Typical-Atypical Interactions: One Patient’s Experience of Weight Bias in an Inpatient Eating Disorder Treatment Setting

Abstract

This article examines one patient’s experiences with weigh bias in an inpatient eating disorder treatment setting with a focus on interactions between the patient and her primary therapist. These therapeutic interactions had multiple unintended consequences, including bolstering feelings of denial, modeling of disordered behaviors, and disrupting the therapeutic alliance. Additional instances of weight bias with other treatment professionals, including an inpatient nutritionist and psychiatrist, are briefly discussed. The article ends with several brief recommendations for how clinicians can more skillfully approach issues of weight and size in the therapeutic alliance in order to resist size-related oppressions rather than reinforce them.     

A daily diary study of internalised weight bias and its psychological,eating and exercise correlates

Objective: The current investigation extends ecological momentary assessment (EMA) and daily diary weight stigma research in internalised weight bias (IWB). This investigation used daily diaries to examine the relationship between IWB, mood, coping, body appreciation, exercise behaviours and eating behaviours. Design: The study sample consisted of individuals who were overweight or obese (85% female) with M_BMI?=?36.0, SD_BMI?=?6.2. Participants completed a daily diary each evening and wore a Fitbit for 30 days. Main Outcome Measures: Participants reported on IWB, mood, coping, body appreciation, exercise behaviours and eating behaviours.

Results: Both within- and between-subjects IWB were significantly related to positive affect, negative affect, several coping responses, body appreciation, eating behaviours and the urge to avoid exercise. Exploratory analyses indicated that positive and negative affect mediated many of the associations between IWB and coping responses, body appreciation, and eating and exercise behaviours.

Conclusion: This investigation provides evidence that IWB experiences have daily impacts on psychological well-being, body appreciation, coping, eating and exercise behaviours. Also, this study raises awareness about IWB and its potential impact on psychological well-being and health behaviours.     

Why is it so hard to change? The role of self-integrity threat and affirmation in weight loss

People are frequently dissatisfied with their body weight. Messages alleging that lower weight is esthetically preferable, healthier, and achievable likely trigger chronic self-integrity threat, the sense that one's personal adequacy is in doubt. We examined whether self-integrity threat, which creates stress and pressure to restore self-integrity, contributes to the challenges of weight and behavior change. Weight-dissatisfied women completed in-lab tasks including a values affirmation manipulation and two-month follow-up. Affirmed women lost weight relative to controls, replicating previous research. Effects were primarily among those with higher initial body masses. Affirmed higher-weighted women also ate more healthful foods compared to unhealthful foods in self-reports and observation. Affirmed participants reported increased exercise, and an exploratory measure showed that their cortisol awakening responses synchronized with their coping needs, suggesting more adaptive physiological function. Results suggest that self-integrity threat is an under-recognized barrier to change, and reducing it can support healthy changes.     

Children's judgements and emotions about social exclusion based on weight

This study examined children's judgements and emotions associated with weight‐based social exclusion using an ethnically diverse sample of one hundred and seventeen 9‐ and 13‐year‐old children. Children were interviewed about three scenarios depicting weight‐based exclusion in athletic, academic, and social contexts. Children's judgements of exclusion, emotions attributed to the excluder and excluded targets, and justifications for judgements and emotions were examined. Overall, children judged weight‐based exclusion to be wrong for moral reasons. However, they viewed weight‐based exclusion in athletic contexts as less wrong compared with academic contexts, and they used more social‐conventional reasoning to justify judgements and emotions attributed to excluders in athletic contexts compared with academic and social contexts. Children also expected excluded targets to feel negative emotions, whereas a range of positive and negative emotions was attributed to excluders. In addition, older children were more accepting of weight‐based exclusion in athletic contexts than in academic and social contexts. We discuss the results in relation to the development of children's understanding of, and emotions associated with, exclusion based on weight.     

Making Space for Every Body: Ending Sizeism in Psychotherapy and Training

Abstract

The importance of addressing weight bias as a social justice issue in psychotherapy and psychology education and training is introduced. The history of the development of fat studies is briefly reviewed. Current coverage of size and sizeism in psychology is critically examined and contrasted with the increasing adoption of the medical model of “obesity.” Fat shaming in the practice of mental health professionals is examined as a barrier to clients’ physical and mental health. Alternatives to medicalized weight management and fat shaming are introduced. Models that emphasize size acceptance and resist negative embodiment are encouraged. The potential for a future that makes space for every body is assessed.     

道德的轻与重：道德的重量具身效应及隐喻的调节作用

本研究采用行为反应时和事件相关电位(ERP)探讨道德的重量具身效应及“重量-道德”隐喻联结对该效应的调节作用。参考内隐联想测验的逻辑，采用联合分类反应任务，在默认的“重量-道德”隐喻表征情境（实验1）和道德垂直空间隐喻的启动情境（实验2）中，要求被试分别使用轻鼠标和重鼠标对道德/不道德词进行分类判断，考察鼠标重量对道德概念的加工所产生的影响。结果显示，在默认情境中，“重-道德，轻-不道德”的联合分类条件比“轻-道德，重-不道德”条件的分类反应时更短，并伴随有更大的脑电晚期正成分（LPC），而在启动道德垂直空间隐喻后，两种联合分类条件下的反应时和LPC结果出现反转。本研究结果表明道德概念的加工会受到重量经验的影响，“重量-道德”具身效应具有心理现实性，且重量概念与道德概念的隐喻联结引导并调节了这种具身效应。