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Bias, Discrimination and Obesity
Abstract
It has been said that obese persons are the last acceptable targets of discrimination.1-4 Anecdotes abound about overweight individuals being ridiculed by teachers, physicians, and complete strangers in public settings, such as supermarkets, restaurants, and shopping areas. Fat jokes and derogatory portrayals of obese people in popular media are common. Overweight people tell stories of receiving poor grades in school, being denied jobs and promotions, losing the opportunity to adopt children, and more. Some who have written on the topic insist that there is a strong and consistent pattern of discrimination, 5 but no systematic review of the scientific evidence has been done.
... The common perception that weight gain and loss is under the control of the individual is an important concept in understanding fat stigma. In this context, it is believed that the individual is personally responsible for their weight and therefore fatness is associated with negative personal traits of laziness, lack of self-discipline and passivity (Puhl & Brownell, 2001). ...
... There have been numerous reviews of the empirical literature to determine if stigma, prejudice and discrimination of fat people exist in healthcare (Brown, 2006; Forhan & Sala, 2013; Mold & Forbes, 2013; Puhl & Brownell, 2001; Puhl & Heuer, 2009). Consistent findings across a number of studies have provided substantial evidence to confirm the presence of weight bias in healthcare. ...
... Consistent findings across a number of studies have provided substantial evidence to confirm the presence of weight bias in healthcare. More specifically, that healthcare professionals endorse stereotypes and hold negative attitudes towards fat patients (Puhl & Brownell, 2001; Puhl & Heuer, 2009). However, the existence of this weight bias appears to be over represented in the literature due to the manner in which these minority findings, which approximate to 20-25% of attitudes, are used. ...
Critically ill fat patients pose considerable healthcare delivery and resource utilisation challenges which are often exacerbated by the patients’ critical condition and types of interventional therapies used in the intensive care environment. Added to these difficulties of managing care is the social stigma that is attached to being fat. Intensive care staff not only have to attend to the specific needs of the critically ill body but also navigate, both personally and professionally, the social terrain of stigma when providing care to this patient population.
The purpose of this research was to explore the culture and influences within the intensive care setting in which doctors and nurses cared for fat patients. A focused ethnographic approach was adopted to elicit the specific knowledge and ‘situated’ experiences of caring for critically ill fat patients from the perspectives of intensive care staff. The setting for this study was an 18 bedded tertiary intensive care unit (ICU) in New Zealand. Participant observation of care practices and interviews with intensive care staff were undertaken over a four month period. This study adopted an insider perspective throughout the research process as the study site was also my place of work. The dual tensions of the nurse and researcher position are reflexively explored through the thesis.
Key findings from this research reveal how fat patients were considered to be ‘misfits’ in the ICU as a result of not fitting the physical, medical, and social norms of intensive care practices. Staff managed their private perceptions of fatness during care situations through the use of emotional labour, behavioural regions, and face-work. Through the construction and presentation of the professional and private ‘face’, staff were able to establish positive social experiences for fat patients.
This study has brought new understandings of fatness; often perceived as the last socially accepted form of discrimination. Conceptualising fat patients as ‘misfits’ in the intensive care setting, reveals the performances of staff in managing the social awkwardness of fat stigma. The implications of this for healthcare is the provision of clinical services that are fit for purpose and a reconceptualisation of how staff use emotional labour in order to deliver non-discriminatory care to socially stigmatised fat patients.
Key words: Fatness, obesity, intensive care, nursing, medicine, emotional labour, face-work, behavioural regions, focused ethnography.
... Treatment of obesity often requires more than just dietary changes but also including exercise, counseling and social support. Overweight and obese persons are at risk for a number of health problems and social difficulties (Puhl & Brownell, 2001). These difficulties range from higher risk for a variety of disorders, including hypertension, infertility, back pain, type II diabetes, stroke, heart attack, and others (Faith, et. ...
... Current literature shows there are prejudicial attitudes Americans hold towards obese and overweight individuals (Puhl and Brownell, 2001). Starting from a young age, if a child is overweight, they are socialized not to participate in sports and are treated with different expectations in the physical domain compared to average weight children (Greenleaf & Weiller, 2005). ...
... In selling them, they are being associated with fat consumers. Then, the stereotypes of fat or larger size people become associated with the company, such as laziness, weak willed, dirty, blame-worthy, slow, unintelligent unhealthy, unattractive, and incompetent (Puhl & Brownell, 2001; Robertson & Vohora, 2008). Only one of the thirteen participants was aware that Nike offered clothing in their size. ...
Substantial research on the functionality of athletic apparel has been conducted; however little consideration has been given to the plus size figure. Societal messages suggest that overweight women are lazy and therefore would not be interested in athletic apparel. The purpose of this study was to determine overweight adult women's experience with athletic clothing. The sample consisted of 14 women, ages 30 to 65 who wore size 1X to 3X. They were each supplied with a Nike brand athletic outfit and participated in two in depth interviews. Data collection methods included qualitative interviews, quantitative surveys and guided journaling. The major findings suggest that overweight women have difficulty shopping for clothing. Difficulty and frustration was experienced on a number of levels including; limited stores, limited selection and styles, fitting issues, over-priced items and less color options compared to smaller sizes. The findings suggest overweight women experience emotional
... Obesity stigma or weight stigma is generally defined as " negative attitudes toward a person because he or she is overweight or obese, such as the stereotype that obese persons are lazy or lacking in willpower. These stereotypes can be manifested in different ways, leading to prejudice and discrimination " [8]. However, there is limited data on the mindset of non-obese people regarding obesity and how they interact with obese people. ...
... Obese people are also considered to be lazy, indecisive and slow, having low self-esteem and are not suitable for work. In addition they are often discriminated against when seeking employment or a promotion [8]. When in reality, research has shown that obesity is not only due to overeating and being lazy, other factors like genetic and environmental changes also play an important role [13]. ...
... proposed by James Neel in 1962 which showed that human beings have a genetic predisposition for developing obesity and metabolic disorders. It is believed that due to certain environmental changes, this gene is now highly active particularly in the South Asian Population [8], additionally it is also linked with subclinical inflammation that leads to the development of metabolic syndrome [16] so the simple notion of obesity being a psychological disease is no longer valid. ...
Apart from the physical health implications obesity partakes on an individual; it also takes its toll on mental and psychological wellbeing of a person. A vicious cycle starts with hostility based on " obesity stigma " , eventually leading the person being stuck in a positive feedback loop. Every attempt to correct his or her obesity problem results in severe detrimental health effects. It is necessary that appropriate awareness programs and legislations are drafted and implemented to strike out the root causes of obesity stigma.
... While this article relies on an outdated understanding of gender identity, the discussion of fat oppression is useful and instructive. 14. Puhl and Brownell 2013. 15. ...
... 21. Puhl andHeuer 2010;Puhl and Brownell 2013;Gordon 2020. 22. Two excellent explanations of the ways in which The Whale is fatphobic are Gay and West. ...
This paper attempts to bring together two lines of thought that might seem unrelated. The first is the idea that the life class should be a safe space that respects and nurtures the creative autonomy of life models. The second is the idea that it is morally, socially, and aesthetically permissible to be fat and that fat persons are entitled to the same dignity, respect, and celebration to which straight-sized persons are entitled. Putting these two thoughts together, I explore the idea that the life class can be a space for the aesthetic exploration and appreciation of fat bodies and hence an important space for combatting fat oppression.I would like to issue a warning about content that may be upsetting or triggering for my readers. In section II, I briefly discuss sexual harassment and sexual assault. In section III, I give quite a few examples of the kinds of harassment and hostility that fat persons face.
... Whitney Thore. 1 La gordura es hoy en día una de las últimas formas de discriminación abiertamente toleradas (Braziel y LeBesco 2001;L. S. Brown 1985;Fikkan y Rothblum 2012;Gaytán y Lara Méndez 2009;Hartley 2001;Kirkland 2011;Kwan y Fackler 2008;Lupton 2013;Puhl y D. K. D. Brownell 2001;Ritenbaugh 1991;Swami et al.., 2010) ¿Qué ocurre en torno a la corporalidad y el género que permite la estigmatización social de otros en virtud de su apariencia? ...
... V. Roehling, P. V. Roehling, y Pichler, 2007). En efecto, los trabajadores con un peso superior a la media sufren más de discriminación en comparación con sus pares de peso "normal" (Carr y M. A. Friedman 2005;Puhl y D. K. D. Brownell 2001;M. V. Roehling et al., 2007), sobre todo si son mujeres (Fikkan y Rothblum, 2012). ...
En la actualidad, los cuerpos gordos femeninos son negativizados y desrrepresentados a través del poder discursivo de los medios comunicacionales. De acuerdo a nuestra tesis, la discriminación contra la gordura se basaría en la constitución mediática de un canon de belleza normativo, mediante el cual se construye un sujeto gordo inferiorizado en función de la reproducción del estatus social positivo vinculado a la delgadez, y su relación histórica a las clases privilegiadas. Este trato simbólico pernicioso es probado a través de un análisis de la representación corporal femenina en la prensa chilena reciente.
La constitución simbólico-discursiva de las corporalidades femeninas se sustenta en dinámicas de poder patriarcal internalizadas, lo cual produce sujetos disciplinados cuya disatisfacción es resuelta ideológicamente en la ilusión consumista de poseer el cuerpo perfecto. Esta estigmatización corporal basada en una lógica oposicional entre delgadez y gordura provee al cuerpo gordo femenino de la capacidad política para denunciar la opresión de género implícita en los cánones de belleza modernos.
Nowadays, fat female bodies are negativized and underrepresented through media’s discur- sive power. According to our thesis, fat discrimination would be based on the mediatic constitution of a normative beauty standard, by which an inferiorized fat subject is built according to the reproduction of a positive social status linked to thinness, and its historic relationship to privileged classes. This detrimental symbolic treatment is proven through a female body re- presentation analysis in recent chilean press.
The symbolical-discursive constitution of female bodies is based on internalized patriarchal power dynamics, which produces disciplined subjects whose dissatisfaction is ideologically solved under the consumerist illusion of owning the perfect body. This corporal dissatisfaction is based on an oppositional logic between thinness and fatness, providing the female fat body with the political capability to denounce the embedded gender oppression that lies in modern beauty standards.
... Across the world, individuals with obesity are viewed as stereotypically lazy, lacking willpower, incompetent, unattractive, and to blame for their excess weight (1). Due to these negative, prejudicial beliefs (known as weight bias), individuals with obesity face public derogation, devaluation, and discrimination (known as weight stigma) (2). Weight stigma is a prominent psychosocial consequence of obesity that is associated with increased risk for depression, anxiety, body dissatisfaction, and low self-esteem (3). ...
... Individuals with obesity frequently experience weight stigma in health care settings (22); increased need for health care services due to poor health may consequently increase exposure to stigma and heighten vulnerability to internalizing it. Heightened disease burden may also increase susceptibility to self-blame due to the perceived controllability of weight (2). A longitudinal study of individuals with varying levels of WBI at baseline, but without obesityrelated comorbidities, could help to clarify the temporal relationship between WBI and risk of metabolic syndrome. ...
Objective:
Weight stigma is a chronic stressor that may increase cardiometabolic risk. Some individuals with obesity self-stigmatize (i.e., weight bias internalization, WBI). No study to date has examined whether WBI is associated with metabolic syndrome.
Methods:
Blood pressure, waist circumference, and fasting glucose, triglycerides, and high-density lipoprotein cholesterol were measured at baseline in 178 adults with obesity enrolled in a weight-loss trial. Medication use for hypertension, dyslipidemia, and prediabetes was included in criteria for metabolic syndrome. One hundred fifty-nine participants (88.1% female, 67.3% black, mean BMI = 41.1 kg/m(2) ) completed the Weight Bias Internalization Scale and Patient Health Questionnaire (PHQ-9, to assess depressive symptoms). Odds ratios and partial correlations were calculated adjusting for demographics, BMI, and PHQ-9 scores.
Results:
Fifty-one participants (32.1%) met criteria for metabolic syndrome. Odds of meeting criteria for metabolic syndrome were greater among participants with higher WBI, but not when controlling for all covariates (OR = 1.46, 95% CI = 1.00-2.13, P = 0.052). Higher WBI predicted greater odds of having high triglycerides (OR = 1.88, 95% CI = 1.14-3.09, P = 0.043). Analyzed categorically, high (vs. low) WBI predicted greater odds of metabolic syndrome and high triglycerides (Ps < 0.05).
Conclusions:
Individuals with obesity who self-stigmatize may have heightened cardiometabolic risk. Biological and behavioral pathways linking WBI and metabolic syndrome require further exploration.
... Avaliações negativas por si mesmos ou outros, prática de atividade física, ou situações de risco ambiental foram apontadas como situações angustiantes; Vergonha do peso e culpa foram relacionadas como preditoras negativas e positivas ao engajamento de estratégias focadas no problema, respectivamente; Perda de peso relacionou-se a queda em estratégias não focadas no problema. Mwendwa et al. (2011) Puhl & Brownell, 2001) e limitações sociais que podem prejudicar a saúde mental, dificultar a adesão a mudanças de comportamentos e ainda provocar constrangimentos em situações do dia-a-dia, tais como experimentar peças de vestuário em lojas, ser alvo de brincadeiras relacionadas ao peso e apresentar dificuldades de locomoção ou de acesso a determinados locais espacialmente limitados. Uma vez que o tratamento da obesidade pode ir além de medicamentos e remédios, chegando ao próprio procedimento cirúrgico, o portador desta doença, além de ter de enfrentar situações adversas vindas da própria condição obesa, como o preconceito vivenciado, ainda passa por uma exaustiva condição de tratamento, que exige diversas mudanças de hábitos e comportamentos. ...
... Um enfrentamento mais adequado é apontado como potencial redutor de problemas alimentares,sejam para populações obesas ou não obesas (Mwendwa et al., 2011). Percebe-se, contudo, que pacientes portadores de obesidade, em geral, tem que desenvolver estratégias mais adaptadas ao controle de situações específicas, tais como preconceitos (Puhl & Brownell, 2001; Mwendwa et al., 2011), o que é, por sua vez, relatado como não frequente: obesos, em geral, apresentam estratégias de enfrentamento não favoráveis, utilizando, frequentemente, o próprio comportamento de comer excessivo como maneira de enfrentar o preconceito ou o fato de terem de mudar a alimentação (Silva & Maia, 2012; Puhl & Brownell, 2006). Percebeu-se uma tendência em se considerar que estratégias de enfrentamento focadas no problema mostram-se mais favoráveis à eliminação, ou não ocorrência de comportamentos alimentares não satisfatórios, assim como para a perda potencial de mais peso (Conradt et al., 2008). ...
Obesity is characterized as a global epidemic and includes functional relationships with psychosocial variables. This study aimed to conduct a survey of the world production related to the topic of coping strategies and treatment of obesity, available from 2012 to 2001. A literature research was conducted in the data bases Pubmed, Capes, Scielo, Lilacs and Google Scholar. Were extracted 92 abstracts and selected 16 full articles. As content, the articles were classified as: (a) Coping strategies and obesity variables (seven items), ( b) Coping strategies and prejudices directed to obese people (four items), and (c) Coping strategies and variables related to bariatric surgery (five items). More adaptive strategies and especially focused on problem solving has proven most effective in combating obesity adversities, including prejudices and maintenance of eating habits.
... Whitney Thore. 1 La gordura es hoy en día una de las últimas formas de discriminación abiertamente toleradas (Braziel y LeBesco 2001;L. S. Brown 1985;Fikkan y Rothblum 2012;Gaytán y Lara Méndez 2009;Hartley 2001;Kirkland 2011;Kwan y Fackler 2008;Lupton 2013;Puhl y D. K. D. Brownell 2001;Ritenbaugh 1991;Swami et al.., 2010) ¿Qué ocurre en torno a la corporalidad y el género que permite la estigmatización social de otros en virtud de su apariencia? ...
... V. Roehling, P. V. Roehling, y Pichler, 2007). En efecto, los trabajadores con un peso superior a la media sufren más de discriminación en comparación con sus pares de peso "normal" (Carr y M. A. Friedman 2005;Puhl y D. K. D. Brownell 2001;M. V. Roehling et al., 2007), sobre todo si son mujeres (Fikkan y Rothblum, 2012). ...
En la actualidad, los cuerpos gordos femeninos son negativizados y des-representados a través del poder discursivo de los medios comunicacionales. De acuerdo a nuestra tesis, la discriminación contra la gordura se basaría en la constitución mediática de un canon de belleza normativo, mediante el cual se construye un sujeto gordo inferiorizado en función de la reproducción del estatus social positivo vinculado a la delgadez, y su relación histórica a las clases privilegiadas. Este trato simbólico pernicioso es probado a través de un análisis de la representación corporal femenina en la prensa chilena reciente.
La constitución simbólico-discursiva de las corporalidades femeninas se sustenta en dinámicas de poder patriarcal internalizadas, lo cual produce sujetos disciplinados cuya disatisfacción es resuelta ideológicamente en la ilusión consumista de poseer el cuerpo perfecto. Esta estigmatización corporal basada en una lógica oposicional entre delgadez y gordura provee al cuerpo gordo femenino de la capacidad política para denunciar la opresión de género implícita en los cánones de belleza modernos.
... Given the association of wasting and its historical depiction of an advancing HIV disease as well as its symbolic value (i.e., being HIV positive), it is plausible that some PLWH may be motivated to maintain a heavier weight as being overweight or obese may offer a protective value against the isolation and rejection associated with HIV stigma (Earnshaw, Smith, Chaudoir, Amico, & Copenhaver, 2013; Lentine et al., 2000; Mahajan et al., 2008; Radcliffe et al., 2015; Rivera et al., 2015; R. Smith et al., 2008) as well as erroneously providing an individual with physical evidence that they are healthy. Overweight and obesity, though traditionally stigmatizing conditions themselves (Carels et al., 2012; Pearl, Puhl, & Brownell, 2012; Puhl & Heuer, 2010; Puhl, Moss-Racusin, Schwartz, & Brownell, 2007; Puhl & Brownell, 2001; Sikorski et al., 2011), may serve as beneficial psychological functions for PLWH because they mask the more commonly associated physical symptoms of HIV. Thus, while PLWH who are overweight or obese may experience obesity stigma, the stigma may not be associated with the negative psychological and physical health consequences typically observed in persons with overweight and obesity (Carels et al., 2009; Hunger & Major, 2014; Puhl & Heuer, 2010; Puhl & Brownell, 2001; Sikorski et al., 2011). ...
... Overweight and obesity, though traditionally stigmatizing conditions themselves (Carels et al., 2012; Pearl, Puhl, & Brownell, 2012; Puhl & Heuer, 2010; Puhl, Moss-Racusin, Schwartz, & Brownell, 2007; Puhl & Brownell, 2001; Sikorski et al., 2011), may serve as beneficial psychological functions for PLWH because they mask the more commonly associated physical symptoms of HIV. Thus, while PLWH who are overweight or obese may experience obesity stigma, the stigma may not be associated with the negative psychological and physical health consequences typically observed in persons with overweight and obesity (Carels et al., 2009; Hunger & Major, 2014; Puhl & Heuer, 2010; Puhl & Brownell, 2001; Sikorski et al., 2011). Because of the proposed protective effect of obesity in PLWH, it is then hypothesized that stigma processes associated with HIV may interfere with motivation for weight reduction in PLWH. ...
Objective: Both obesity and HIV are highly stigmatized diseases; however, little is known about the psychological experience of individuals at the intersection of these two conditions. This cross-sectional study examined whether PLWH with overweight or obesity endorsed and experienced less anticipated and enacted stigma due to their weight status. Methods: PLWH (n = 671; 428 male and 196 females) were recruited from a holiday donation center in Atlanta, Georgia. Self-reports of medical history, HIV and weight stigma, body image, perceptions of weight status, and nutritional intake were collected. Results: 26.8% were overweight (BMI >25-25.9 kg/m2) and 32.4% were obese (BMI >30 kg/m2). No differences were seen in levels of anticipated or enacted stigma across weight categories. Body image across weight categories was also relatively equal. Post hoc analyses displayed a meditational effect of body image on internalized HIV stigma and BMI. BMI also served as a moderator on body image and internalized weight stigma, as body image increased so did internalized stigma. Differences were also seen in perceptions of weight status, with individuals that were overweight or obese perceiving themselves to be slightly underweight or about the right weight. Conclusion: Results suggests there were no differences in anticipated or experienced HIV stigma as a result of weight status; however, internalized stigma was closely related to body image. Overweight and obesity were the norm in this sample as well as poor dietary quality, emphasizing the need for weight management interventions that are sensitive to the unique challenges of PLWH.
... 15 As a result, it is present across a wide variety of life areas such as employment, health and educational settings. 16 Mass media also plays an important role in the perpetuation of the negative stereotypes about obesity, whereby male characters play these negative stereotypes more often than women. 17,18 Bias towards obesity is also present in a wide variety of professions, especially in healthcare professionals such as pharmacists, 19 nurses, 20 primary care professionals 21 and also in exercise and nutrition professionals. ...
Weight discrimination is one of the worst forms of prejudice and is deeply rooted in society. The aim of this study was to adapt the anti‐fat attitudes scale (AFA) to the Spanish general population. The sample consisted of 1248 participants from the Spanish community population. They were recruited through the internet and participated voluntarily. Women (77.8%) were more predominant than men. Regarding body weight categories, 5.3% were underweight, 43.5% were normal‐weight, 24.9% were overweight and 26.3% had obesity. A cross‐validation method with an exploratory and confirmatory factor analysis confirmed the three‐factor structure of the AFA. The Spanish version of the AFA showed a satisfactory internal consistency for all three factors, as well as adequate test–retest reliability after a 1‐month interval. Finally, the Spanish version of the AFA seems to be an adequate tool to assess negative attitudes towards obesity in both clinical and research settings. Men presented more negative attitudes towards obesity and were convinced that obesity is under someone's control. Women presented more fear of gaining weight. Normal‐weight people were those who discriminated more. Participants with overweight or obesity suffered more fear of gaining weight. There was no intra‐group discrimination between individuals with overweight and obesity.
... Por un lado, desde el plano médico, se aboga por la despatologización de la gordura a partir de la interpretación de la evidencia médica desde el paradigma de los Critical Weight Studies opuesto al paradigma de la obesidad (O'Hara y Taylor, 2018;Bacon y Aphramor, 2011;Gard y Wright, 2005). Por otro lado, desde un plano social, se denuncia la "gordofobia" como sistema estructural de discriminación contra las personas gordas que incluye discriminación laboral (Puhl y Brownell, 2001), desigual acceso a la atención médica y psicológica (Hebl y Xu, 2001), y a los servicios reproductivos y el ejercicio parental (Brown, 2019). Por último, desde un plano filosófico se analiza cómo los sujetos gordos en las sociedades actuales están representados de forma muy negativa y abjectificada, como sujetos no sólo enfermos y feos, sino también pasivos, con problemas mentales, poco disciplinados, antihigiénicos y estúpidos (Robinson et. ...
La epidemia de la obesidad se considera una de las grandes amenazas del siglo XXI a
nivel socioeconómico. Sin embargo, desde los Fat Studies, campo interdisciplinar que
repiensa críticamente la gordura, se denuncia las lógicas biopolíticas y disciplinantes en
estos discursos alarmista y culpabilizadores del individuo a través de la medicalización
de la gordura. Tomando las teorías de Michel Foucault en torno al cuerpo, la institución
médica y la disciplina, se pretende dilucidar en qué lugar se encuentran hoy las
corporalidades gordas y, especialmente, en aquellos cuerpos que son leídos como
femeninos.
... [1] Also, Puhl and Brownell's paper also pointed out that obese people suffer from mood disorders and anxiety disorders such as depression more than 25% more than normal weight people. [2] As a country with a very fast growing economy and a population of over 1.4 billion people, there have always been numerous employers and employees in the Chinese labor market. The causes and subsequent effects in Chinese labor market have actually been a controversial and great topic to research. ...
... Second and relatedly, another possibility is that consumers may believe that others weigh more than they do, and therefore need a larger amount of food than they do (Chandon and Wansink 2007). This perspective would again be underpinned by a below-average effect on weight, as overweight people are the object of various negative associations (Levine and Schweitzer 2015;Puhl and Brownell 2001). ...
Consumers’ portion size choices are important, both as larger portion sizes can lead to overeating and as uneaten portions can contribute to food waste. Existing research has largely focused on consumers’ portion size choices for themselves—even though consumers often choose for others. Fourteen studies examine portion size choices for others, testing: Do consumers choose smaller, similar, or larger portion sizes for others, compared to various benchmarks—(1) how much they choose for themselves, (2) how much others want to receive, and (3) predictions about how much others actually want to eat? Studies show that consumers choose larger portion sizes for others across multiple choosing-for-others contexts, involving everyday favors, gift-giving, and joint consumption. Consumers’ goal to be considerate of others’ needs and desires given uncertainty about others’ consumption is one broad “baseline” driver of this multiply determined phenomenon. Consumers do not choose larger portion sizes for others when they lack a considerateness goal, when choosing larger portions is inconsiderate, or when a responsibility goal instead dominates (as in the choosing-for-others context of caregiving). This research offers theoretical implications for understanding choices for others and portion size choices and practical implications through identifying a potential cause of overeating and/or food waste.
... In modern Western societies, being overweight or obese can also carry stigma (Puhl and Heuer 2009). Population representative surveys find that people associate being overweight or obese with being lazy, having a lack of motivation and self-discipline, and being incompetent (Roehling 1999;Puhl and Brownell 2001). The perception that being overweight or obese is associated with "laziness," whether true at the individual level or not, means that body mass is a readily available visual cue perceived as signaling something important about an individual's underlying nature (Jutel 2005). ...
Despite the large literature examining predictors of fertility, previous research has not offered a population‐level perspective on how health in early adulthood is related to male fertility. Using Swedish population and military conscription registers, we study how body mass index (BMI), physical fitness, and height are associated with total fertility and parity transitions by 2012 among 405,427 Swedish men born 1965–1972, meaning we observe fertility up to age 40 or older. Applying linear regression and sibling fixed effects, we find that these anthropometric measures are strong predictors of fertility, even after accounting for education and cumulative income. Men with a “normal” BMI and in the highest decile of physical fitness have the most children. Men who were obese at ages 17–20 had a relative probability of childlessness almost twice as high as men who had a “normal” BMI, and men in the bottom decile of physical fitness had a relatively probability of childlessness more than 50 percent higher than men in the top decile. In sibling comparison models the tallest men have the most children and men in the lowest two deciles of height have significantly lower fertility. Further analyses show that the strong associations persist even among men who married.
... Cultural schemata about fat guide how we think of our own and others' bodies. Pejorative schemata, in turn, can produce stigmatization of and discrimination against overweight individuals (Puhl and Brownell, 2001). When a pejorative schema is used to "fill in the blanks" about a fat person, that person may be perceived as lazy and immoral, based on no evidence other than his body size processed through a particular cultural schema. ...
Overweight individuals, and especially women, are disparaged as immoral, unhealthy, and low class. These negative conceptions are not intrinsic to obesity; they are the tainted fruit of cultural learning. Scholars often cite media consumption as a key mechanism for learning cultural biases, but it remains unclear how this public culture becomes private culture. Here we provide a computational account of this learning mechanism, showing that cultural schemata can be learned from news reporting. We extract schemata about obesity from New York Times articles with word2vec, a neural language model inspired by human cognition. We identify several cultural schemata that link obesity to gender, immorality, poor health, and low socioeconomic class. Such schemata may be subtly but pervasively activated by our language; thus, language can chronically reproduce biases (e.g., about weight and health). Our findings also reinforce ongoing concerns that machine learning can encode, and reproduce, harmful human biases.
... Several studies have shown the negative impact of being overweight on the labour market, especially for women 21 22 as well as in the education system. 23 In addition, a lower level of education and income is associated with obesogenic behaviour such as a poor diet and a lack of exercise caused by factors such as stress. 24 Moreover, Bourdieu 25 sees the most decisive determinant of a healthy lifestyle in socioeconomic class. ...
Objectives
Obesity is considered a global health issue, because of its health-related consequences and also because of its impact on social status as a result of stigma. This study aims to review the quantitative state of research regarding socioeconomic characteristics’ influence on weight-related stigmatisation and discrimination. Based on Bourdieu’s Theory of Class and his concept of ‘habitus’, it is assumed that people with a higher level of education and income show stronger negative attitudes towards people with obesity.
Method
A narrative systematic literature review was conducted in 2017 using PubMed, PsychINFO, Web of Science and the Cochrane Library. Seventeen studies that measured weight bias and either educational attainment or level of income were included in the analysis.
Results
The results of the studies included were inconsistent: six of these studies were found to support the hypothesis, whereas two of the studies contradicted it. The remaining seven studies did not show any significant correlation between weight bias and either education or income.
Conclusion
In light of the inconsistent and heterogeneous results of the studies that report a significant association between weight bias and socioeconomic variables, the findings must be discussed concerning their cultural context, that is, cultural and governmental differences. Furthermore, educational attainment seems to be more likely to predict weight bias than income. The review revealed a lack of research when it came to examining the impact of socioeconomic capital on weight bias.
... The food industry has shown itself to be highly organised, and has endeavoured to adopt the 'energy balance' argument to pass the responsibility for weight control onto individuals, emphasising that inadequate physical activity rather than excess energy intake is where authorities should focus their efforts A repercussion of the focus on personal responsibility for body weight is that overweight and obesity become stigmatised conditions, and this too is an area of similarity between this issue and problem gambling. Discrimination against people who are overweight or obese has been reported in workplaces (Rudolph, Wells, Weller, & Baltes, 2009), health care settings (Phelan et al., 2015) and social contexts (Puhl & Brownell, 2001). Recent research concerning 'fat shaming' has found that this has contributed to worsened health outcomes for those who are overweight or obese (Pearl et al., 2017). ...
This report draws on lessons from other areas of public health to identify effective interventions for reducing or preventing gambling related harm.
... However, negative reactions to obese individuals are pervasive (Crandall 1994). They are often considered to be lazy, unhealthy, lacking in self-discipline, dishonest, unsuccessful, and stupid (Crandall 1994;Greenleaf et al. 2004;Puhl and Brownell 2001). Consequently, overweight employees are relatively less likely to get a pay raise and to be promoted (Pingitore et al. 1994), are less likely to receive appropriate treatment from physicians (Price et al. 1987), and are more likely to receive poor academic evaluations (Solovay 2000). ...
Observers' reactions to a service failure and their attributions of responsibility for its occurrence can depend on fortuitous characteristics of the protagonists that happen to draw their attention. Four field and laboratory experiments show that when observers have an incidental similarity to one of the persons involved in a service failure (the customer or the service provider), their attention is drawn to this protagonist, often leading them to construe the situation from this person's perspective and consequently to blame the protagonist less for the negative event they observe. However, when an incidentally similar protagonist is rude or has an undesirable personal characteristic (i.e., obesity), observers' greater attention to that person increases their attributions of responsibility to him or her rather than decreasing it. These opposing effects of incidental similarity on attributions influence not only observers' evaluations of the persons involved in the situation they observe, but also their willingness to patronize the establishment. These effects occur both when observers actually witness a conflict offline and when they consider it online on the basis of reviews. © 2018 The Author(s). Published by Oxford University Press on behalf of Journal of Consumer Research, Inc. All rights reserved.
... In Western industrialised nations, the fat individual attracts a broad array of negative stereotypes (Puhl et al. 2015). Fat people are commonly seen as lazy, undisciplined, lacking willpower, unmotivated, sloppy, and untidy, as well as thinking more slowly, having poorer work habits and attendance, and generally being less competent in the workplace (Pascal & Kurpius 2012;Puhl & Brownell 2001). Negative attitudes toward fat people are a form of weight bias, which research suggests is on the rise globally (Andreyeva, Puhl & Brownell 2008;Brewis et al. 2011). ...
Being fat is widely recognised as a stigmatised identity which disproportionately impacts women, both personally and professionally. Women are numerically dominant as therapy practitioners, and we use this group to explore the ways a “fat counsellor” is imagined in the context of counselling. A qualitative story completion task, about a woman starting therapy, was presented to 203 British young people ages 15–24. Participants were 75% female, 88% white, 93% heterosexual, and 98% able-bodied. The story stem did not specify the sex of the counsellor, who was identified as fat; the vast majority of stories assumed the counsellor was female. Overall, fatness was perceived as negatively affecting therapy and the counsellor’s professional credibility because fatness was equated with a lack of psychological health, which rendered fat counsellors professionally “unfit.” This finding extends the literature on “weight bias” in professional settings and has implications for counsellors of all body sizes.
... Generally these health promotion programs are based on the assumptions that weight loss is intrinsically health-giving, that individuals are able to make rational and free decisions about their lifestyle, that individual lifestyles are at the root of body weight and health, and that individuals are consequently responsible for both (Brownell et al. 2010;Campos et al. 2006b). This oversimplification, often promoted with stereotypical images of fat individuals eating or doing the putatively "wrong thing," produces the socially shared "knowledge" that fat individuals are lacking in willpower, are lazy, unattractive, and so on, and are essentially behaving irresponsibly in relation to their personal and society's health (e.g., Lewis et al. 2010;Puhl & Brownell 2001;Puhl, Andreyeva & Brownell 2008;Puhl & Heuer 2009). In contemporary neoliberal societies, public health functions as a system of morality and regulation (Greenhalgh 2012;Petersen & Lupton 1996), where people are presumed to be able as well as obliged to take responsibility for their health and make the medically and socially approved healthy choices. ...
In Western societies, health is closely associated with body weight and weight loss, achieved through individual health behaviour. I examined such associations in constructions of weight-loss motivations and health in stories generated using the novel method of story completion. The story stem featured either a female or male protagonist deciding to lose weight; 148 women and 22 men (ages 18–24) provided stories in response. A social constructionist thematic analysis identified five themes: health as clothing size and means to an end; weight-loss activity as good for every woman; tomorrow is going to be the start of the rest of their life; tell me when I’m okay — it’s not about wellbeing; and weight loss as signifier of the “true self.” Considering the adverse social and psychological consequences reflected in the stories and the longstanding elusiveness of successful weight-loss methods, I support calls to review the dominant weight-focused approach to public health.
... This 1 3 manifests in ubiquitous moral accusations, disadvantages regarding education and employment chances, and making jokes at their expense, all of which fat people have to face on a daily basis (cf. Puhl and Brownell 2001). ...
Since overweight and obesity have been framed as one of the main contemporary health challenges in industrialized countries, it has become a matter of public health efforts. While the belief that obese individuals are personally responsible for their body weight prevails in public opinion, evidence-based health science widely acknowledges that obesity is significantly influenced by socio-economic factors and thus that prevention requires structural changes. This constellation bears the chance of politicizing an issue formerly conceived of as private which really is dependent on societal contingencies, such as the particular availability of food. Reflecting on the prevention of obesity from an ethical point of view, therefore, requires an elaborate concept of political responsibility. The core thesis of this paper is that existing approaches within the field of obesity ethics fall short in reasonably grasping the political dimensions at play, due to the prevailing individualistic understanding of responsibility. Drawing upon Iris Marion Young’s concept of political responsibility, I propose an alternative approach that emphasizes the structural determinants of obesity. By arguing this way, obesity prevention comes into view as a public endeavor that involves public discourse as well as shared action. Political responsibility then cannot be discharged merely by intrusive governmental action nor by individuals on their own, but should be considered as a task all of us share. As I will sketch in the last part of the paper, this includes contesting discourses on interpretations of need. Thereby, the paper contributes to recognizing obesity as a social instead of an individual problem.
... This is also likely for the case of body weight, where strong negative stereotypes are prevalent. For example, as several studies show, many people perceive the overweight and obese as less dutiful, loyal, intelligent, or emotionally stable and more weak-headed, lazy, and insecure (Polinko and Popovich, 2001;Puhl and Brownell, 2001;Roehling et al., 2008;Sikorski et al., 2012). ...
The wage weight penalty is a well-established finding in the literature, but not much is known about the mechanisms that bring this phenomenon about. This article aims to provide answers to the question of why overweight and obese people earn less. Using the data of the German Socio-Economic Panel, we conduct three theory-driven litmus tests for mechanisms that explain the weight wage gap: human capital differences, discrimination due to asymmetric information, or taste-based discrimination. Due to conflicting predictions from the three theories, interaction effects between weight and structural conditions serve as the key identification strategy. Results show that for men, productivity-related variables (e.g. education, work experience, occupation, and physical health) almost completely explain the weight-specific variance in wages. In contrast, for women, neither performance nor a lack of information can solve the puzzle of weight-based differences in wages. We therefore conclude that - at least in Germany - overweight and obese women suffer from taste-based discrimination, whereas overweight and obese men earn less due to human capital differences. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected]
... Women who are slender, but not emaciated, are more likely than fat women to be judged worthy of receiving help after a minor accident (Swami et al. 2008). As Puhl and Brownell (2001) discuss, obese people are subject to a wide variety of penalties. In studies, researchers found that 24% of nurses were "repulsed" by obese patients, and 12% preferred not to touch them (Bagley et al. 1989). ...
This article argues for an aesthetic approach to resisting oppression based on judgments of bodily unattractiveness. Philosophical theories have often suggested that appropriate aesthetic judgments should converge on sets of objects consensually found to be beautiful or ugly. The convergence of judgments about human bodies, however, is a significant source of injustice, because people judged to be unattractive pay substantial social and economic penalties in domains such as education, employment and criminal justice. The injustice is compounded by the interaction between standards of attractiveness and gender, race, disability, and gender identity.
I argue that we should actively work to reduce our participation in standard aesthetic practices that involve attractiveness judgments. This does not mean refusing engagement with the embodiment of others; ignoring someone’s embodiment is often a way of dehumanizing them. Instead, I advocate a form of practice, aesthetic exploration, that involves seeking out positive experiences of the unique aesthetic affordances of all bodies, regardless of whether they are attractive in the standard sense. I argue that there are good ethical reasons to cultivate aesthetic exploration, and that it is psychologically plausible that doing so would help to alleviate the social injustice attending judgments of attractiveness.
... Nutritionists have been reported most suitable to provide weight management counseling to obese patients [11]. The need for educational intervention in dietetics and nutritionists training with emphasis on increasing awareness of weight bias in existing curriculum was recommended [35]. Online courses for nutritionist professionals and other health-care professionals are effective for increasing the knowledge, skills, and self-efficacy of the professionals in using an ecological approach to prevent and manage obesity [36]. ...
The idea of engaging community pharmacists and nutritionists in weight management services has been well accepted by the community, as both can help to improve behavior and knowledge regarding obesity among obese patients. The aim of this study is to summarize research findings from developed and developing countries as well as from Pakistan regarding role of community pharmacists and nutritionists in obesity management. A total of 38 studies were reviewed regarding trends in obesity management. The review concluded that the role of community pharmacists and nutritionists in obesity management is not well acknowledged in most of the developing countries including Pakistan. Limited data are available on a number of nutritionists and type of services provided by them for weight management in these countries. There is urgent need to identify the barriers and gaps to further enhance the effectiveness of obesity management. Beside this intervention studies involving multi-disciplinary health- care professionals must be designed to control current obesity crisis worldwide.Keywords: Community pharmacists, Counseling, Nutritionists, Obesity, Weight management program.
... There is widespread evidence that health care providers share these biases -resulting in care that is either deficient, lacking in caring attitude, or involves extensive judgment. The phenomena of physician biases, distancing, and reluctance to treat, certain groups of people has been studied extensively, including people who are obese, have mental health disorders, substance abuse disorders, and eating disorders [38]. Research comparing the attitudes of the general public and physicians to alcohol addiction found that these two groups did not display distinct stigmatizing attitudes on alcohol addiction, in fact; B2 out of 3 people in both groups have negative attitudes towards alcohol addicts and medical education did not change these attitudes^ [39] Medical students, for example, display clear preferences for particular categories of patients, and were less sympathetic toward those whom they believed to be undeserving of treatment because they were responsible for their condition, for example people with eating disorders [40] and the obese [41,42]. ...
Addiction appears to be a deeply moralized concept. To understand the entwinement of addiction and morality, we briefly discuss the disease model and its alternatives in order to address the following questions: Is the disease model the only path towards a ‘de-moralized’ discourse of addiction? While it is tempting to think that medical language surrounding addiction provides liberation from the moralized language, evidence suggests that this is not necessarily the case. On the other hand non-disease models of addiction may seem to resuscitate problematic forms of the moralization of addiction, including, invoking blame, shame, and the wholesale rejection of addicts as people who have deep character flaws, while ignoring the complex biological and social context of addiction. This is also not necessarily the case. We argue that a deficit in reasons responsiveness as basis for attribution of moral responsibility can be realized by multiple different causes, disease being one, but it also seems likely that alternative accounts of addiction as developed by Flanagan, Lewis, and Levy, may also involve mechanisms, psychological, social, and neurobiological that can diminish reasons responsiveness. It thus seems to us that nondisease models of addiction do not necessarily involve moralization. Hence, a non-stigmatizing approach to recovery can be realized in ways that are consistent with both the disease model and alternative models of addiction.
... Anthropological analysis suggests this is because of the high cultural value placed on individual effort, responsibility, and work, with a slim body seen as reflecting that success (Brewis, 2011). This set of beliefs breeds weight-related stigma, producing strong moral associations between being " fat " and being lazy, unmotivated, and greedy (Puhl and Brownell, 2001). Experiencing this stigma does not seem to encourage successful weight loss. ...
... On the front lines of health, and the " war on obesity, " are healthcare providers. Anti-fat attitudes in healthcare providers are incredibly welldocumented (Hebl and Xu, 2001; Puhl and Brownell, 2001; Budd et al., 2011; Johnston, 2012; Forhan and Salas, 2013). ...
In this paper, we explore barriers to health for fat people. By shifting the focus from what fat people do or do not do, neoliberal principles are replaced by a focus instead on structural and institutional policies, attitudes, and practices. This includes the impact of stigma on the health treatment and health-seeking behavior of fat people. For example, we consider the role that provider anti-fat attitudes and confirmation bias play in the failure to provide evidenced-based healthcare to fat patients. This is an autoethnographic paper, which provides the opportunity to read research from the perspective of fat scholars, framed by questions such as: can fat people have health? Is health itself a state of being, a set of behaviors, a commodity, a performance; perhaps the new social contract? As a co-written autoethnographic paper, one aspect of the evidence provided is the recorded experiences of the two fat authors. This includes writing from notes, journals, compiled and repeated experiences with medical professionals, family, and the community. Framed by feminist standpoint and supported by literature drawn from Fat Studies, Public Health, Obesity Research, and other interdisciplinary fields, this is a valuable opportunity to present an extended account of fat discrimination and the impact of the stigma fat people face through the medical profession and other sectors of the community, written by fat individuals. The paper concludes by considering the health pathways available to fat people. Special attention is paid to whether Bacon and Aphramor's Health at Every Size paradigm provides a path to health for fat individuals.
... Ancak literatürde sağlık, tıp, hemşirelik alanında alınmış eğitime rağmen kilolu ve obez bireylere karşı sergilenen olumsuz tutumların değişmediğini hatta daha da kötüleştiği bildiren çalışmalara rastlamakta mümkündür. Örneğin yurtdışında öğretmenler arasında yapılan bir çalışmada katılımcılara obezite ile ilgili görüşleri sorulduğunda katılımcıların %28'i obeziteyi bir insanın başına gelmesi muhtemel en kötü olay " olarak tanımlamışlardır (Puhl ve Brownell, 2001). Bu bakış açısına sahip öğretmenlerin kendi kilolu ve obez öğrencilerine karşı olumlu bir tutum sergileyip sergilemeyeceklerinin cevabı aranması gereken önemli bir konu olduğu düşünülebilir. ...
Aim: The main purpose of this study was to compare the attitudes toward obese persons scale (ATOP) scores of the students in Physical Education and Sports School (PES) in terms of classes and some variables.
Material and Methods: Causal comparative research method was used in this study. The study was performed 330 students (age:22.33±2.31) (117 female/213 male). In order to determine the attitudes toward obese persons ATOP scale developed by Alison et al (1991) and validated for Turkish population (T-ATOP) by Dedeli et al (2014) was used.
Results: ANOVA test indicated that the T-ATOP scores of the classes showed significant differences, F(3, 326)=6.51, p<0.05. Consequently, T-ATOP scores of 4. class students was significantly higher than the other classes. The main significant result of this study was that as the classes get higher, the attitude towards overweight and obese people changed positively.
Conclusion: It can be considered that the students of PES have positive attitudes towards overweight and obese persons by being informed about the mechanism of obesity through their courses which directly or indirectly related to obesity during their undergraduate education. In addition to this courses, it can be thought that in the last year of undergraduate education, such as the practice of collective service application, internship, coaching practice, it is possible to create a chance to practice the theoretical knowledge practically, which may lead to students becoming more understanding of overweight obese persons they meet and to explain the sudden change of attitude in the positive direction.
Key words: Physical education and sports,Attitudes toward obese persons,University students, Bias.
... Even as average weights continue to rise in the U.S., anti-fat norms and weight-related stigma seem to be both spreading and strengthening. 1 Anthropological analysis suggests this is because of the high cultural value placed on individual effort, responsibility, and work, with a slim body seen as reflecting that success. 2 This set of beliefs breeds weight-related stigma, producing strong moral associations between being "fat" and being lazy, unmotivated, and greedy. 3 Experiencing this stigma does not seem to encourage successful weight loss. Rather, a range of studies show that feeling stigmatized (i.e., feeling judged, mistreated, or excluded) because of body weight tends to exert negative effects on successful weight loss behaviors, discouraging exercise, and encouraging disordered eating. ...
College populations are groups of emerging adults undergoing significant transitions in eating and diet, being exposed to new social influences; many experience weight gain. Theoretically, college campuses should be places where weight stigma is evident and matters for dietary decision-making. We present the findings from two studies conducted within the same college population at a large public university, including anthropometric measures of body mass. Study 1 included two different measures of weight stigma (implicit and explicit) and measures of weight-control eating behaviors and fruit and vegetable consumption in a randomized representative sample of 204 students. Study 2 included a measure of weight responsibility and multiple measures of eating (food frequency, alcohol intake, and 24-hour dietary recalls), among freshman students (n=202, n=157 with 24-hour dietary recalls). Study 1 showed that the three types of stigmas were prevalent. Study 2 had a high prevalence of weight stigma attitudes and demonstrated the occurrence of unhealthful eating and binge drinking behaviors. Both studies found no relationship between weight stigma/responsibility and eating behaviors regardless of weight status. Beyond considering limitations of the study design, we propose two possible reasons for college students' relative immunity to the effects of weight stigma. Those with very high levels of stigma could be suppressing stigmatizing attitudes based on what they think others think is acceptable in a liberal college setting, or the chaotic form of “normal” eating in this population hides the effects of weight stigma.
... describe the total costs of obesity in excess of €25 billion (Knoll & Hauner 2008). In addition to costs, obesity causes discrimination in important areas such as work (Baum & Ford 2004, Carr & Friedman 2005, Glass et al. 2010, Judge & Cable 2011, Conley & Glauber 2007), education (Karnehed et al. 2006), marriage market (Mukhopadhyay 2008, Silventoinen et al. 2003, Conley & Glauber 2007) and healthcare (WHO 2016, Puhl & Brownell 2001 Although obesity affects all social groups, research consistently documents socioeconomic disparities in obesity or body mass index (BMI) (Conley & Glauber 2007, Wang & Zhang 2006), defining obesity as one important example of social inequality. Most importantly, the risk of obesity is negatively correlated with an individual's socio-economic status (McLaren 2007). ...
p>The aim is to understand causal effects of gender, socio-economic status, and ageing on body mass index (BMI) of individuals in three industrialized countries which are characterized by different BMI distributions.
Data comes from three large population representative panel surveys in the USA, Switzerland, and Germany including about 65 000 individuals and 254 000 measurements. Individuals report up to eleven times, measured annually (Switzerland) or bi-annually (USA and Germany). We use fixed effects models to interprete causal effects and random effects models to estimate coefficients of time invariant covariates. We find that not working increases BMI in the US and Germany, in women, and in lower educated individuals. A higher income increases BMI in men and in the US. Ageing is the driving force in all countries, in particular in Germany. Women increase their BMI faster than men, and the lower educated faster than those with a higher education. We conclude that the generally more deprived individuals (women, not working, lower educated, people from less affluent countries) suffer from a comparatively stronger BMI increase over their lifetime.</p
... Regarding psychosocial aspects obese individuals experience significant damage which affect multiple aspects of their lives 14 . Because of these many damages, as well as different forms of discrimination, obese people have experienced problems related to depreciation and dissatisfaction with their body image 15,11 . ...
BACKGROUND:
Bariatric surgery helps significantly in weight loss. Little is known whether
the change in body shape and size is enough to meet the expectations created
preoperatively.AIM: To evaluate
the different perceptions of body size and shape before and after bariatric
surgery.METHOD: A
total of 423 patients were evaluated by Nine-figure Outline Scale. Of these,
32% were pre-surgery (PreS), 20% were evaluated between 10 and 12 months after
surgery (PO-1), 13% between 18 and 24 months (PO-2), 15% between 30 and 36 months
(PO-3) and 20% after 42 months of operation (PO-4). Groups were compared using
one-way analysis of variance.RESULTS:
When choosing figures that represented a man and a woman of normal size, no
differences were observed between groups. Regarding the choice of figures representing
the own size, differences were observed between groups PreS and all other groups
(p<0.001), and PreS chosen larger figures. In choosing figures that represented
a size that believed they could achieve, PreS differed from the PO-1, PO-2 and
PO-3 (p <0.001), showing a tendency to choose larger silhouettes after surgery.
When choosing figures that represented a size that would like to have PO-4 differed
from PO-1 and PO-2 (p <0.05), showing that in the PO-4 there was a tendency
to choose larger figures.CONCLUSION:
The body perception seems to comply with own body size, even after weight loss.
As longer postoperative period, the participants were more aware of the real
possibilities of weight loss. There were signs of dissatisfaction with the body
size and shape, mainly in the PO-1 and PO-2, which can lead to frustration and
little use of the benefits of the surgery for health and quality of life.
Introduction
Obesity is an increasingly prevalent public health problem often associated with poorly controlled gastroesophageal reflux disease. Fundoplication has been shown to have limited long-term efficacy in patients with morbid obesity and does not address additional weight-related co-morbidities. Roux-en-Y gastric bypass (RYGB) is the gold standard operation for durable resolution of GERD in patients with obesity, and is also used as a salvage operation for GERD after prior foregut surgery. Surgeons report access to RYGB as surgical treatment for GERD is often limited by RYGB-specific benefit exclusions embedded within insurance policies, but the magnitude and scope of this problem is unknown.
Methods
A 9-item survey evaluating surgeon practice and experience with insurance coverage for RYGB for GERD was developed and piloted by a SAGES Foregut Taskforce working group. This survey was then administered to surgeon members of the SAGES Foregut Taskforce and to surgeons participating in the SAGES Bariatrics and/or Foregut Facebook groups.
Results
187 surgeons completed the survey. 89% reported using the RYGB as an anti-reflux procedure. 44% and 26% used a BMI of 35 kg/m² and 30 kg/m² respectively as cutoff for the RYGB. 89% viewed RYGB as the procedure of choice for GERD after bariatric surgery. 69% reported using RYGB to address recurrent reflux secondary to failed fundoplication. 74% of responders experienced trouble with insurance coverage at least half the time RYGB was offered for GERD, and 8% reported they were never able to get approval for RYGB for GERD indications in their patient populations.
Conclusion
For many patients, GERD and obesity are related diseases that are best addressed with RYGB. However, insurance coverage for RYGB for GERD is often limited by policies which run contrary to evidence-based medicine. Advocacy is critical to improve access to appropriate surgical care for GERD in patients with obesity.
In this chapter, the authors provide an overview of the most prominent social consequences for adults and youth with obesity due to weight bias; summarize recent research on the impact of weight stigma on health, and identify promising avenues for preventing and reducing weight stigma. Through multiple pathways across institutional, interpersonal, and intrapersonal domains, stigma facilitates social and health inequities. The authors highlight two prominent domains in which weight stigma contributes to these disparities among adults with obesity: employment and health care. The anticipation, experience, and internalization of weight discrimination and stigmatization have profound effects on the mental and physical health of adults and youth with obesity. As stigma may occur at institutional, interpersonal, or intrapersonal levels, interventions can also be designed to target stigma at each of these levels.
Introduction. – Despite the high prevalence of depressive symptoms among women being overweight orhaving obesity, the role of stigma and causal attributions in the expression of these symptoms in Frenchwomen has been largely under-explored to date.
Objective. – The aim of this research is to study the role of internalized stigmatization, stigmatizingexperiences and causal attribution in the intensity of depressive symptoms in overweight and obeseFrench women.
Method. – These four variables were measured in 160 French women being overweight or having obesity.
Results. – Our analyses highlight positive correlations between stigmatizing experiences, internalizedstigmatization and depressive symptomatology. It is important to note that stigmatizing experiencesseem to play a more preponderant role than internalized stigmatization in the expression of depressivesymptoms.
Conclusion. – For women with significant depressive symptoms, it appears essential to integrate inter-ventions aimed at reducing their level of stigma. Moreover, from a preventive perspective, it also seemsessential to promote campaigns in France aimed at reducing the stigmatization in this population
Obesity is a medical term that describes a condition in which adipose tissue, a body fat storage depot, increases beyond a healthy level. The risk of developing a chronic disease persists as body fat increases. Some examples of obesity-related chronic diseases are cardiovascular disease, nonalcoholic fatty liver disease, and diabetes mellitus. As the incidence of obesity spreads across a population so does disease burden, health care costs, losses in productivity, and early mortality. The sustainable health of populations requires managing obesity, a known cause of costly chronic conditions. In this chapter, we discuss sustainable ways to mitigate the adverse impact of obesity on community wellbeing, prioritizing a whole systems approach. A whole systems approach considers the multifaceted drivers of obesity and its disease outcomes. We discuss the critical importance of communities and neighborhoods in promoting effective health care systems, providing socially supported obesity control, and mitigation interventions. We open the chapter with a review of obesity and metabolic syndrome, a collection of obesity-related chronic diseases. Next we consider pertinent historical landmarks in obesity and related disease research with an emphasis on current practices and evolving community-level interventions. We then propose community-level strategies that promote physical activity, healthy food environments, and robust community health systems to reduce the prevalence of obesity in a given population. In discussing these community-oriented interventions, we consider the cultural, professional, and/or legislative issues relevant to those practices across locations and disciplines. Lastly, we discuss the future research and practice evidence needed to strengthen sustainable community-level interventions to reduce the incidence of obesity and related chronic diseases.
Background:
Among adults, weight stigma is associated with markers of poor cardiometabolic health. Although weight-based teasing (WBT) is common among youth with high body weight, few studies have examined its associations with cardiometabolic markers. Owing to unique stressors (e.g., parental deployment and frequent moves), military-dependent youth may be at particularly high risk for obesity, WBT, and poor cardiometabolic health. We, therefore, assessed associations between WBT and cardiometabolic health markers among adolescent military dependents presenting for a weight gain prevention trial.
Methods:
Participants underwent fasting phlebotomy; had fasting weight, height, and waist circumference measured; and completed assessments of WBT, anxiety, and loss-of-control eating. Multivariate analysis of covariance, adjusting for relevant covariates including demographics and body composition, was used to examine differences in metabolic syndrome (MetS) components (waist circumference, systolic and diastolic blood pressure, high-density lipoprotein cholesterol, triglycerides, and glucose) between youth reporting WBT and youth reporting no WBT. Bootstrapped models examined whether WBT mediated the relationship between BMIz and MetS components.
Results:
Data from 142 youth (57.7% female; 14.4 ± 1.6 years; 51.2% non-Hispanic White, 20.9% non-Hispanic Black; BMIz: 1.9 ± 0.4) were analyzed. WBT was not significantly associated with any MetS component. Relationships were observed between BMIz and all MetS components (except systolic blood pressure and glucose), although WBT did not significantly mediate these relationships (p's > 0.05).
Conclusions:
This study did not find support for a relationship between WBT and MetS components in adolescent military dependents at risk for adult obesity. Prospective research is needed to determine whether associations between WBT and adverse cardiometabolic outcomes emerge primarily in adulthood.
Everyone has the right to exercise their body, but does everyone have the same opportunity when it comes to exercise apparel? Are women of all shapes and sizes allotted the same shopping and purchasing experiences when it comes to exercise apparel? Are all yoga pants, bras, and tank tops created equal? This chapter aims to explore size inclusiveness in the exercise apparel industry and illuminates a viewpoint that all pants are not in fact created equal.
This chapter provides an overview of the main and most consistently reported psychological factors that play a role in the onset and persistence of obesity. Taking psychological factors into account is crucial, as a pure biomedical model does not explain sufficiently the sizeable individual variability of weight gain, and persistence of abnormal weight. From a biopsychosocial perspective, we focus on eating behaviour, how eating behaviour is affected by psychological factors and consequences of eating behaviour. We discuss the role of emotional and cognitive factors, mood and emotional regulation, stigma and discrimination and personality traits in relation to obesity. Studies show that individuals with obesity have a stronger sensitivity (attentional bias) for, and motivational drive ("wanting") towards foods rich in fat and sugar (palatable food) coupled with deficient impulse control in contexts of anticipated palatable food. Negative mood has been shown to be implicated in obesity and to induce compensatory (excessive) intake of palatable food. It should be noted that negative mood has a bidirectional relation with obesity; obesity has also been shown to result in negative mood. Certainly, adding to this is the fact that obesity is associated with stigma, discrimination, bullying and stereotypical media portrayals. Importantly, it should be emphasized that there is a considerable overlap of the condition of obesity with addiction, both in terms of phenomenology as well as with respect to the brain mechanism that drives maladaptive behaviour. Indeed, it has been suggested that obesity should be characterized a mental disorder. Currently, obesity is not classified as a mental disorder mainly because of the heterogeneity and uncertainty with respect to its etiology. This may be surprising as this is the case with several other included disorders, and the debate continues. At least part of the issue of current suboptimal treatment approaches is a lack of understanding of the key mechanism implicated in obesity. Hence, increased insight into the main psychological mechanisms could assist in future treatment directions.
Individuals with bigger bodies (Body Mass Index > 30) often experience body weight shame, and are at increased risk for mental health vulnerabilities such as depression and anxiety. To date, there have been no studies specifically designed and pilot tested to help with body weight shame for individuals with bigger bodies that do not have a diagnosed clinical condition. The aim of current study is to investigate the initial feasibility of Compassion Focused Therapy (CFT) as a 12‐session group intervention for the reduction in body weight shame for individuals with bigger bodies. The study used a mixed methods repeated measures design, with both quantitative and qualitative measures, to assess the initial feasibility of the CFT group based intervention. Participants (N = 5) attended a 12‐session/2‐hour group CFT program aimed to directly target body weight shame by cultivating compassion. Measurements were conducted at three time points (pre‐, post‐, and three‐month follow‐up intervention). Results indicated that CFT had a positive impact on reducing body weight shame, increasing compassion, and improving health engaging behaviors. Qualitative feedback indicated the importance of the group dynamics to help with the de‐shaming of body appearance for individuals. Results from this feasibility trial are promising and future research using randomized controlled trial methodologies should be conducted to evaluate the effectiveness of CFT as a treatment option for body weight shame for individuals with bigger bodies.
Binge eating disorder (BED) is characterized by recurrent binge eating and marked distress in the absence of inappropriate compensatory behaviors for weight control. BED is prevalent in men and women, is associated with elevated psychosocial and functional impairment, and is associated strongly with obesity and related medical comorbidities. The aim is to provide a brief, state-of-the-art review of the major and recent findings to inform educational and awareness campaigns, stigma reduction interventions, as well as current clinical practice and future research. A narrative approach was used to synthesize emerging literature on the public and healthcare professionals’ knowledge and attitudes toward individuals with BED in comparison to other eating disorders (EDs) or mental illness. A total of 13 articles were reviewed. Nine studies investigated community samples and four studies investigated healthcare professionals. The reviewed literature suggested that BED is perceived by the public as less impairing, less severe, and “easier-to-treat” than other EDs. Attitudes and beliefs reflecting perceived blameworthiness and lack of self-discipline were ascribed to vignettes with BED. Community studies indicated a low level of public awareness that BED constitutes a discreet eating disorder. The literature on healthcare professionals’ knowledge and attitudes toward BED remains very limited. The few existing studies suggest encouraging trends in recognition and diagnostic accuracy, yet there remains a need for increased clinical awareness of BED-associated medical complications and knowledge of full BED diagnostic criteria.
Obesity has been recognized as a global epidemic by WHO, followed by many empirical evidences to prove its infectiousness. However, the inter-person spreading dynamics of obesity are seldom studied. A distinguishing feature of the obesity epidemic is that it is driven by a social contagion process which cannot be perfectly described by the infectious disease models. In this paper, we propose a novel belief decision model based on the famous Dempster-Shafer theory of evidence to model obesity epidemic as the competing spread of two obesity-related behaviors: physical inactivity and physical activity. The transition of health states is described by an SIS model. Results reveal the existence of obesity epidemic threshold, above which obesity is quickly eradicated. When increasing the fading level of information spread, enlarging the clustering of initial obese seeds, or introducing small-world characteristics into the network topology, the threshold is easily met. Social discrimination against the obese people plays completely different roles in two cases: on one hand, when obesity cannot be eradicated, social discrimination can reduce the number of obese people; on the other hand, when obesity is eradicable, social discrimination may instead cause it breaking out.
Objetivos: Verificar la capacidad de reproducibilidad de una escala que valora la actitud a la obesidad y desarrollar estándares de percentil para jóvenes universitarios de la región del Maule (Chile).
Material y Métodos: Se efectuó una encuesta en 918 jóvenes universitarios (535 hombres y 383 mujeres) de la región del Maule (Chile). Se evaluó el peso y la estatura. Se calculó el Índice de Masa Corporal (IMC) y se aplicó una escala de actitud a la obesidad. Se utilizó el método LMS para desarrollar las curvas de percentil.
Resultados: La escala de actitud a la obesidad (EAO) mostró valores aceptables de Alfa de Cronbach (hombres 0,70) y mujeres 0,73). Las referencias de percentil fueron distribuidas en P15, P50 y P85 que permiten valorar por indicador (Preferencia/Rechazo, Preocupación/Desinterés y Voluntad/Apatía), rango de edad y sexo.
Conclusiones: La escala de actitud a la obesidad es un instrumento confiable y las referencias de percentiles propuestas son una alternativa para diagnosticar, controlar y monitorizar la actitud a la obesidad de jóvenes universitarios.
Objectives
This study explored weight bias amongst Australian Accredited Practising Dietitians (APDs) and the effect of client weight status on dietetic practice.
Methods
Participants were 201 APDs, recruited using purposive sampling. A self‐administered questionnaire, the fat phobia scale (FPS), was completed to assess explicit weight bias. Participants were then randomized to receive either a female within the healthy weight range or female with obesity, accompanied by an identical case study for a condition unrelated to weight. Participants assessed the client based on data provided, provided recommendations and rated their perception of the client.
Results
Mean FPS scores indicated mild fat phobia. However, dietetic practice was significantly affected by the client's weight status. Dietitians presented with the female with obesity assessed the client to have significantly lower health and were more likely to provide unsolicited weight management recommendations. In addition, dietitians rated the client as less receptive, less motivated and as having a lower ability to understand and sustain recommendations.
Conclusions
The contribution of this study is the exploration of how weight status may impact dietetic practice including assessment, recommendations and perceptions of the client. Dietitians may practice in a manner that represents or could be perceived as negative implicit weight bias, despite the explicit FPS assessing only mild fat phobia. Further research to understand the extent of the problem and how it impacts client outcomes and to test possible solutions is required.
Pregnancy and childbirth are associated with dramatic shifts in body shape
and size. For many women, these changes are perceived negatively, resulting
in body dissatisfaction, or a negative body image, despite being at a stage of
life when social pressures for slimness might be expected to be relaxed. From
examining the literature, it appears that poor body image during pregnancy
is a growing issue. Emerging evidence suggests that social media use may
increase the risk of poor wellbeing among pregant women
Purpose:
To explore the psychological impact of weight labels.
Design:
A double-blind experiment that randomly informed participants that they were "normal weight" or "overweight."
Setting:
Public university in Honolulu, Hawai'i.
Participants:
Normal-weight and overweight female undergraduates (N = 113).
Measures:
The Body Image States Scale, Stunkard Rating Scale, Weight Bias Internalization Scale, Positive and Negative Affect Schedule, General Health question from the 12-item Short Form Health Survey, modified version of the Weight Loss Methods Scale, and a manipulation check.
Analysis:
A 2 × 2 between-subjects analysis of variance explored the main effects of the assigned weight label and actual weight and interactions between assigned weight label and actual weight.
Results:
Significant main effects of the assigned weight label emerged on measures of body dissatisfaction, F(1, 109) = 12.40, p = .001, [Formula: see text] = 0.10, internalized weight stigma, F(1, 108) = 4.35, p = .039, [Formula: see text] = .04, and negative affect, F(1, 108) = 9.22, p = .003, [Formula: see text] = .08. Significant assigned weight label × actual weight interactions were found on measures of perceived body image, F(1, 109) = 6.29, p = .014, [Formula: see text] = .06, and perceived health, F(1, 109) = 4.18, p = .043, [Formula: see text] = .04.
Conclusion:
A weight label of "overweight" may have negative psychological consequences, particularly for overweight women.
Background
Chronic illness is a risk factor for low self-esteem, and the research literature needs to include more studies of self-esteem and its development in chronic illness groups using longitudinal and comparative designs. The aim of this study was to explore the trajectories of self-esteem and of positive and negative affect in persons with morbid obesity and in persons with chronic obstructive pulmonary disease (COPD).
Methods
Patient education course attendants in Norway having morbid obesity (n=139) or COPD (n=97) participated in the study. Data concerning self-esteem, positive and negative affect, and sociodemographic background were collected at the start and at the end of the patient education, with subsequent follow-ups at 3, 6, and 12 months. Data were analyzed using linear mixed models for repeated measures.
Results
Taking all measurements into account, our data revealed a statistically significant increase in self-esteem for participants with morbid obesity but not for those with COPD. There were no significant differences in levels of negative and positive affect between the two groups, and the time-trajectories were also similar. However, participants in both groups achieved lower levels of negative affect for all the successive measurement points.
Conclusion
An increase in self-esteem during the first year after the patient education course was observed for persons with morbid obesity, but not for persons with COPD. Initial higher levels of self-esteem in the participants with COPD may indicate that they are less troubled with low self-esteem than people with morbid obesity are. The pattern of reduced negative affect for both groups during follow-up is promising.
The stigma associated with obesity is likely to limit the opportunities obese women have to develop social skills. This hypothesis was tested by having obese (n = 15) and nonobese (n = 22) women converse on the telephone with college students who were unaware of the women's weights. Ratings made by judges who listened to the women's contributions to the conversations but who were unaware of their weights showed that obesity was negatively related to judgments about the women's likability, social skills, and physical attractiveness. The telephone partners of obese women rated the women and themselves more negatively than did the partners of nonobese women. Obese and nonobese women generally did not differ in their evaluations of their own and their telephone partners' behavior, and they also did not differ on a measure of social self-esteem. These findings suggest that there are real differences in the social behavior of obese and nonobese women and that these differences affect the impressions formed by those with whom they interact.
A puppet program for elementary school children was implemented through early childhood education to promote size acceptance. School children (N = 152) completed an evaluation of the program and 45 fifth grade girls completed the Figure Rating Scale either before or after the program. To students, the program's most important message was “not to tease others” and “be a good friend.” Figure Rating Scale data suggest that the program reduces negative stereotypes about large body shapes. This preliminary report suggests that the puppet program achieves its goal of promoting greater acceptance of diverse body shapes by discouraging teasing and encourag-ing students to treat everybody well.