Effects of perceived weight discrimination on willingness to adopt unhealthy behaviours: influence of genomic information

Objective: Weight-based discrimination negatively influences health, potentially via increased willingness to engage in unhealthful behaviours. This study examines whether the provision of genomic obesity information in a clinical context can lead to less willingness to engage in unhealthy eating and alcohol consumption through a mediated process including reduced perceptions of blame and discrimination.

Design: A total of 201 overweight or obese women aged 20–50 interacted with a virtual physician in a simulated clinical primary care environment, which included physician-delivered information that emphasised either genomic or behavioural underpinnings of weight and weight loss.

Main Outcome Measures: Perceived blame and weight discrimination from the doctor, and willingness to eat unhealthy foods and consume alcohol.

Results: Controlling for BMI and race, participants who received genomic information perceived less blame from the doctor than participants who received behavioural information. In a serial multiple mediation model, reduced perceived blame was associated with less perceived discrimination, and in turn, lower willingness to eat unhealthy foods and drink alcohol.

Conclusion: Providing patients with genomic information about weight and weight loss may positively influence interpersonal dynamics between patients and providers by reducing perceived blame and perceived discrimination. These improved dynamics, in turn, positively influence health cognitions.     

Recognizing the Fundamental Right to be Fat: A Weight-Inclusive Approach to Size Acceptance and Healing From Sizeism

Abstract

Sizeism permeates and shapes how scientific and professional communities—including therapists—perceive, understand, and behave toward anyone considered fat. In this article, we use scientific evidence to argue for the recognition and establishment of fat acceptance to subvert sizeism. We first critically review the Weight Normative Approach, which dominates scientific discourse on weight, despite being based on sizeist assumptions that are discredited by data. We then articulate the tenets of the Weight Inclusive Approach, which honors size diversity and the promotion of wellness within a social justice framework. We end with strategies for therapists to align their practice with the Weight Inclusive Approach.     

Long‐term Self‐monitoring of Weight: A Case Study

The aim of this study was to examine the self‐monitoring of weight on a daily basis over a long period of time in order to understand the process of weight regain. An obese female client measured her weight every morning over a period of 10 years. The subject made a total of 2081 weight measurements. Thus, her weight was measured on 67% of all possible days. After the initial weight loss a pattern of gradual weight gain was observed. The subject gained weight during August and September, and at the end of December, in particular. Furthermore, her weight increased slightly at the weekends. This case study highlights the advantage of self‐monitoring of weight on a daily basis. Individual patterns of weight change possibly associated with season and weekly variation may be crucial when obese subjects try to maintain their weight after weight loss. However, it may take several months or even years to detect the weekly and yearly rhythms or other patterns in the data. Thus, self‐control of weight is problematic, since patterns in the weight regain process are difficult to detect. This may be one reason why self‐control of weight is so difficult.     

Beyond personal responsibility: Effects of causal attributions for overweight and obesity on weight-related beliefs,stigma, and policy support

Objective: The objective of this research was to compare the effects of different causal attributions for overweight and obesity, among individuals with overweight and obesity, on weight-related beliefs, stigmatising attitudes and policy support.

Design: In Study 1, an online sample of 95 US adults rated the extent to which they believed various factors caused their own weight status. In Study 2, 125 US adults read one of three randomly assigned online passages attributing obesity to personal responsibility, biology, or the ‘food environment.’ All participants in both studies were overweight or obese.

Main outcome measures: All participants reported beliefs about weight loss, weight-stigmatising attitudes, and support for obesity-related policies.

Results: In Study 1, biological attributions were associated with low weight-malleability beliefs and blame, high policy support, but high internalised weight bias. ‘Food environment’ attributions were not associated with any outcomes, while ‘personal responsibility’ attributions were associated with high prejudice and blame. In Study 2, participants who received information about the food environment reported greater support for food-related policies and greater self-efficacy to lose weight.

Conclusion: Emphasising the role of the food environment in causing obesity may promote food policy support and health behaviours without imposing the negative consequences associated with other attributions.     

Weight Bias Internalization and Psychosocial,Physical, and Behavioral Health: A Meta-Analysis of Cross-Sectional and Prospective Associations

Coinciding with widespread efforts to address obesity, weight bias internalization (a process of self-devaluation wherein individuals apply weight-biased stereotypes to themselves) has gained increased attention as a robust correlate of poor health outcomes. The present meta-analysis aimed to provide the largest quantitative synthesis of associations between weight bias internalization and health-related correlates. Studies that provided zero-order correlations for cross-sectional or prospective associations between weight bias internalization and physical, psychosocial, and behavioral health correlates were included in the meta-analysis. Meta-regression determined whether these associations differed based on demographic (sex/gender, race, age), anthropometric (body mass index), and study-level (publication status, sample type, study quality) moderators. Data for 149 (sub)samples were identified that included between 14 and 18,766 participants (M sample size = 534.96, SD = 1,914.43; M age = 34.73, SD = 12.61, range = 9.95–65.70). Results indicated that greater weight bias internalization was concurrently associated with worse psychosocial (e.g., negative and positive mental health, social functioning), physical (e.g., BMI, weight maintenance, health-related quality of life [HRQoL]), and behavioral health (e.g., disordered eating behaviors, healthy eating, physical activity) across most constructs, with effects ranging from small to very large in magnitude. Preliminary evidence also suggested that greater weight bias internalization was subsequently associated with less weight loss and increased negative mental health. Notable variations in the nature and magnitude of these associations were identified based on the health-related correlate and moderator under consideration. These findings indicate that weight bias internalization is linked to multiple adverse health-related outcomes and provide insight into priorities for future research, theory building, and interventions in this area.     

Negotiating control: Patients’ experiences of unsuccessful weight-loss surgery

Interviews were carried out with 10 men and women who had undergone weight-loss surgery (WLS) up to 10 years ago and felt that it had failed. Seven had had a further successful procedure. Data were analysed using Interpretative Phenomenological Analysis. Weight regain following surgery was explained in terms of either the mechanics of the operation or with participants describing ways to ‘cheat’ as food continued to be used for emotional regulation. Everyone spoke of how surgery neglected their mind. Following the second successful surgery, participants described changes in both their eating behaviour and cognitions emphasising how their mind had been brought ‘in gear’ through the investment of two invasive procedures. Transcending all accounts was the mind/body relationship and the issue of control with attributions for both failed and successful surgery shifting from the self to the surgical mechanism as the participants negotiated the pathway between self-blame and responsibility and utilised conflicting frameworks in which the mind and body were either divided or united. Whereas failed surgery is characterised by a battle for control, successful surgery involves handing control over to their restricted stomachs or considering WLS as a tool to be worked with.     

AN INDEX FOR ASSESSING WEIGHT CHANGE IN CHILDREN: WEIGHT/HEIGHT RATIOS1

Weight and height data from two studies were recomputed, and original data were computed using a Weight Index formula that accounts for the interaction of actual weight/height changes in growing children and compares this ratio with that of normed weight/height ratios for equal-aged children. Recomputing the data of one study showed that the Weight Index is a more sensitive procedure for assessing long-term behavioral treatment of obesity for girls than weight alone. Recomputing the data of a second study showed that the Weight Index formula is consistent for boys and girls and is a more sensitive procedure for assessing long-term effects of a variety of medical treatments for obesity than the Ponderal Index or weight alone. Computation of the data for 17 “normal” children in a preschool class showed a zero Weight Index score before and after a six-month interval elapsed without treatment. The procedure may be useful in assessing ponderosity or anorexia over intervals of six months or more with growing children or difference between actual and normed weight over shorter intervals.     

Treatment of overweight children: The relationship between dependent measures and a clinically significant outcome

Behavioral treatments for overweight children have not fared well in achieving or maintaining clinically significant weight losses. The use of more appropriate dependent measures which also take height, sex, and age into consideration is suggested. A multiple-baseline analysis of the behavioral treatment of seven overweight children was conducted. Results support the contention that a more clinically significant outcome emerges when appropriate measures are used.     

Eating Behavior—Choice or Reconstruction of Past Experience? A Randomized Clinical Trial of Changing Eating Intentions of Healthy Adults Through Hypnotic Suggestions

Recent meta-analyses have shown that psychological interventions have a small to medium effect on weight loss. We propose here a different approach to changing eating intentions. According to the Free Will literature, people decide to act before they acknowledge it, and they decide based on the reconstruction of previous experiences. The action can thus be inhibited immediately (max 100 ms) after awareness. We wanted to test if intervention based on this model, using hypnotic suggestions, can effectively change the intentions of eating. This study aims to identify which format of hypnotic suggestion can be more effective in changing eating intentions regarding high-calorie foods. Therefore, 88 healthy adult participants randomized in four groups received one session of hypnotic induction and suggestions or placebo. We measured the eating intentions through a computer task in which participants could choose pictures of low and high caloric food before, during, and after hypnosis. For the within-subject effect, results showed that two types of hypnotic suggestions significantly impacted the intentions of eating on high-calorie foods with large-effect, namely Cognitive Rehearsal (d = 0.81, p < .001) and Memory Substitution (d = 0.82, p < .001). After controlling for pretest ratings, we found a significant between-effect: the Cognitive Rehearsal group differed significantly from the Control in terms of intentions of eating (d = 0.85, p < .05). We conclude that hypnosis with Cognitive Rehearsal suggestions can help to positively impact the intentions of eating.     

The Effects of Object Weight on the Kinematics of Prehension

The purpose of these experiments was to determine the effects of object weight and condition of weight presentation on the kinematics of human prehension. Subjects performed reaching and grasping movements to metal dowels whose visible characteristics were similar but whose weight varied (20, 55, 150, 410 g). Movements were performed under two conditions of weight presentation, random (weight unknown) and blocked (weight known). Three-dimensional movements of the thumb, index finger, and wrist were recorded, using a WATSMART system to obtain information regarding the grasp and transport components. The results of the first experiment indicated that object weight and condition of presentation affected the temporal and kinematic measures for both the grasp and transport components. In conjunction with the results of a second experiment, in which time in contact with the dowel was measured, it was shown that the free-motion phase of prehension (i.e., up to object contact) was invariant over the different conditions, however. The changes were observed in the finger-object interaction phase (when subjects applied forces after contact with the dowel), prior to lift-off. These results were interpreted as indicating (a) object weight does not influence the planning and execution of the free-motion phase of prehension and (b) there are at least two motor control phases involved in prehension, one for making contact with the object and the other for finger-object interaction. The changing contributions of visual, kinesthetic, and haptic information during these two phases is discussed.     

Step-down approach to behavioural weight loss treatment: a pilot of a randomised clinical trial

Background: In a stepped-down approach, patients begin with a more intensive treatment and are stepped down to a less intensive treatment based on achieving treatment goals. This study compared a standard behavioural weight loss programme (BWLP) to a stepped-down approach to treatment.

Methods: Fifty-two overweight/obese adults (Age: M?=?47?years, SD?=?13.5; female?=?67%) participated in an 18-week BWLP. Half of them were randomly assigned to be stepped down from weekly group meetings based on completion of weight loss goals (3%) every 6?weeks, while the other half remained in their groups regardless of weight loss.

Results: There was a significant difference favouring the BWLP in the proportion of participants who met or exceeded their 3% weight loss goal during the first six weeks. While not statistically significant by the end of treatment, the BWLP participants lost nearly 3% more body weight than stepped-down participants (SC?=?4.9% vs. BWLP?=?7.8%; p?=?.10). Greater self-monitoring was associated with increased likelihood of stepped-care eligibility and higher percent weight loss at the end of treatment (p?<?.01).

Conclusion: There was little evidence to support the efficacy of the stepped-down approach for behavioural weight loss treatment employed in this investigation.     

Body image and body change strategies among adolescent males and females from Fiji, Tonga and Australia

The current study was designed to investigate the body image and body change strategies of adolescents from Fiji, Tonga and Australia. Participants were 628 Fijians, 463 Indo-Fijians, 598 Tongans and 535 European Australians. Adolescents completed measures of height, weight, body dissatisfaction, strategies to lose weight, increase weight and increase muscles. The results demonstrated that overweight adolescents were more dissatisfied with their bodies than those who were normal weight. Overweight Fijians and Tongans were more satisfied with their body than Indo-Fijian or Australian adolescents. Tongans, followed by Fijians and Indo-Fijians, were more likely to engage in strategies to lose weight, increase weight and increase muscles. These results are consistent with the focus in Fiji and Tonga on the value of the large body ideal, but may also reflect the recent focus on the attainment of a healthy body size.     

‘He's got his father's bias’: Parental influence on weight bias in young children

Our aim was to explore the role of parents in the transmission of stereotypical body size attitudes and awareness of weight loss strategies to preschool children. Participants were 279 3‐year‐old children and their parents, who provided data at baseline and 1 year later. Parents completed self‐report body size attitude and dieting measures. Child weight bias and awareness of weight loss strategies were assessed through interview. Over time, negative associations with large bodies and awareness of weight loss strategies increased. Fathers’ attitudes prospectively predicted boys’ weight bias and awareness of weight loss strategies. Among girls, parental attitudes were less predictive. Findings confirm the importance of fathers in the development of boys’ body attitudes and inform prevention programmes.     

Lean and mean rats: Some effects of acute changes in the food supply upon territorial aggression

In experiment 1, individually housed rats subjected to short-term food restriction displayed more territorial aggression toward conspecific intruders than controls maintained on a free-feeding diet. In experiment 2, small groups of three adult male rats had access to either a standard laboratory diet or the standard diet plus sucrose. Groups with the sucrose supplement were significantly less aggressive toward intruders than controls. Sucrose availability did not produce appreciable gains in body weight but it did reliably decrease within-colony weight variation. The results suggest the existence of an effective dietary mechanism that enables a social species such as Rattus norvegicus to tolerate each other in dense feeding aggregations when food is abundant. Conversely, when food is limited, social intolerance increases and serves to limit the development of large feeding groups.     

‘Damned one way or another’: Bariatric surgeons’ reflections on patients’ suboptimal outcomes from weight loss surgery

Objective: A minority of patients show sub-optimal outcomes after weight loss surgery. Research has identified predictors of poor outcomes focusing on the patients’ perspective. No research has explored surgeons’ accounts. Design: Ten Bariatric surgeons were interviewed using a critical incident approach to explore their explanations for sub-optimal outcomes in the context of a real-life case. Data were analysed using thematic analysis. Results: Three main themes were developed: ‘Challenges to success’ highlighting the role of psychosocial issues, poor adherence and patient non-disclosure; ‘Ideal world solutions’ describing who should identify and address psychosocial issues; and ‘Real world compromise’ reflecting the impact of limited resources and weighing up risk between carrying out versus not carrying out surgery. Transcending these themes was the notion of ‘responsibility’ with surgeons balancing the role of the patient, themselves and the health care system. Conclusion: Some surgeons concluded that if they had known before surgery what they know now, they may not have operated. All emphasised that they could only know what was disclosed by the patient, that they were not convinced that not operating would have resulted in better outcomes in the longer term and many felt that they were ‘damned one way or the other’.     

正常体重代谢性肥胖研究进展

肥胖症现正日益成为一种严重威胁人类健康的流行病。即使在正常体重人群中,也存在一部分人,表现与肥胖者相似的代谢异常,如高血糖、血脂异常、高血压等,并与糖尿病、心血管疾病的发生有密切关系,其发生机制可能与游离脂肪酸、多种脂肪因子有关。早期诊断和治疗这一人群,对预防多种代谢相关疾病将具有重要的意义。     

Development and validation of the Eating Behavior Inventory

The Eating Behavior Inventory (EBI) is a self-report instrument for assessing behaviors that have been theoretically implicated in weight loss, e.g., self-monitoring of food intake and of weight, refusing offers of food, eating at only one place, shopping from a list, eating in response to emotions. Thirty items were constructed in the form of first-person statements, e.g., I eat in the middle of the night. Each item was to be rated with a 5-point scale according to how often it was true for the respondent. Items were scored such that higher scores always reflected more appropriate (theoretically facilitative of weight control) eating patterns. Validity of individual items and total score was assessed in four studies. Twenty-six of the original items appeared valid and were retained. The resulting total score demonstrated validity in these studies and in two cross-validational comparisons. Internal consistency as measured by split-half reliability and correlations of item scores with total score was acceptable. One month test-retest reliability of item and total scores was satisfactory. Clinical and research applications of the EBI are discussed.An early version of this article was presented at the Taos International Conference on Treatment of Addictive Behaviors, Taos, New Mexico, February 1979.     

焦虑对重量感知判断的影响

行动经济理论认为个体对物理环境的感知与其具备的资源有关,而焦虑与资源不足有关。基于此,本研究通过3个实验来探讨3种不同性质的焦虑对重量感知判断的影响。实验1通过身体姿势诱发焦虑,结果发现同放松的身体姿势相比,焦虑的身体姿势能诱发出焦虑且此姿势下个体会认为背包的重量更重。实验2通过具有压力性的外部任务诱发焦虑,结果显示同奇偶判断任务相比,心算任务能诱发出明显的焦虑且此任务下个体将背包的重量判断为更重。实验3探讨特质焦虑的影响,结果发现高特质焦虑个体同低特质焦虑者相比会认为背包的重量更重。本研究表明焦虑会影响个体对物体物理属性的感知。