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Potential unintended consequences of graphic warning labels on sugary drinks: do they promote obesity stigma?
Hayward, LE, Vartanian, LR
Obesity science & practice. 2019;5(4):333-341
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Consumption of sugar-sweetened beverages is associated with increased body weight and poor nutrition and health outcomes, including Type 2 diabetes and coronary heart disease. The aim of this study was to test the hypothesis that the graphic warning promotes weight bias (Study 1) and is also viewed as stigmatizing by people with overweight and obesity (Study 2). Study 1 Participants were randomly allocated to one of two conditions: a warning label condition (n = 324) or a control condition (n = 357). Results indicate that participants who were presented with the graphic warning label were more likely to intend to purchase water (instead of the soda) than participants who were presented with the standard label. Study 2 Participants (n=561) were randomly assigned to one of two conditions – overweight or obese. Results show that the majority of participants rated the warning label as personally stigmatizing. Moreover, after being exposed to the label, the participants experienced worse mood. Authors conclude that it is important for policymakers to strike a balance between the benefits and costs of public health interventions.
Abstract
INTRODUCTION Public health interventions need to balance the benefits with any potential harms. One proposed intervention for reducing sugar-sweetened beverage consumption involves placing graphic warning labels on products and advertisements. A recent study found that a graphic warning label that contained negative imagery of obesity reduced purchases of sugar-sweetened beverages. However, these labels may also promote obesity stigma, which is concerning given that weight stigma is associated with harmful health consequences including weight gain and increased risk of mortality. METHODS In Study 1 (n = 681), participants viewed a standard soda label or the graphic warning label online and then completed measures of disgust and prejudice towards people with obesity. In Study 2 (n = 506), participants who identified as having overweight or obesity viewed the graphic warning label online before or after completing measures of mood and state self-esteem. RESULTS In Study 1, participants who had viewed the graphic warning label reported higher disgust and weight bias. In Study 2, the majority of participants perceived the warning label to be stigmatizing, and participants displayed worse mood and, through this, lower self-esteem after viewing the label. CONCLUSIONS Although the graphic warning label has been found to reduce sugary drink purchases, it also promotes obesity stigma and is perceived as stigmatizing by individuals with overweight and obesity. Given that weight stigma predicts harmful health and well-being consequences, the benefits of graphic warning labels need to be balanced against the potential costs.
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How and why weight stigma drives the obesity 'epidemic' and harms health.
Tomiyama, AJ, Carr, D, Granberg, EM, Major, B, Robinson, E, Sutin, AR, Brewis, A
BMC medicine. 2018;16(1):123
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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. In this opinion-based study, authors discuss that: • Latest literature indicates that weight stigma can trigger physiological and behavioural changes linked to poor metabolic health and increased weight gain. • Healthcare is a setting in which weight stigma is particularly pervasive, with significant consequences for the health of higher-weight patients. This stigma has direct and observable consequences for the quality and nature of services provided to those with obesity. • Stigma may be an unintended consequence of anti-obesity efforts, undermining their intended effect. Moreover, focusing solely on obesity treatment runs the risk of missing other diagnoses. • The science of weight stigma crystallizes a key point for future success – to tackle the obesity ‘epidemic’ we must tackle the parallel epidemic of weight stigma. • Public service messages are needed to educate people about the stigma, discrimination, and challenges facing higher-weight individuals. Authors conclude that to advance as an equal society, healthcare providers should lead the way for weight stigma eradication.
Abstract
BACKGROUND In an era when obesity prevalence is high throughout much of the world, there is a correspondingly pervasive and strong culture of weight stigma. For example, representative studies show that some forms of weight discrimination are more prevalent even than discrimination based on race or ethnicity. DISCUSSION In this Opinion article, we review compelling evidence that weight stigma is harmful to health, over and above objective body mass index. Weight stigma is prospectively related to heightened mortality and other chronic diseases and conditions. Most ironically, it actually begets heightened risk of obesity through multiple obesogenic pathways. Weight stigma is particularly prevalent and detrimental in healthcare settings, with documented high levels of 'anti-fat' bias in healthcare providers, patients with obesity receiving poorer care and having worse outcomes, and medical students with obesity reporting high levels of alcohol and substance use to cope with internalized weight stigma. In terms of solutions, the most effective and ethical approaches should be aimed at changing the behaviors and attitudes of those who stigmatize, rather than towards the targets of weight stigma. Medical training must address weight bias, training healthcare professionals about how it is perpetuated and on its potentially harmful effects on their patients. CONCLUSION Weight stigma is likely to drive weight gain and poor health and thus should be eradicated. This effort can begin by training compassionate and knowledgeable healthcare providers who will deliver better care and ultimately lessen the negative effects of weight stigma.
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Predictors of weight stigma experienced by middle-older aged, general-practice patients with obesity in disadvantaged areas of Australia: a cross-sectional study.
Spooner, C, Jayasinghe, UW, Faruqi, N, Stocks, N, Harris, MF
BMC public health. 2018;18(1):640
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People in higher categories of obesity are at substantially increased health risk because mortality increases sharply as body mass index rises above 30. In addition to physical health risks, people with obesity commonly experience weight-related stigma. The aim of this study was to identify predictors of perceived weight stigma among patients with obesity attending general practices in socioeconomically disadvantaged urban areas of Australia. This is a cross-sectional study for which data from telephone interviews with patients with obesity were used. Patients were recruited from 17 general practices in socioeconomically disadvantaged areas of Sydney and Adelaide. Results indicate that one-third of the sample had experienced direct forms of weight discrimination in the week before being interviewed. Furthermore, weight discrimination was more likely to be experienced by patients in higher obesity categories, who were not employed, who spoke a language other than English at home and who had lower scores on the Health Literacy Questionnaire domain (that measures the ability to actively engage with healthcare providers). Authors conclude that weight stigma may compound other forms of social disadvantage. Thus, strategies are needed to address weight stigma at the individual, system and population levels and to educate primary care providers to be more alert to the needs of their patients with obesity.
Abstract
BACKGROUND Rates of obesity have increased globally and weight stigma is commonly experienced by people with obesity. Feeling stigmatised because of one's weight can be a barrier to healthy eating, physical activity and to seeking help for weight management. The aim of this study was to identify predictors of perceived weight among middle-older aged patients with obesity attending general practices in socioeconomically disadvantaged urban areas of Australia. METHODS As part of a randomised clinical trial in Australia, telephone interviews were conducted with 120 patients from 17 general practices in socioeconomically disadvantaged of Sydney and Adelaide. Patients were aged 40-70 years with a BMI ≥ 30 kg/m2. The interviews included questions relating to socio-demographic variables (e.g. gender, language spoken at home), experiences of weight-related discrimination, and the Health Literacy Questionnaire (HLQ). Multi-level logistic regression data analysis was undertaken to examine predictors of recent experiences of weight-related discrimination ("weight stigma"). RESULTS The multi-level model showed that weight stigma was positively associated with obesity category 2 (BMI = 35 to < 40; OR 4.47 (95% CI 1.03 to 19.40)) and obesity category 3 (BMI = ≥ 40; OR 27.06 (95% CI 4.85 to 150.95)), not being employed (OR 7.70 (95% CI 2.17 to 27.25)), non-English speaking backgrounds (OR 5.74 (95% CI 1.35 to 24.45)) and negatively associated with the HLQ domain: ability to actively engage with healthcare providers (OR 0.12 (95% CI 0.05 to 0.28)). There was no association between weight stigma and gender, age, education or the other HLQ domains examined. CONCLUSIONS Weight stigma disproportionately affected the patients with obesity most in need of support to manage their weight: those with more severe obesity, from non-English speaking backgrounds and who were not in employment. Additionally, those who had experienced weight stigma were less able to actively engage with healthcare providers further compounding their disadvantage. This suggests the need for a more proactive approach to identify weight stigma by healthcare providers. Addressing weight stigma at the individual, system and population levels is recommended. TRIAL REGISTRATION The trial was registered with the Australian Clinical Trials Registry ACTRN126400102162 .
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Comparing Self-Report Measures of Internalized Weight Stigma: The Weight Self-Stigma Questionnaire versus the Weight Bias Internalization Scale.
Hübner, C, Schmidt, R, Selle, J, Köhler, H, Müller, A, de Zwaan, M, Hilbert, A
PloS one. 2016;11(10):e0165566
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Individuals with overweight and obesity are exposed to weight stigmatization in many domains of life, for example, in employment, in educational and health care settings, in the media as well as in interpersonal relationships. The aim of this study was to compare the psychometric properties and predictive values for health outcomes of two different self-report questionnaires (the Weight Self-Stigma Questionnaire and the Weight Bias Internalization Scale). This study was part of a larger project that investigated the impact of body contouring surgery after bariatric surgery on psychosocial aspects. It is a cross-sectional study which included all data of a subsample consisting of N = 78 patients prior bariatric surgery. Results indicate that both measures did not differ with respect to overall convergent validity and predictive values for multiple psychosocial health outcomes. Findings also showed that the Weight Bias Internalization Scale has better internal consistency compared to the Weight Self-Stigma Questionnaire. Authors suggest that clinical practice and research might give preference to the Weight Bias Internalization Scale in bariatric surgery samples because of the marginally better reliability, convergent validity, and greater predictive power.
Abstract
BACKGROUND Internalized weight stigma has gained growing interest due to its association with multiple health impairments in individuals with obesity. Especially high internalized weight stigma is reported by individuals undergoing bariatric surgery. For assessing this concept, two different self-report questionnaires are available, but have never been compared: the Weight Self-Stigma Questionnaire (WSSQ) and the Weight Bias Internalization Scale (WBIS). The purpose of the present study was to provide and to compare reliability, convergent validity with and predictive values for psychosocial health outcomes for the WSSQ and WBIS. METHODS The WSSQ and the WBIS were used to assess internalized weight stigma in N = 78 prebariatric surgery patients. Further, body mass index (BMI) was assessed and body image, quality of life, self-esteem, depression, and anxiety were measured by well-established self-report questionnaires. Reliability, correlation, and regression analyses were conducted. RESULTS Internal consistency of the WSSQ was acceptable, while good internal consistency was found for the WBIS. Both measures were significantly correlated with each other and body image. While only the WSSQ was correlated with overweight preoccupation, only the WBIS was correlated with appearance evaluation. Both measures were not associated with BMI. However, correlation coefficients did not differ between the WSSQ and the WBIS for all associations with validity measures. Further, both measures significantly predicted quality of life, self-esteem, depression, and anxiety, while the WBIS explained significantly more variance than the WSSQ total score for self-esteem. CONCLUSIONS Findings indicate the WSSQ and the WBIS to be reliable and valid assessments of internalized weight stigma in prebariatric surgery patients, although the WBIS showed marginally more favorable results than the WSSQ. For both measures, longitudinal studies on stability and predictive validity are warranted, for example, for weight-related and psychosocial outcomes.
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Being 'fat' in today's world: a qualitative study of the lived experiences of people with obesity in Australia.
Thomas, SL, Hyde, J, Karunaratne, A, Herbert, D, Komesaroff, PA
Health expectations : an international journal of public participation in health care and health policy. 2008;11(4):321-30
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The obesity epidemic is one of the most pressing contemporary public health problems. The aim of this study was to develop a picture of both lived experiences of obesity and the impact of socio-cultural factors on obesity. The study adopted a qualitative research design (n=76) . A broad interview schedule was developed by the authors aimed at individuals from a broad range of backgrounds and experiences of obesity. Results indicate that: (a) the experiences of obesity are diverse but there are common themes. (b) people living with obesity have heard the messages but find it difficult to act upon them. (c) interventions should be tailored to address both individual and community needs. (d) there should be a different approach towards obesity interventions. Authors conclude that interventions should respond directly to the social and cultural dimensions of communities and clusters of individuals.
Abstract
OBJECTIVE To develop an in-depth picture of both lived experience of obesity and the impact of socio-cultural factors on people living with obesity. DESIGN Qualitative methodology, utilizing in-depth semi-structured interviews with a community sample of obese adults (body mass index >or=30). Community sampling methods were supplemented with purposive sampling techniques to ensure a diverse range of individuals were included. RESULTS Seventy-six individuals (aged 16-72) were interviewed. Most had struggled with their weight for most of their lives (n=45). Almost all had experienced stigma and discrimination in childhood (n=36), as adolescents (n=41) or as adults (n=72). About half stated that they had been humiliated by health professionals because of their weight. Participants felt an individual responsibility to lose weight, and many tried extreme forms of dieting to do so. Participants described an increasing culture of 'blame' against people living with obesity perpetuated by media and public health messages. Eighty percent said that they hated or disliked the word obesity and would rather be called fat or overweight. DISCUSSION AND CONCLUSION There are four key conclusions: (i) the experiences of obesity are diverse, but there are common themes, (ii) people living with obesity have heard the messages but find it difficult to act upon them, (iii) interventions should be tailored to address both individual and community needs and (iv) we need to rethink how to approach obesity interventions to ensure that avoid recapitulating damaging social stereotypes and exacerbating social inequalities.