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The stigma of type 2 diabetes (T2D) has received growing attention in the healthcare setting. However, there has been almost no research examining how healthcare professional biases about diabetes relate to patient care. This cross-sectional study examined how physicians' self-reported biases, stereotypes, and attributions about diabetes and obesity were related to their patient care practices. Methods: Physicians treating T2D, specializing in internal medicine or endocrinology (n=205), completed a battery of online questionnaires. Results: Physicians who attributed poor patient compliance as the primary barrier to provision of diabetes care had worse perceptions of individuals with T2D and were less likely to use person-centered approaches with their patients. Physicians' stigmatizing attitudes about T2D were associated with less use of person-first language, while more positive perceptions of individuals with T2D were associated with greater use of motivational interviewing. Weight-related stigma was associated with less use of person-centered approaches to care and less confidence in their ability to provide care. Conclusions: Findings reiterate the associations between weight stigma and poorer physician communication and suggest that similar patterns occur in the provision of care for individuals with T2D. Physicians who treat T2D may benefit from stigma reduction interventions for both diabetes and weight-related stigmas. • Physicians' stigmatizing attitudes were linked to worse communication practices • Stigmatizing attitudes were associated with less person-centered approaches to care • Stigmatizing attitudes were associated with lower confidence in provision of care • Biased attitudes were associated with more patient-attributed barriers to T2D care • Effective and scalable stigma interventions for healthcare professionals are needed [ABSTRACT FROM AUTHOR]

Weight stigma is a prevalent problem in adolescents and a risk factor for disordered eating behaviors (DEBs). This study examined whether positive family/parenting factors were protective for DEBs among an ethnically/racially and socioeconomically diverse sample of adolescents with and without weight stigmatizing experiences. In Project Eating and Activity over Time (EAT) 2010–2018, 1,568 adolescents (mean age = 14.4 ± 2.0 years) were surveyed and followed into young adulthood (mean age = 22.2 ± 2.0 years). Modified Poisson regression models examined the relationships between three weight-stigmatizing experiences and four DEBs (e.g., overeating and binge eating) in models adjusted for sociodemographic characteristics and weight status. Interaction terms and stratified models examined whether family/parenting factors were protective for DEBs based on weight stigma status. Higher family functioning and support for psychological autonomy were cross sectionally protective for DEBs. However, this pattern was primarily observed in adolescents who did not experience weight stigma. For example, among adolescents who did not experience peer weight teasing, high support for psychological autonomy was associated with lower prevalence of overeating (high support: 7.0%, low support: 12.5%, p =.003). Whereas, in participants who experienced family weight teasing, the difference in prevalence of overeating based on support for psychological autonomy was not statistically significant (high support: 17.9%, low support: 22.4%, p =.260). General positive family and parenting factors did not entirely offset the effects of weight-stigmatizing experiences on DEBs, which may reflect the strength of weight stigma as a risk factor for DEBs. Future research is needed to identify effective strategies family members can use to support youth who experience weight stigma. [ABSTRACT FROM AUTHOR]

Critical weight communication between parents and their adolescent children is prevalent and harmful. However, research on adolescent perspectives about parental weight communication is limited. The present mixed-methods study aimed to address this gap using inductive thematic analysis of 1743 adolescents' (M age =14.61 years, SD age =2.48) preferences regarding parental weight communication in response to an open-ended prompt, and quantitative analyses to examine age, gender, race/ethnicity, and weight-related differences in subthemes. In their responses, adolescents articulated 1) whether and 2) how parental weight communication should—or should not—occur, and 3) what these conversations should entail. We identified 15 subthemes across these categories—the endorsement of which often varied by adolescents' demographic and anthropometric characteristics. For example, some adolescents (especially cisgender girls and transgender/gender diverse adolescents) preferred that their parents talk about weight less often (n = 184), while others (especially multiracial/ethnic or Hispanic/Latinx adolescents) hoped that, if parents were to discuss weight with them, they do so in a manner that was compassionate and respectful (n = 150). Across most subthemes, adolescents described adverse responses (e.g., feeling insecure, embarrassed, or hurt) when parents discussed their weight in non-preferred ways. Collectively, findings can inform interventions to promote more supportive health-focused communication in families. • We identified 15 preferences teens have for weight conversations with parents. • Preferences varied depending on teens' age, race/ethnicity, gender, body weight. • When parents discuss weight in non-preferred ways, it has negative consequences. [ABSTRACT FROM AUTHOR]

After bariatric surgery, some patients experience adverse psychiatric outcomes, including substance use, suicidality, and self-harm. These factors are commonly associated with posttraumatic stress disorder (PTSD) and related symptoms (PTSD-S) that develop following adverse childhood experiences (ACEs) and traumatic events. However, emerging evidence suggests that chronic discrimination also may contribute to PTSD-S. Weight-based discrimination is salient for people with obesity but has received little attention in relation to PTSD-S. Our study examined factors that may contribute to the link between experienced weight stigma (WS), which is common in individuals seeking bariatric surgery, and PTSD-S. Teaching hospital and surgical weight loss center in the United States. A total of 217 participants completed self-report surveys of experienced and internalized WS, ACEs, and PTSD-S. Demographics and trauma history were obtained from patient medical records. A stepwise multiple regression examined associations between experienced WS and internalized WS with PTSD-S, co-varying demographics, ACEs, and trauma, followed by examination of whether findings held co-varying anxiety/depressive symptoms in a participant subset (n = 189). After accounting for covariates in step 1 and ACEs and trauma in step 2 (Δ R 2 =.14) , experienced WS and internalized WS accounted for substantial PTSD-S variance in steps 2 and 3 (Δ R 2 =.12 and.13, respectively; overall model R 2 =.44; P <.001). Findings held after co-varying anxiety/depressive symptoms. Over and above ACEs and trauma, e xperienced WS and internalized WS may contribute to PTSD-S. Longitudinal research is needed to better elucidate the pathways underlying these associations. • Experienced weight stigma accounts for PTSD symptom (PTSD-S) variance • Internalized weight stigma likewise accounts for PTSD-S variance • Findings hold controlling for other traumatic stressors • Both factors account for greater PTSD-S variance than other traumatic stressors [ABSTRACT FROM AUTHOR]

• Weight discrimination remains legal almost everywhere in the world. • Public support is present for policies to target weight bullying and discrimination. • Multidisciplinary collaboration is needed for effective stigma reduction efforts. • Social media platforms can be harnessed to elevate activism on weight stigma. • Social media can be a tool to engage the public and policy makers on weight stigma. Efforts to promote positive body image and body acceptance confront considerable challenges in the face of pervasive societal stigma against people who have a high body weight or large body size. Despite decades of evidence documenting the prevalence and harmful consequences of weight stigma and discrimination, policies to address this social injustice are lacking and primarily absent. This article summarizes the current status of policies to address societal weight-based mistreatment and highlights evidence documenting public support for different types of policies and laws that could be implemented to reduce weight-based bullying and discrimination. While considerable public policy support is present, efforts to scale up activism are needed to help curtail societal weight stigma. Social media has been an underutilized approach that could provide a powerful platform to elevate public awareness and promote policy change to help eliminate weight stigma. [ABSTRACT FROM AUTHOR]

Weight teasing from family members is common during adolescence. However, little is known about parental factors that increase adolescents' risk for family weight teasing and its adverse health sequelae. Using multi-informant data from adolescents, mothers and fathers, the current longitudinal study examined how parental concerns about their child's weight and their own weight contribute to family weight teasing in adolescence and its long-term health consequences. Data were collected in the population-based Project EAT 2010–2018 (Eating and Activity over Time) study, following a longitudinal cohort of young people (N = 2,793). Parental weight concerns for their adolescent and themselves were reported by mothers (N = 2,298) and fathers (N = 1,409) at baseline and examined as a predictor of family weight teasing in adolescence as well as a moderator of family weight teasing effects on health eight years later. Mothers' and fathers' concerns about their child's weight, as well as mothers' dieting frequency, increased the likelihood of adolescents experiencing family weight teasing. Longitudinal analyses revealed that adolescents teased about their weight by family had higher levels of stress (β =.21, 95% confidence interval [CI] =.09–.33) and substance use (β =.16, 95% CI =.04–.28), and lower self-esteem (β = −.16, 95% CI = −.28 to −.05) in young adulthood. Findings highlight parent weight concern, particularly concern for their child's weight, as a risk factor for family weight teasing. These findings underscore the importance of encouraging parental attention to health, rather than weight, in family-based treatment and public health initiatives. [ABSTRACT FROM AUTHOR]

Introduction: Adolescents who identify as a sexual or gender minority are vulnerable to multiple health disparities because of stigma-based peer harassment. Given that sexual and gender minority adolescents may be bullied for several stigmatized identities that may exacerbate health risk, it is important to examine factors that can simultaneously reduce multiple forms of targeted victimization among sexual and gender minority adolescents. This study examines whether variation in health risk across sexual and gender minority adolescents who attend schools with versus without a gay-straight alliance can be explained by lessened bias-based bullying across a broad scope of stigmatized identities and attributes.Methods: Data on school-based gay-straight alliances, bias-based bullying, and health risk indicators were collected from the LGBTQ National Teen Survey (n=17,112; mean age=15.57 [SD=1.27] years) and analyzed in 2019. Multiple mediation analysis was conducted using latent variable structural equation modeling.Results: The majority (73%) of sexual and gender minority adolescents were bullied for stigmatized identities other than those related to their gender or sexual orientation. Compared to schools without a gay-straight alliance, student reports of multiple forms of bias-based bullying (based on body weight, gender, religion, disability, gender typicality, sexual orientation) were lower at schools with gay-straight alliances, which in turn attenuated adverse health outcomes (i.e., stress, sleep problems, depression, and unhealthy weight control behaviors).Conclusions: Sexual and gender minority adolescents experience multiple forms of bias-based bullying, which independently heighten health risk, and this study extends previous work on gay-straight alliances to highlight a wider range of potential positive contributions to adolescent health. [ABSTRACT FROM AUTHOR]

Introduction Obesity is an ongoing public health concern in the U.S. Weight stigma is linked to a number of obesogenic health outcomes, which complicate obesity treatment and prevention. Despite higher rates of obesity in female and minority populations, little research has examined weight stigma in non-white women and men. This study investigated intersectionality in weight stigma and health-related coping responses to stigmatizing experiences across racial groups. Methods In 2015, a total of 2,378 adults completed questionnaires about weight stigma, weight bias internalization, and coping strategies. Analyses were conducted in 2016. Results No differences in weight stigma emerged as a function of race or gender, but women reported higher weight bias internalization ( B =0.19, p =0.004). Further, black men and women reported less weight bias internalization than white men and women ( B =–0.43, p =0.009). Compared with white women, black women were less likely to cope with stigma using disordered eating ( B =–0.57, p =0.001), whereas Hispanic women were more likely to cope with stigma using disordered eating ( B= 0.39, p =0.020). Black men were more likely than white men to cope with stigma via eating ( B =–0.49, p =0.017). Conclusions Findings highlight that weight stigma is equally present across racial groups, but that groups internalize and cope with stigma in different ways, which exacerbate health risks. Increased research and policy attention should address stigma as an obstacle in prevention and treatment for obesity to reduce weight-based inequities in underserved populations. [ABSTRACT FROM AUTHOR]

Weight stigma induces cardiovascular health consequences for people with obesity. How stigma affects cardiovascular reactivity in individuals with both obesity and hypertension is not known. In a randomized experiment, we assessed the influence of two video exposures, depicting either weight stigmatizing (STIGMA) or non-stigmatizing (NEUTRAL) scenes, on cardiovascular reactivity [resting blood pressure (BP), heart rate (HR), ambulatory BP (ABP), and ambulatory HR (AHR)], among women with obesity and high BP (HBP; n =24) or normal BP (NBP; n =25). Systolic ABP reactivity was the primary outcome. Laboratory BP and HR were measured before/during/following the videos, and ABP and AHR were measured over 19 hours (10 awake hours, 9 sleep hours) upon leaving the laboratory. A repeated measures ANCOVA tested differences in BP and HR changes from baseline in the laboratory and over ambulatory conditions between the two groups after each video, controlling for body mass index, baseline BP and HR. Laboratory SBP/DBP increased 5.5 + 7.3/2.4 + 8.8mmHg more in women with HBP than NBP following the STIGMA versus NEUTRAL video (P s<0.05). For the primary outcome, ABP increased more in HBP than NBP over sleep (SBP/DBP=4.2 + 20.6/4.7 + 14.2mmHg; P s<0.05) following the STIGMA versus NEUTRAL video, as did HR during sleep (7.5 + 15.7bpm more in HBP than NBP; P <0.05). Weight stigma increases cardiovascular reactivity among women with obesity and HBP in the laboratory and under ambulatory conditions. Registered at ClinicalTrials.gov (Identifier: NCT04161638). • Weight stigma is linked to increased physiological stress in people with obesity. • Weight stigma increased blood pressure (BP) in women with obesity and high BP. • BP response to weight stigma persisted into the sleep hours. • Initiatives are needed to mitigate stigma-induced cardiovascular health consequences. [ABSTRACT FROM AUTHOR]

Both experiencing and internalizing weight bias are associated with negative mental and physical health outcomes, but internalization may be a more potent predictor of these outcomes. The current study aimed to differentiate between causal effects of experiencing versus internalizing weight bias on emotional responses and psychological well-being. Adults with overweight/obesity ( N = 260) completed an online experiment in which they were randomly assigned to focus on either the experience or internalization of weight bias, and completed measures of affect, self-esteem, and body dissatisfaction. Results indicated that the Internalization condition led to more negative affect, less positive affect, and lower self-esteem than the Experience condition. The Internalization condition also led to heightened body dissatisfaction among men, but not women. These findings suggest that weight bias internalization may be a stronger predictor of poor mental and physical health than experiences alone, and carry implications for developing weight bias interventions. [ABSTRACT FROM AUTHOR]

Highlights: [•] We modify the Weight Bias Internalization Scale for samples of diverse body weights. [•] The modified scale is psychometrically sound. [•] The scale predicts psychopathology across body weight categories. [•] Body dissatisfaction and eating pathology correlate with the modified measure. [•] The scale can be used as an assessment tool in both research and clinical practice. [Copyright &y& Elsevier]

Abstract: This study examined links between eating behaviors, weight-based victimization (WBV) and preferences for bullying intervention among adolescents. Adolescents enrolled in weight loss camps participated in an online survey (N =361). Regression models examined relationships between key variables. Almost half of adolescents who experienced WBV engaged in unhealthy eating behaviors, which corresponded to less desire for supportive intervention. Unhealthy eating behaviors may offset adaptive coping strategies to deal with WBV, such as support from peers and family. [Copyright &y& Elsevier]

Despite significant attention to the medical impacts of obesity, often ignored are the negative outcomes that obese children and adults experience as a result of stigma, bias, and discrimination. Obese individuals are frequently stigmatized because of their weight in many domains of daily life. Research spanning several decades has documented consistent weight bias and stigmatization in employment, health care, schools, the media, and interpersonal relationships. For overweight and obese youth, weight stigmatization translates into pervasive victimization, teasing, and bullying. Multiple adverse outcomes are associated with exposure to weight stigmatization, including depression, anxiety, low self-esteem, body dissatisfaction, suicidal ideation, poor academic performance, lower physical activity, maladaptive eating behaviors, and avoidance of health care. This review summarizes the nature and extent of weight stigmatization against overweight and obese individuals, as well as the resulting consequences that these experiences create for social, psychological, and physical health for children and adults who are targeted. [Copyright &y& Elsevier]

Abstract: Objectives: Overweight youth are frequent targets of weight-based victimization during Physical Education (PE) and sports. In addition, previous research indicates that teachers’ perceptions and expectations may influence their likelihood of intervening during victimization, and physical educators may endorse biased perceptions and expectations of overweight youth. Despite this evidence, no research has examined how physical educators respond to weight-based victimization of their students. Thus, the current study examined PE teachers’ and coaches’ responses to different types of victimization involving average weight and overweight students. Design: This study utilized an experimental design that assessed participants’ reactions to situations of weight-related victimization using hypothetical scenarios accompanied by photographs of youth. Methods: PE teachers and sport coaches (N = 162) were randomly presented with a scenario and follow-up questions about an average weight or an overweight student. Each participant completed two conditions: one with a male target, and one with a female target. Results: Participants were more likely to take action when overweight female students were victims of bullying, specifically in situations of verbal and relational victimization. Male participants were less likely to respond to victimization than female participants. Conclusions: Findings suggest the importance of increasing awareness about weight-based victimization and its consequences, especially among male physical educators. Implications for the psychological, social, and physical development of overweight youth are discussed. [Copyright &y& Elsevier]

Abstract: Objective: The aims of this study were to compare weight-based attitudes in obese Latino adults with and without binge eating disorder (BED) and to examine whether these attitudes are related to indices of eating disorder psychopathology and psychological functioning. Method: Participants were a consecutive series of 79 monolingual Spanish-speaking-only obese Latinos (65 female, 14 male) participating in a randomized placebo-controlled trial performed at a Hispanic community mental health center. Participants were categorized as meeting the criteria for BED (n = 40) or obese non–binge-eating controls (n = 39) based on diagnostic and semistructured interviews administered by fully bilingual research clinicians trained specifically for this study. Results: Analyses revealed that negative attitudes toward obesity did not differ significantly between the BED and non–binge-eating groups nor were they correlated with the intensity of eating disorder psychopathology (eg, levels of weight and shape concerns). Overall, the levels of negative attitudes toward obesity in this Latino/Latina group are similar to those reported previously for samples of English-speaking primarily white obese persons. Discussion: These findings suggest that it may be obesity per se—rather than eating disorder psychopathology or body image—that heightens vulnerability to negative weight-based attitudes. [Copyright &y& Elsevier]

Objective: The aim of this study was to determine whether memories of parental rules about food during childhood are linked to adult eating behaviors. Method: An adult community sample (N=122) (56% female, 44% male) with a mean age of 44.6 years completed self-report measures of weight and dieting history, current eating patterns, and recollection of different types of rules about food from their parents. Three types of food rules were assessed: (a) rules which restrict intake of certain foods, (b) rules which encourage food intake, and (c) rules where food is used to reward or punish behavior. Results: Binge eating and dietary restraint in adulthood are significantly related to participants'' recollection of their parents using food to control their behavior in childhood. These results held true regardless of body mass index (BMI), ethnicity, age, or childhood weight status. Discussion: This study suggests that some childhood food rules may have a long-lasting impact on eating behaviors. Further research on the impact of using food to reward and punish children''s behavior is needed to inform recommendations to parents regarding the use of food for behavioral control. [Copyright &y& Elsevier]

Objective: This study examines weight stigma experiences in a population-based sample of young adults from diverse ethnic/racial and socio-economic backgrounds, and explores cross-sectional associations between weight stigma and self-compassion, including gender differences in this relationship.Methods: Data come from EAT 2018, a population-based study of weight and related behaviors in young adults (N = 1523, mean age = 22 years, 53.5% females). Adjusted models tested associations between different experiences of weight stigma and the Self-Kindness Subscale of the Self-Compassion Scale, controlling for age, body mass index (BMI), ethnicity/race, and SES.Results: Over a third (32.3-52.2%) of participants reported experiences of weight teasing, and almost half (39.2-54.8%) indicated that people in their work or school settings are treated differently based on weight. There were few differences across ethnic/racial groups in reports of weight stigma. The prevalence of weight stigma experiences reported by participants in their current school or work environment was similar across gender, and those who had experienced weight stigma had lower levels of self-kindness. Among both females and males, lower self-kindness scores were associated with the experience of weight teasing (females: χ2 = 22.6, df = 1, p < .001, d = 0.32; males χ2 = 7.6, df = 1, p < .001, d = 0.22). For females only, lower self-kindness scores were associated with being treated unfairly due to weight (χ2 = 11.1, df = 1, p < .001, d = 0.23), and having others make comments about your weight (χ2 = 14.6, df = 1, p < .001, d = 0.28). Findings remained after adjusting for race/ethnicity, BMI, and SES.Conclusion: Associations between self-compassion and experiences of weight stigma found in our diverse sample of young adults offers insights on this understudied relationship. [ABSTRACT FROM AUTHOR]

Abstract: Record levels of obesity in children and adolescents are predictable in light of powerful conditions that promote high consumption of calorie-dense, nutrient-poor foods and discourage physical activity. Default conditions for youth are dangerous, and include multiple and relentless forms of marketing, poor foods promoted in schools, and a variety of other conditions that undermine personal resources, individual responsibility, and parental authority. This article discusses how optimal defaults can be created using five issues as examples: framing of the obesity issue, treating versus preventing obesity, nutrition in schools, marketing, and addressing weight bias and discrimination. By adopting a public health approach that addresses the conditions causing obesity, there is hope of reversing troubling trends in prevalence. [Copyright &y& Elsevier]

Objective: To describe trainee healthcare professionals' preferred terms when talking about obesity, their beliefs about initiating discussions about weight, and their confidence about consulting with obese people. Methods: A self-completed questionnaire collected data on demographics, preferred terms, beliefs about initiation of discussions, confidence and training needs from 1036 pre-registration dieticians, nurses and doctors. Results: Participants' preferred terms when raising the issue of obesity with clients were BMI (mean=.96), weight (mean=.71) and unhealthy BMI (mean=.43). When defining a client's bodyweight, students endorsed the euphemism 'your weight may be damaging your health' (67.6%). A proactive, collaborative communication style was preferred by 34.9% of participants. 58.2% of participants felt confident about discussing obesity with clients and 95.1% felt that that more training would be useful. Conclusion: It is reassuring that U.K. trainee healthcare professionals avoid value-laden terms and broadly endorse words preferred by people with obesity. It is, however, concerning that the majority of participants did not favor a proactive, collaborative communication style. Practice Implications: Educators of tomorrow's healthcare professionals could take advantage of students' desire for more training on how to effectively talk to clients with obesity about their weight. Such training would, however, require the development of clear guidelines on terminology and communication styles. [ABSTRACT FROM AUTHOR]

People react to, and are affected by, stigmatizing experiences in different ways. The current study examined different reactions to weight stigma to identify who may be vulnerable to lasting distress from these experiences. Using a mixed methods approach, this study compared qualitative descriptions of reactions to experiences of weight stigma in conjunction with quantitative measures of weight bias internalization (WBI) and other health indices. Data were collected from September 2017 to August 2018. Participants were U.S. adults enrolled in a commercial weight management program (n = 425, 96% female) who reported previous experiences of weight stigma (on quantitative measures), and who also qualitatively described feeling either no longer distressed (n = 178) or still distressed (n = 247) by those experiences. Qualitative analyses revealed that participants who were no longer distressed engaged in self-acceptance, were not concerned about other's evaluations of them, and prioritized health rather than appearance. Those who were still distressed from previous weight stigma experiences considered their body weight, and being stigmatized for it, as playing a prominent role in shaping their self-perception, they blamed themselves for experiencing the consequences of weight stigma, and ruminated on their memories of stigmatizing experiences. Hierarchical regressions demonstrated that participants who were still distressed reported greater WBI, greater perceived stress, and poorer mental health than participants who were no longer distressed. When adding WBI to the model predicting perceived stress, differences between participants who were no longer distressed versus still distressed attenuated and became statistically insignificant, suggesting that these qualitative reaction patterns to stigma may be related to participants' level of WBI. Given that some people may experience longer term distress from weight stigma than others, this study can inform interventions aimed to prevent or mitigate the negative consequences associated with being stigmatized. • Internalized weight bias may help explain distress in response to weight stigma. • Enduring distress from experienced weight stigma relates to poorer mental health. • Adults with enduring distress expressed negative self-image, self-blame, rumination. • Adults with less distress expressed self-acceptance, resisting social judgement. [ABSTRACT FROM AUTHOR]