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1.
Exposure to written content eliciting weight stigmatization: Neural responses in appetitive and food reward regions.
Anguah, KOB, Christ, SE
Obesity (Silver Spring, Md.). 2024;(1):80-90
Abstract
OBJECTIVE Neural activity in food reward- and appetite-related regions was examined in response to high-calorie (HC), low-calorie, and non-food pictures after exposure to written weight stigma (WS) content. Relationships with eating behavior (by Three-Factor Eating Questionnaire [TFEQ]), blood glucose, and subjective appetite were also explored. METHODS Adults with overweight and obesity were randomized to read either a WS (n = 20) or control (n = 20) article and subsequently underwent brain scans while they rated pleasantness of food pictures. Fasting glucose, TFEQ, stigma experiences, and appetite were measured before reading the article, appetite after reading, and glucose and appetite again after the scan. RESULTS A priori region of interest analyses revealed significant group differences in activation to HC > low-calorie food cues in the caudate and thalamus whereas exploratory whole-brain analyses suggested significant differences in regions including left insula, left thalamus, left inferior temporal gyrus, right lingual gyrus, and bilateral middle occipital gyrus and superior parietal lobule (p < 0.005 uncorrected, k ≥ 200 m3 ). No significant relationships were observed between the pattern of activation and TFEQ, glucose, or subjective appetite in the WS group. CONCLUSIONS Exposure to WS was associated with increased responsiveness to HC food content in the dorsal striatum and thalamus in individuals with overweight and obesity.
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2.
Current status of weight bias and stigma in pediatrics and the need for greater focus on populations at risk.
Waldrop, SW, Wang, D, Kancherla, D, Stanford, FC
Current opinion in pediatrics. 2024;(1):42-48
Abstract
PURPOSE OF REVIEW Obesity is one of the most common pediatric chronic conditions in the United States, affecting approximately 20% of American youth and is more common amongst Black, Latino, and Indigenous and low socioeconomic populations. The condition places children and adolescents at increased risk of physical and mental health conditions partly mediated by the weight bias and stigmatization experienced during the potentially vulnerable periods of childhood and adolescence. RECENT FINDINGS Weight bias and the resulting stigma are pervasive in society. Children have been shown to internalize this bias and its devaluation, which have been shown to contribute to worsening metabolic and mental health outcomes independently. Studies suggest weight stigmatization more adversely affects Black, Latino, and Indigenous children, suggesting the potential for adverse synergistic effects of these historical biases on such youth. SUMMARY Addressing childhood obesity successfully across all racial, ethnic, and socioeconomic lines requires addressing weight bias and stigma. Steps toward this end include collaborative efforts to promote cross-cultural competence and upstander bias education and training for those who care for children, person-centered communication, and a culture of inclusivity across governmental, healthcare, educational, entertainment, and advertising sectors.
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3.
Assessing the Clinical Efficacy of a Virtual Reality Tool for the Treatment of Obesity: Randomized Controlled Trial.
Anastasiadou, D, Herrero, P, Garcia-Royo, P, Vázquez-De Sebastián, J, Slater, M, Spanlang, B, Álvarez de la Campa, E, Ciudin, A, Comas, M, Ramos-Quiroga, JA, et al
Journal of medical Internet research. 2024;:e51558
Abstract
BACKGROUND Virtual reality (VR) interventions, based on cognitive behavioral therapy principles, have been proven effective as complementary tools in managing obesity and have been associated with promoting healthy behaviors and addressing body image concerns. However, they have not fully addressed certain underlying causes of obesity, such as a lack of motivation to change, low self-efficacy, and the impact of weight stigma interiorization, which often impede treatment adherence and long-term lifestyle habit changes. To tackle these concerns, this study introduces the VR self-counseling paradigm, which incorporates embodiment and body-swapping techniques, along with motivational strategies, to help people living with obesity effectively address some of the root causes of their condition. OBJECTIVE This study aims to assess the clinical efficacy of ConVRself (Virtual Reality self-talk), a VR platform that allows participants to engage in motivational self-conversations. METHODS A randomized controlled trial was conducted with 68 participants from the bariatric surgery waiting list from the obesity unit of the Vall d'Hebron University Hospital in Barcelona, Spain. Participants were assigned to 1 of 3 groups: a control group (CG), which only received treatment as usual from the obesity unit; experimental group 1 (EG1), which, after intensive motivational interviewing training, engaged in 4 sessions of VR-based self-conversations with ConVRself, and underwent embodiment and body-swapping techniques; and experimental group 2 (EG2), which engaged in 4 VR-based sessions led by a virtual counselor with a prerecorded discourse, and only underwent the embodiment technique. In the case of both EG1 and EG2, the VR interventions were assisted by a clinical researcher. Readiness to change habits, eating habits, and psychological variables, as well as adherence and satisfaction with ConVRself were measured at baseline, after the intervention, 1 week after the intervention, and 4 weeks after the intervention. RESULTS Regarding the primary outcomes, EG1 (24/68, 35%) and EG2 (22/68, 32%) showed significant improvements in confidence to lose weight compared to the CG (22/68, 32%) at all assessment points (β=-.16; P=.02). Similarly, EG1 demonstrated a significant increase after the intervention in readiness to exercise more compared to the CG (β=-.17; P=.03). Regarding the secondary outcomes, EG1 participants showed a significant reduction in uncontrolled eating (β=.71; P=.01) and emotional eating (β=.29; P=.03) compared to the CG participants, as well as in their anxiety levels compared to EG2 and CG participants (β=.65; P=.01). In addition, participants from the experimental groups reported high adherence and satisfaction with the VR platform (EG1: mean 59.82, SD 4.00; EG2: mean 58.43, SD 5.22; d=0.30, 95% CI -0.30 to 0.89). CONCLUSIONS This study revealed that using VR self-conversations, based on motivational interviewing principles, may have benefits in helping people with obesity to enhance their readiness to change habits and self-efficacy, as well as reduce dysfunctional eating behaviors and anxiety. TRIAL REGISTRATION ClinicalTrials.gov NCT05094557; https://www.clinicaltrials.gov/study/NCT05094557.
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4.
Finding kindness: A randomized controlled trial of an online self-compassion intervention for weight management (SC4WM).
Brenton-Peters, JM, Consedine, NS, Cavadino, A, Roy, R, Ginsberg, KH, Serlachius, A
British journal of health psychology. 2024;(1):37-58
Abstract
INTRODUCTION Weight loss is hard to achieve and even harder to maintain. Engaging in effortful behavioural change to manage body weight can sometimes result in feelings of guilt and shame. Self-compassion, the tendency to find kindness for oneself in times of struggle, may facilitate coping with the unique challenges of weight management. This study assessed whether a remotely delivered self-compassion intervention improved weight management outcomes when delivered as a supplement to an existing digital behavioural weight management programme, Weight Watchers (WW). METHOD Using a mixed-method study design, 249 adults seeking to manage weight were randomized to either the WW programme or WW supplemented with the self-compassion for weight management intervention (SC4WM). Participants completed measures of self-compassion, eating behaviour, physical activity, body weight and emotional well-being along with potential moderators, including weight self-stigma, eating restraint, psychological coping and perceived stress at baseline, post-intervention (4 weeks) and follow-up (12 weeks). RESULTS There was no evidence that the SC4WM intervention had a significantly different effect than WW alone. Other than body weight, all outcomes improved over time in both groups. Self-compassion was slightly higher overall in the SC4WM group (p = .05), with this group reporting higher self-kindness at 4 weeks (p = .014) and lower self-judgement at 12 weeks (p = .023) compared to the control group. CONCLUSIONS Although the SC4WM intervention group did show a small increase in self-kindness and reduction in self-judgement, weight management outcomes were not improved over and above the existing WW programme. Recommendations for adapting the SC4WM intervention to improve efficacy to augment weight management outcomes are provided.
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5.
Clinical practice guidelines for the management of overweight and obesity published internationally: A scoping review.
Gaskin, CJ, Cooper, K, Stephens, LD, Peeters, A, Salmon, J, Porter, J
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2024;(5):e13700
Abstract
With the increasing prevalence of obesity placing additional demands on healthcare systems, many jurisdictions and professional bodies have developed clinical practice guidelines to support practitioners in the management of people with overweight and obesity. This scoping review aimed to identify key features of contemporary guidelines for the clinical management of overweight and obesity. Searches of MEDLINE, Guidelines International Network's international guidelines library, and other grey literature sources identified 38 guidelines of 18 countries and one region published since 2010. Guidelines were developed by committees (n = 36, 95%) that comprised knowledgeable experts (n = 36, 95%) and were multidisciplinary (n = 33, 87%), with limited consumer representation (n = 11, 29%). Guideline documentation incorporated review questions (n = 23, 61%), systematic reviews (n = 25, 66%), evidence grading systems (n = 33, 87%), processes for reaching consensus (n = 19, 50%), and guideline review details (n = 28, 74%). Treatment approaches included in most guidelines were nutrition and physical activity (n = 38, 100%), psychology (n = 37, 97%), pharmacotherapy (n = 32, 84%), and bariatric surgery (n = 31, 82%). Most guidelines targeted populations based on age (n = 30, 79%). Guidelines contained recommendations for pregnancy (n = 12, 32%), older adults (n = 9, 24%), and people with eating disorders (n = 8, 21%). Future guidelines would benefit from involvement of consumers including groups known to be at increased risk of overweight and obesity, targeted guidance for at risk groups, and consideration of weight bias and stigma.
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6.
Tackling obesity while preventing obesity stigma.
Darling, JC, Rudolf, MCJ, Rubino, F, Greenough, A
Archives of disease in childhood. 2024
Abstract
Obesity is a significant public health problem. Prevalence is rising in children and young people, with lifelong health impacts and implications for paediatric clinical practice. Obesity stigma is increasingly acknowledged as a problem within health services. Health professionals can inadvertently contribute to this stigma, which is harmful and in itself can promote weight gain. A complex web of factors contributes to obesity, and a simplistic approach exclusively focused on personal responsibility, diet and exercise is unhelpful. A more nuanced, sensitive and informed approach is needed, with careful use of language and non-judgemental partnership working.
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7.
Why we struggle to make progress in obesity prevention and how we might overcome policy inertia: Lessons from the complexity and political sciences.
Hagenaars, LL, Schmidt, LA, Groeniger, JO, Bekker, MPM, Ter Ellen, F, de Leeuw, E, van Lenthe, FJ, Oude Hengel, KM, Stronks, K
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2024;(5):e13705
Abstract
Despite evidence for the effectiveness of policies that target obesogenic environments, their adoption remains deficient. Using methods and concepts from complexity and political science (Stock-and-Flow analysis and Punctuated Equilibrium Theory) and a qualitative literature review, we developed system maps to identify feedback loops that hinder policymaking on mitigating obesogenic environments and feedback loops that could trigger and sustain policy change. We found numerous self-reinforcing feedback loops that buttress the assumption that obesity is an individual problem, strengthening the biomedical and commercial weight-loss sectors' claim to "ownership" over solutions. That is, improvements in therapies for individuals with obesity reinforces policymakers' reluctance to target obesogenic environments. Random events that focus attention on obesity (e.g., celebrities dismissing soda) could disrupt this cycle, when actors from outside the medical and weight-loss sector (e.g., anti-weight stigma activists) successfully reframe obesity as a societal problem, which requires robust and politically relevant engagement with affected communities prior to such events taking place. Sustained prioritization of policies targeting obesogenic environments requires shared problem ownership of affected communities and nonhealth government sectors, by emphasizing cobenefits of policies that target obesogenic environments (e.g., ultraprocessed food taxation for raising revenue) and solutions that are meaningful for affected communities.
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8.
Obesity and sexual health: focus on postmenopausal women.
Barbagallo, F, Cucinella, L, Tiranini, L, Chedraui, P, Calogero, AE, Nappi, RE
Climacteric : the journal of the International Menopause Society. 2024;(2):122-136
Abstract
Menopause is a cardiometabolic transition with many women experiencing weight gain and redistribution of body fat. Hormonal changes may affect also several dimensions of well-being, including sexual function, with a high rate of female sexual dysfunction (FSD), which displays a multifactorial etiology. The most important biological factors range from chronic low-grade inflammation, associated with hypertrophic adipocytes that may translate into endothelial dysfunction and compromised blood flow through the genitourinary system, to insulin resistance and other neuroendocrine mechanisms targeting the sexual response. Psychosocial factors include poor body image, mood disorders, low self-esteem and life satisfaction, as well as partner's health and quality of relationship, and social stigma. Even unhealthy lifestyle, chronic conditions and putative weight-promoting medications may play a role. The aim of the present narrative review is to update and summarize the state of the art on the link between obesity and FSD in postmenopausal women, pointing to the paucity of high-quality studies and the need for further research with validated end points to assess both biomarkers of obesity and FSD. In addition, we provide general information on the diagnosis and treatment of FSD at menopause with a focus on dietary interventions, physical activity, anti-obesity drugs and bariatric surgery.
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9.
Factor structure and measurement invariance of the Weight-Related Abuse Questionnaire (WRAQ).
Magallares, A, Recio, P, Jáuregui-Lobera, I, Benito de Valle, P, Irles, JA, Hymowitz, G
Eating behaviors. 2024;:101827
Abstract
Weight-related abuse is defined as verbal or physical maltreatment specific to one's weight. The Weight-Related Abuse Questionnaire (WRAQ) is an instrument specifically designed to measure weight-related abuse. The main goal of this research was to study the factor structure and measurement invariance of the Spanish version of the WRAQ in a non-clinical and a clinical sample. The clinical sample included 150 participants with obesity (60 % women) from the Hospital de Valme (Sevilla, Spain). The non-clinical sample included 301 students (79 % women) from the Spanish Open University (UNED). Scales to measure weight self-stigma and fear of gaining weight were used to analyze the convergent validity of the WRAQ. A confirmatory factor analysis showed that a two-factor model (verbal and physical abuse) was an acceptable fit for the data in both the clinical and non-clinical samples. Multigroup Confirmatory Factor Analysis revealed scalar measurement invariance by sample and gender. Cronbach's alpha coefficients and composite reliability for both samples were found to be good, with values ranging from 0.83 to 0.96. Fear of gaining weight was correlated to verbal (r = 0.36, p < .01) and physical (r = 0.12, p < .05) abuse, and weight self-stigma was also related to physical (r = 0.21, p < .01) and verbal (r = 0.41, p < .01) abuse. These results suggest that the WRAQ can be used in clinical and non-clinical samples to assess verbal and physical abuse in both men and women.
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10.
Weight Stigmatisation - NED Infobite
BANT's scientific NED InfoBites are designed to provide key elements of the latest research using plain language. They provide quick overviews on particular health issues and nutrition topics for a speedy introduction to the science. Visually attractive and easily shareable with clients and social media followers.
2024
Abstract
Weight stigma is defined as the social rejection and devaluation that accrues to those who do not comply with prevailing social norms of adequate body weight and shape. This BANT Infobite highlights some of the latest research on weight stigma and how and why weight stigma may be a driver of obesity.