus effect) and social cues (via stereotype threat) on overweight children's exercise attitudes and game performance in a virtual running game.A 2 (avatar body size: Normal versus overweight) 2 (stereotype threat: Present versus absent) factorial design experiment was conducted with 140 overweight children between 9 to 12 years of age. Dependent variables measured were participants' exercise attitudes, exercise motivation, exercise motivation with regard to the Nintendo(庐) (Kyoto, Japan) Wii , and their in-game performance.Multivariate analysis of covariance tests showed that overweight children assigned to avatars of normal body size scored significantly better on all four variables compared with those assigned to avatars of large body size, whereas overweight children assigned to a stereotype threat absent condition scored significantly better on three of the four variables compared with those assigned to a stereotype threat present condition.Using avatars with normal body size and not being subjected to stereotypical messages has the potential to increase the effectiveness of exergames among overweight children. Exergame developers should consider designing avatars that are slim and toned and set "weight neutral" goals and challenges. These may provide more motivation and yield greater attitudinal and behavioral changes among overweight children.
Teaching acceptance and mindfulness to improve the lives of the obese: A preliminary test of a theoretical model,
Abstract BACKGROUND: Obesity is a growing epidemic. Weight control interventions can achieve weight loss, but most is regained over time. Stigma and low quality of life are significant problems that are rarely targeted. PURPOSE: A new model aimed at reducing avoidant behavior and increasing psychological flexibility, has shown to be relevant in the treatment of other chronic health problems and is worth examining for improving the lives of obese persons. METHODS: Patients who had completed at least 6 months of a weight loss program (N = 84) were randomly assigned to receive a 1-day, mindfulness and acceptance-based workshop targeting obesity-related stigma and psychological distress or be placed on a waiting list. RESULTS: At a 3-month follow-up, workshop participants showed greater improvements in obesity-related stigma, quality of life, psychological distress, and body mass, as well as improvements in distress tolerance, and both general and weight-specific acceptance and psychological flexibility. Effects on distress, stigma, and quality of life were above and beyond the effects due to improved weight control. Mediational analyses indicated that changes in weight-specific acceptance coping and psychological flexibility mediated changes in outcomes. CONCLUSION: Results provide preliminary support for the role of acceptance and mindfulness in improving the quality of life of obese individuals while simultaneously augmenting their weight control efforts.
The psychological weight of weight stigma,
ABSTRACT The authors theorized that overweight individuals experience social identity threat in situations that activate concerns about weight stigma, causing them to experience increased stress and reduced self-control. To test these predictions, women who varied in body mass index (BMI) gave a speech on why they would make a good dating partner. Half thought they were videotaped (weight visible); the remainder thought they were audiotaped (weight not visible). As predicted, higher BMI was associated with increased blood pressure and poorer performance on a measure of executive control when weight was visible and concerns about stigma were activated but not when weight was not visible. Compared to average weight women, overweight women also reported more stress-related emotions when videotaped versus audiotaped. Findings suggest that weight stigma can be detrimental to mental and physical health and deplete self-regulatory resources necessary for weight control.
Reducing anti-fat prejudice in preservice health students: A randomized trial,
Abstract Anti-fat sentiment is increasing, is prevalent in health professionals, and has health and social consequences. There is no evidence for effective obesity prejudice reduction techniques in health professionals. The present experiment sought to reduce implicit and explicit anti-fat prejudice in preservice health students. Health promotion/public health bachelor degree program students ( n = 159) were randomized to one of three tutorial conditions. One condition presented an obesity curriculum on the controllable reasons for obesity (i.e., diet/exercise). A prejudice reduction condition presented evidence on the uncontrollable reasons for obesity (i.e., genes/environment); whereas a neutral (control) curriculum focused on alcohol use in young people. Measures of implicit and explicit anti-fat prejudice, beliefs about obese people, and dieting, were taken at baseline and postintervention. Repeated measures analyses showed decreases in two forms of implicit anti-fat prejudice (decreases of 27 and 12%) in the genes/environment condition relative to other conditions. The diet/exercise condition showed a 27% increase in one measure of implicit anti-fat prejudice. Reductions in explicit anti-fat prejudice were also seen in the genes/environment condition ( P = 0.006). No significant changes in beliefs about obese people or dieting control beliefs were found across conditions. The present results show that anti-fat prejudice can be reduced or exacerbated depending on the causal information provided about obesity. The present results have implications for the training of health professionals, especially given their widespread negativity toward overweight and obesity.
Weight-related teasing, emotional eating, and weight control behaviors in Hispanic and African American girls,
Abstract PURPOSE: To assess the association among parent and peer weight-related teasing, emotional eating, and weight control behaviors in minority girls. METHODS: 141 Hispanic and African American preadolescent girls (mean age = 11.1 years, SD = 1.5 years) participated. Most of the participants were of Hispanic origin, had a bicultural orientation, and were obese. Participants completed surveys assessing weight-related teasing, emotional eating, weight control behaviors, demographic, and acculturation characteristics. Body weight and height were also assessed. Hierarchical regression analyses were run to determine the associations among study variables. RESULTS: Fifty-nine percent of participants reported being weight-related teased by peers and 42% participants reported weight-related teasing by parents. Weight-related teasing by parent was associated with emotional eating and binge eating, whereas peer weight-related teasing was only associated with emotional eating. CONCLUSIONS: Findings demonstrated the differential association of weight-related teasing from peers and parents to emotional and binge eating in minority girls. 2013.
Correlates of weight stigma in adults with overweight and obesity: A systematic literature review,
Objective While evidence regarding associations between weight stigma and biopsychosocial outcomes is accumulating, outcomes are considered in isolation. Thus, little is known about their complex relationships. This article extends existing work by systematically reviewing the biopsychosocial consequences of stigma in adults with overweight/obesity. Methods Articles were identified through Medline, CINAHL, PsycINFO, Embase, Web of Science, and Cochrane databases. Independent extraction of articles was conducted using predefined data fields, including data on biopsychosocial correlates in each study. Results Twenty-three studies published from 2001 and addressing correlates of stigma in adults with overweight/obesity (body mass index 25 kg m 2; 18-65 years) were identified. Numerous biopsychosocial correlates of weight stigma were studied, particularly in treatment-seeking individuals. Available research shows that weight stigma is consistently associated with medication non-adherence, mental health, anxiety, perceived stress, antisocial behavior, substance use, coping strategies, and social support. Biopsychosocial correlates were not considered in combination in research. Psychological correlates were well documented in comparison to biological and social correlates for each weight stigma type. There were some indications that associations are stronger once stigma is internalized. Conclusions While there is evidence for biopsychosocial correlates of weight stigma, these are not considered in combination in research; thus their inter-relationships are unknown. Conclusions from the review are limited by this and the small number of studies, types of designs, and variables considered.
The adverse effect of weight stigma on the well-being of medical students with overweight or obesity: Findings from a national survey,
The stigma of obesity is a common and overt social bias. Negative attitudes and derogatory humor about overweight/obese individuals are commonplace among health care providers and medical students. As such, medical school may be particularly threatening for students who are overweight or obese.The purpose of our study was to assess the frequency that obese/overweight students report being stigmatized, the degree to which stigma is internalized, and the impact of these factors on their well-being.We performed cross-sectional analysis of data from the Medical Student Cognitive Habits and Growth Evaluation Study (CHANGES) survey.A total of 4,687 first-year medical students (1,146 overweight/obese) from a stratified random sample of 49 medical schools participated in the study.Implicit and explicit self-stigma were measured with the Implicit Association Test and Anti-Fat Attitudes Questionnaire. Overall health, anxiety, depression, fatigue, self-esteem, sense of mastery, social support, loneliness, and use of alcohol/drugs to cope with stress were measured using previously validated scales.Among obese and overweight students, perceived stigma was associated with each measured component of well-being, including anxiety (beta coefficient [b] = 0.18; standard error [SE]-= 0.03; p < 0.001) and depression (b = 0.20; SE = 0.03; p < 0.001). Among the subscales of the explicit self-stigma measure, dislike of obese people was associated with several factors, including depression (b = 0.07; SE = .01; p < 0.001), a lower sense of mastery (b = -0.10; SE = 0.02; p < 0.001), and greater likelihood of using drugs or alcohol to cope with stress (b = .05; SE = 0.01; p < 0.001). Fear of becoming fat was associated with each measured component of well-being, including lower body esteem (b = -0.25; SE = 0.01; p < 0.001) and less social support (b = -0.06; SE = 0.01; p < 0.001). Implicit self-stigma was not consistently associated with well-being factors. Compared to normal-weight/underweight peers, overweight/obese medical students had worse overall health (b = -0.33; SE = 0.03; p < 0.001) and body esteem (b = -0.70; SE = 0.02; p < 0.001), and overweight/obese female students reported less social support (b = -0.12; SE = 0.03; p < 0.001) and more loneliness (b = 0.22; SE = 0.04; p < 0.001).Perceived and internalized weight stigma may contribute to worse well-being among overweight/obese medical students.
Impact of weight bias and stigma on quality of care and outcomes for patients with obesity,
Abstract The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care. 2015 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of International Association for the Study of Obesity (IASO).
The dynamic effects of obesity on the wages of young workers,
This paper considers effects of body mass on wages in the years following labor market entry. The preferred models allow current wages to be affected by both past and current body mass, as well as past wages, while also addressing the endogeneity of body mass. I find that a history of severe obesity has a large negative effect on the wages of white men. White women face a penalty for a history of being overweight, with additional penalties for both past and current BMI that begin above the threshold for severe obesity. Furthermore, the effects of past wages on current wages imply that past body mass has additional, indirect effects on wages, especially for white women.
A systematic review of variables associated with the relationship between obesity and depression,
Abstract Obesity is one of the leading causes of preventable diseases and disability worldwide, and depression is among the leading causes of burden of disease. Both disorders are increasingly prevalent and comorbid. This comorbidity compounds associated health. While there is consistent evidence of a bidirectional obesity depression relationship, little is known about the biopsychosocial variables associated with this relationship. A systematic review was undertaken to identify variables associated with the relationship between obesity (Body mass index090009>09000930090009kg090009m(-2) ) and depression. Forty-six studies were identified. Obesity, educational attainment, body image, binge eating, physical health, psychological characteristics and interpersonal effectiveness were consistently associated with the relationship between obesity and depression. The current review identified potential biopsychosocial variables associated with the relationship between obesity and depression. This knowledge can inform future research examining moderators, mediators and mechanisms of the relationship between obesity and depression. Improved understanding of this relationship will inform identification, prevention and intervention efforts. 0008 2013 The Authors. obesity reviews 0008 2013 International Association for the Study of Obesity.
The stigma of obesity: A review and update,
This article provides an update of scientific evidence on weight bias toward overweight and obese adults through a systematic review of published literature since 2001. The review expands on previous findings of weight bias in major domains of living, documents new areas where weight bias has been studied, and highlights research questions that need to be addressed to advance this field of stud...
Obesity stigma: Important considerations for public health,
Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. We examine evidence to address these assumptions and discuss their public health implications. On the basis of current findings, we propose that weight stigma is not a beneficial public health tool for reducing obesity. Rather, stigmatization of obese individuals threatens health, generates health disparities, and interferes with effective obesity intervention efforts. These findings highlight weight stigma as both a social justice issue and a priority for public health.
Weight discrimination and bullying,
Bias, discrimination, and obesity,
Health consequences of weight stigma: Implications for obesity prevention and treatment,
Despite decades of research documenting consistent stigma and discrimination against individuals with obesity, weight stigma is rarely considered in obesity prevention and treatment efforts. In recent years, evidence has examined weight stigmatization as a unique contributor to negative health outcomes and behaviors that can promote and exacerbate obesity. This review summarizes findings from published studies within the past 4 years examining the relationship between weight stigma and maladaptive eating behaviors (binge eating and increased food consumption), physical activity, weight status (weight gain and loss and development of obesity), and physiological stress responses. Research evaluating the effects of weight stigma present in obesity-related public health campaigns is also highlighted. Evidence collectively demonstrates negative implications of stigmatization for weight-related health correlates and behaviors and suggests that addressing weight stigma in obesity prevention and treatment is warranted. Key questions for future research to further delineate the health effects of weight stigmatization are summarized.
Fatty, fatty, two-by-four: Weight-teasing history and disturbed eating in young adult women,
Objective. We investigated the long-term effect of weight teasing during childhood.Methods. Young adult women (n = 1533; aged 18-26 years) from 3 large universities participated in a survey (Fall 2009 to Spring 2010) that assessed disturbed eating behaviors; weight status at ages 6, 12, and 16 years; and weight-teasing history.Results. Nearly half of the participants were weight-teased as a child. Participants who experienced childhood weight teasing were significantly more likely to have disturbed eating behaviors now than non-weight-teased peers. As the variety of weight teasing insults recalled increased, so did disturbed eating behaviors and current body mass index. Those who recalled their weight at ages 6, 12, or 16 years as being heavier than average endured weight teasing significantly more frequently and felt greater distress than their lighter counterparts.Conclusions. Weight teasing may contribute to the development of disturbed eating and eating disorders in young women. Health care professionals, parents, teachers, and other childcare givers must help shift social norms to make weight teasing as unacceptable as other types of bullying. To protect the health of children, efforts to make weight teasing unacceptable are warranted.
Personal, behavioral and socio-environmental predictors of overweight incidence in young adults: 10-yr longitudinal findings,
Background The objective of this study was to identify 10-year longitudinal predictors of overweight incidence during the transition from adolescence to young adulthood. Methods Data were from Project EAT (Eating and Activity in Teens and Young Adults). A diverse, population-based cohort (N???=???2,134) completed baseline surveys in 1998???1999 (mean age???=???15.0??1.6, ???adolescence???) and follow-up surveys in 2008???2009 (mean age???=???25.4??1.7, ???young adulthood???). Surveys assessed personal, behavioral and socio-environmental factors hypothesized to be of relevance to obesity, in addition to height and weight. Multivariable logistic regression was used to estimate the adjusted odds for each personal, behavioral and socio-environmental factor at baseline, and 10-year changes for these factors, among non-overweight adolescents (n???=???1,643) being predictive of the incidence of overweight (BMI?????????25) at 10-year follow-up. Results At 10-year follow-up, 51% of young adults were overweight (26% increase from baseline). Among females and males, higher levels of body dissatisfaction, weight concerns, unhealthy weight control behaviors (e.g., fasting, purging), dieting, binge eating, weight-related teasing, and parental weight-related concerns and behaviors during adolescence and/or increases in these factors over the study period predicted the incidence of overweight at 10-year follow-up. Females with higher levels of whole grain intake and breakfast and dinner consumption frequency during adolescence were protected against becoming overweight. Among males, increases in vegetable intake protected against the incidence of overweight 10 years later. Conclusions Findings suggest that obesity prevention interventions for adolescents should address weight-specific factors from within the domains of personal, behavioral, and socio-environmental factors such as promoting positive body image, decreasing unhealthy weight control behaviors, and limiting negative weight talk.
Assessment of weight stigma,
The stigma of obesity: Does perceived weight discrimination affect identity and physical health?,
Why positive psychology is necessary,
The authors provide a definition of positive psychology and suggest that psychologists should try to cultivate a more appreciative perspective on human nature. Examples are given of a negative bias that seems to pervade much of theoretical psychology, which may limit psychologists' understanding of typical and successful human functioning. Finally, a preview of the articles in the special section is given.
Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: A practice-friendly meta-analysis,
Do positive psychology interventions-that is, treatment methods or intentional activities aimed at cultivating positive feelings, positive behaviors, or positive cognitions-enhance well-being and ameliorate depressive symptoms? A meta-analysis of 51 such interventions with 4,266 individuals was conducted to address this question and to provide practical guidance to clinicians. The results revealed that positive psychology interventions do indeed significantly enhance well-being (mean r=.29) and decrease depressive symptoms (mean r=.31). In addition, several factors were found to impact the effectiveness of positive psychology interventions, including the depression status, self-selection, and age of participants, as well as the format and duration of the interventions. Accordingly, clinicians should be encouraged to incorporate positive psychology techniques into their clinical work, particularly for treating clients who are depressed, relatively older, or highly motivated to improve. Our findings alsosuggest that clinicians would do well to deliver positive psychology interventions as individual (versus group) therapy and for relatively longer periods of time.
Perceived weight discrimination and C-reactive protein,
Perceived weight discrimination has been linked to health outcomes, including risk of obesity. Less is known about how discrimination is associated with intermediate physiological markers of health, such as systemic inflammation. This research examined the association between weight discrimination and C‐reactive protein (CRP) and whether it varied by participants' body mass index (BMI).
Are anti-stigma films a useful strategy for reducing weight bias among trainee healthcare professionals? Results of a pilot randomized control trial,
Background: Weight bias is an important clinical issue that the educators of tomorrow's healthcare professionals cannot afford to ignore. This study, therefore, aimed to pilot a randomized controlled trial of the effects of educational films designed to reduce weight stigmatization toward obese patients on trainee dietitians' and doctors' attitudes. Methods: A pre-post experimental design with a 6-week follow-up, which consisted of an intervention group (n = 22) and a control group (n = 21), was conducted to assess the efficacy of brief anti-stigma films in reducing weight bias, and to test whether future, larger-scale studies among trainee healthcare professionals are feasible. Results: Participants at baseline demonstrated weight bias, on both implicit and explicit attitude measures, as well as strong beliefs that obesity is under a person's control. The intervention films significantly improved explicit attitudes and beliefs toward obese people, and participant evaluation was very positive. The intervention did not significantly improve implicit anti-fat bias. Conclusion: The current study suggests both that it is possible to conduct a substantive trial of the effects of educational films designed to reduce weight stigma on a larger cohort of trainee healthcare professionals, and that brief educational interventions may be effective in reducing stigmatizing attitudes in this population. Copyright (C) 2013 S. Karger GmbH, Freiburg
Weight stigma is stressful. A review of evidence for the Cyclic Obesity/Weight-Based Stigma model,
Abstract Weight stigma is highly pervasive, but its consequences are understudied. This review draws from theory in social psychology, health psychology, and neuroendocrinology to construct an original, generative model called the cyclic obesity/weight-based stigma (COBWEBS) model. This model characterizes weight stigma as a "vicious cycle" - a positive feedback loop wherein weight stigma begets weight gain. This happens through increased eating behavior and increased cortisol secretion governed by behavioral, emotional, and physiological mechanisms, which are theorized to ultimately result in weight gain and difficulty of weight loss. The purpose of this review is to evaluate the existing literature for evidence supporting such a model, propose ways in which individuals enter, fight against, and exit the cycle, and conclude by outlining fruitful future directions in this nascent yet important area of research. Copyright 2014 Elsevier Ltd. All rights reserved.
Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise,
Abstract Experiences with weight stigma negatively impact both psychological outcomes (e.g., body dissatisfaction, depression) and behavioral outcomes (e.g., dieting, exercise). However, not everyone is equally affected by experiences with weight stigma. This study examined whether internalized societal attitudes about weight moderated the impact of weight stigma. Adult participants (n = 111) completed measures of experiences with weight stigma, as well as two indexes of internalized societal attitudes (the moderators): Internalized anti-fat attitudes and internalization of societal standards of attractiveness. Psychological outcomes included self-esteem, body dissatisfaction, drive for thinness, and bulimic symptoms; behavioral outcomes included avoidance of exercise and self-reported exercise behavior. Weight stigma was positively correlated with body dissatisfaction, drive for thinness, and bulimic symptoms, and was negatively correlated with state and trait self-esteem. Both indexes of internalized attitudes moderated the association between weight stigma and avoidance of exercise: Individuals high in anti-fat attitudes and high in internalization of societal standards of attractiveness were more motivated to avoid exercise if they also experienced a high degree of weight stigma; individuals low in anti-fat attitudes and low in internalization were relatively unaffected. Avoidance of exercise was negatively correlated with self-reported strenuous exercise. These findings suggest that weight stigma can negatively influence motivation to exercise, particularly among individuals who have internalized societal attitudes about weight. Reducing internalization might be a means of minimizing the negative impact of weight stigma and of facilitating healthy weight management efforts.
Weight stigma and eating behavior: A review of the literature,
Weight stigma is a pervasive social problem, and this paper reviews the evidence linking weight stigma to eating behavior. Correlational studies consistently find that experiences with weight stigma are associated with unhealthy eating behaviors and eating pathology (such as binge eating, skipping meals), although results vary somewhat depending on the sample being studied and the specific stigma/eating constructs being assessed. Experimental studies consistently find that manipulations such as priming overweight stereotypes, exposure to stigmatizing content, and social exclusion all lead to increased food intake, but whether or not those manipulations capture the impact of weight stigma experiences per se is less clear. Finally, studies of stigma experiences in daily life show that more frequent stigma experiences are associated with decreased motivation to diet and with less healthy eating behaviors. Overall, this research highlights the potential for weight stigma to negatively impact individuals' eating behavior, which in turn could have consequences for their overall health and well-being.
Primum non nocere: Obesity stigma and public health,
Overweight and obesity: Prevalence, consequences, and causes of a growing public health problem,
This paper provides an overview of the evidence on the current epidemic of obesity in the United States. The prevalence of overweight and obesity now exceeds 60% among US adults, and the rate is rapidly increasing among children and adolescents. Dismal medical, social, and economic consequences are already apparent and likely to worsen without multipronged intervention. Increased rates of hypertension, diabetes, and dyslipidemia, among other medical conditions, threaten to shorten the longevity of the American populace by as much as 5 years. The incidence of depression is increasing and experts suggest this is linked with the increased prevalence of obesity. The cost of obesity-related medical care has increased astronomically since 1987, in addition to lost productivity and income. Novel multidisciplinary, preventive, and therapeutic approaches, and social changes are needed that address the complex interplay of biologic, genetic, and social factors that have created the current obesity epidemic.
Obesity: Preventing and Managing the Global Epidemic: Report of WHO Consultation on Obesity
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