Stigma childhood obesity literature review

Disease and Stigma: A Review of Literature

berryman and colleagues assessed negative attitudes toward obesity among dietetics and nondietetics students (52). the principal author and mk conducted the literature search and screened abstracts and titles. attribution of obesity to be a result of the food environment contributed to variance explanation the most.%) agreed a bad food environment to be one possible cause of obesity. settingsin their 2001 review, puhl and brownell summarized research documenting weight‐based prejudice and discrimination in employment settings (2). among a sample of 400 dietitians, less than half felt prepared to treat clients who are obese and only one‐third believed that dietitians are effective in the management of obesity (54). during the early 2000s only 2 to 3 per cent of the population considered obesity to be one of the most important health issues [1], while nowadays the majority in e. one item - linking obesity to access to poor foods - showed to be a highly significant predictor for support of all three policies. across the studies found, regulative prevention is supported by about half of the population, while childhood prevention has highest approval rates. they suggest that providers avoid assumptions that a patient's obesity is to blame for all of their health concerns and that they treat obese patients with the same respect and concern as any other patient suffering from a chronic disease (83,84). report results of agreement with different perceived causes of obesity that were allocated to underlying factors [2]. especially the review of sociodemographic influences on prevalence of stigmatizing attitudes, causal attribution and prevention support was restricted by the scarce number of studies. article is organized similarly to the first review published by puhl and brownell (2), with sections on weight bias in settings of employment, health care, and education. instruments applied in the investigations were primarily constructed by the authors themselves and were based on previous research and current literature. however, to the extent that the media serves to alienate those who are overweight, the consequences of weight prejudice are deemed to have no bearing on the issue of obesity (133). this review summarized weight stigma in domains of employment, health care, and education, demonstrating the vulnerability of obese persons to many forms of unfair treatment. the authors then review stigma-reduction efforts that have been tested to improve attitudes toward obese children, and they highlight complex questions about the role of weight bias in childhood obesity prevention. with these literatures assembled, areas of research are outlined to guide efforts on weight stigma in youths, with an emphasis on the importance of studying the effect of weight stigma on physical health outcomes and identifying effective interventions to improve attitudes. research on public attitudes toward and perception of overweight and obesity is urgently needed to depict the prevailing degree of stigmatization. this is, however, the first review to focus on nationally representative studies. as this review shows, prevalence of stigmatizing attitudes is rather high. in addition, a study using data from a nationwide prospective cohort in the united states (n = 4,290) estimated the effect of obesity on future employment. one item - linking obesity to access to poor foods - showed to be a highly significant predictor for support of all three policies. support for preventive measures was highest for childhood prevention and informational campaigns (89. the societal side of stigma consequence, according to attribution theory [7], the attribution of obesity to internal factors leads to negative reactions and less empathy and willingness to help the affected individual.

Stigma, obesity, and the health of the nation's children.

this may require education about the complex causes of obesity and the harmful consequences of stigma, recognition of the difficulties of obtaining significant and sustainable weight loss, efforts to challenge weight‐based stereotypes, promotion of weight tolerance in multiple settings where bias is present, and legislation to prohibit inequities based on body weight. introducing a multidimensional concept of the etiology of obesity to the lay public might be a starting point in stigma reduction. a recent review summarizes discrimination and stigmatizing attitudes [4], so far, causal beliefs on obesity have not been summarized in a comprehensive review yet. additionally, patients' obesity was unrelated to provider discussions regarding nutrition. block and colleagues found that internal medicine residents (n = 87) had a poor grasp of the tools necessary to identify and evaluate obesity. although relatively few cases have been filed using this approach (200), and only “morbid obesity” is potentially protected as a “perceived disability” status (14), there has been an increase in the number of perceived disability discrimination claims in recent years (199) with obese plaintiffs achieving more success than cases where obesity‐related actual disability claims are filed (199). toall how tochemicals & bioassaysdna & rnadata & softwaredomains & structuresgenes & expressiongenetics & medicinegenomes & mapshomologyliteratureproteinssequence analysistaxonomytraining & tutorialsvariationabout ncbi accesskeysmy ncbisign in to ncbisign out. coverage on obesity emphasizes internal, controllable factors of the condition while neglecting societal contributions [34]. study aimed at reviewing a) prevalence of stigmatizing attitudes, b) causal attribution of obesity of the lay public and its predictors as well as c) determinants of prevention support. found that frequency of weight stigma experiences was positively associated with depression in a sample of 93 treatment‐seeking obese adults, even after controlling for the effects of age, gender, age of obesity onset, and bmi (152). longitudinal studies are needed to determine whether, and to what degree, experiences of weight stigma are responsible for increases in psychological symptoms, and to examine the effects of childhood weight‐based teasing over time. another study examined the relationship between childhood weight‐based teasing and psychological functioning in 174 bariatric surgery candidates, demonstrating that teasing history was associated with higher levels of depression, even after controlling for childhood onset of obesity (156). relatively few studies have examined these questions, but emerging research over the past several years suggests that weight bias may increase vulnerability to maladaptive eating behaviors and avoidance of physical activity, both of which may ultimately reinforce additional weight gain and obesity. participants were 185 adults in the trevose behavior modification program; an obesity treatment model that includes the unusual strategy of requiring members to lose a prescribed minimum amount of weight each month (or to maintain weight loss after reaching their goal weight), and members who do not meet these standards are subject to dismissal from the program. attribution described in 7 specific metaphors:obesity as sinful behaviour; a disability; a form of eating disorder; a food addiction; a reflection of time crunch; a consequence of manipulation by commercial interests; as result of a toxic food environmentfor what percentage of overweight americans does [metaphor] account for? the authors assessed agreement with two items on each factor of possible explanations of obesity (genetics, environmental and personal attribute). furthermore, discussions of obesity were influenced by pre‐existing cultural and moral understandings about fatness, which tend to focus on individual willpower (131). research was funded by the rudd center for food policy and obesity at yale university. studies analyzing data from the national longitudinal survey of youth suggest that obesity also negatively affects wages. another study of 510 family physicians found that 72% believed that they had limited efficacy in treating obesity and considered themselves poorly prepared by their medical training to treat overweight patients. additionally, a 2007 study using data from the national longitudinal study of adolescent health n = 10,829) reported that obesity undermined the educational attainment of female students. it is interesting to note that references to personal solutions for obesity continue to outnumber references to personal causes (128). of obesity to internal causes still seems a major source of stigmatization and discrimination of obese individuals which provides an ideal starting point for intervention approaches: introducing a multidimensional concept of the etiology of obesity to the public ought to help reduce stigmatization. to this date, prevalence rates of obesity are still rising. and methodological limitationsa recent article in newsweek titled “the obese should have to pay more for airline tickets,” referred to instituting weight surcharges for airplane tickets as an added “social disincentive to obesity” and further eluded to “drilling fat people for fuel” (134).

The Stigma of Obesity: A Review and Update - Puhl - 2009 - Obesity

linking obesity to a bad food environment which, as mentioned before, might be a factor associated with internal control, positively predicts prevention support. in a study of 15,061 respondents to the 1996 health survey for england, obesity was associated with lower educational attainment in both men and women (86). review was prepared according to the systematic literature review guidelines of the centre for reviews and dissemination [20] and follows prisma (preferred reporting items for systematic reviews and meta-analyses) suggestions [21]. in light of the immense burden of obesity on health care systems and also on the individuals' quality of life, accepted and subsidized preventive measures are needed. since obesity is a widespread condition, representative research is needed in order to come to reliable conclusions. the authors declare obesity to be a sign of underlying causes that lead a positive energy intake balance. this relationship was mediated by internal attributions about the causes of obesity. in a study of fitness professionals (n = 325), 62% agreed that obesity is a significant cause of personal rejection, and most participants believed that personal factors such as sedentary lifestyle, poor eating behaviors, and psychological problems were the most important causes of obesity (50). most studies found in the process of literature search investigated the opinion of the u. weight bias may also mediate the relationship between obesity and self‐esteem. research on public attitudes toward and perception of overweight and obesity is urgently needed to depict the prevailing degree of stigmatization for several reasons. crandall & moriarty conclude from their study that the more a disease is perceived as under volitional control, the more it is stigmatizing - with obesity generally being perceived as highly under control [10, 11]. in a british study of 398 nurses, nearly 69% agreed that personal choices about food and physical activity explain why a person becomes obese, one‐third agreed that obesity is due to a lack of willpower concerning food, and only 8. in light of the immense burden of obesity on health care systems and also on the individuals' quality of life, accepted and subsidized preventive measures are needed. furthermore, a greater perceived significance of obesity, stronger societal responsibility for a solution to the obesity problem, and more causal attribution of obesity to lack of activity behavior showed to be significant associations of prevention support [2]. policy support might be determined by views of the lay public on causes of obesity and resulting weight stigma. it seems, however, that the public acknowledges the multicausality of obesity to some extent. research suggests that obesity negatively affects dating relationships for women. after adjusting for sociodemographic characteristics, smoking status, exercise, and self‐reported health, obesity was associated with reduced employment for both men and women (18). results of the systematic literature search are shown in figure 1. policy support might be determined by views of the lay public on causes of obesity and resulting weight stigma. coverage on obesity emphasizes internal, controllable factors of the condition while neglecting societal contributions [34]. attribution of obesity to be a result of the food environment contributed to variance explanation the most. entered into a regression equation with stigmatizing attitudes as the dependent variable, causal attribution of obesity to behavior (internal) contributed to the explanation of variance the most (r2 = 0. specifically, research is needed to determine the most effective ways to educate providers' about weight bias in health care, dispel damaging obesity stereotypes, and to promote strategies to improve patient care. Resume falsification and legal consequences

Weight stigma is stressful. A review of evidence for the Cyclic

a recent review by puhl & heuer (2009) finds disadvantages for obese people in numerous areas, including employment, health care settings as well as in interpersonal relationship aspects [4]. thus, despite a broader understanding of the causes of obesity, solutions remain within the individual (131). examining obese treatment samples have demonstrated that a history of appearance‐based teasing is related to lower self‐esteem (153), and that greater frequency of stigmatization experiences predicts low self‐esteem even after controlling for differences in psychological functioning due to age, gender, age of obesity onset, and bmi (152). in light of the immense burden of obesity on health care systems [14, 15], prevention efforts that are accepted and potentially subsidized by the public are crucial to obviate a further rise in obesity prevalence rates. especially women seem to acknowledge this circumstance, seeing the food environment as an important contributor to the obesity problem. this is, however, the first review to focus on nationally representative studies.., aids and cancer), the media seldom discusses the implications of its perspective on those affected by obesity, which may be damaging to individuals' health by invoking feelings of shame, guilt, and inadequacy. across the studies found, regulative prevention is supported by about half of the population, while childhood prevention has highest approval rates. most studies found in the process of literature search investigated the opinion of the u. the authors assessed agreement with two items on each factor of possible explanations of obesity (genetics, environmental and personal attribute). furthermore, a greater perceived significance of obesity, stronger societal responsibility for a solution to the obesity problem, and more causal attribution of obesity to lack of activity behavior showed to be significant associations of prevention support [2]. however, for obese individuals to qualify under this statute their obesity must meet the definition of a disability and be established from a physiological cause, making it difficult for most people to successfully bring discrimination claims (195,196). the principal author and mk conducted the literature search and screened abstracts and titles. providers who endorsed negative attitudes toward obese patients were less likely to subscribe to medical journals, suggesting that gps may not have been familiar with current research examining the complex causes of obesity (32). (2009) by assessing perceived causes of obesity with metaphors, both, metaphors displaying high individual blame (obesity as a sinful behavior, an addiction) and metaphors with low individual blame (industry manipulation, toxic food environment) are seen as important or very important explanations [22]. however, patients (n = 599) in the study were more likely to attribute obesity to medical causes or low income (42). regression analyses demonstrated that obesity itself was not distressing, and that obese persons reported better emotional health than thinner peers after controlling for a number of obesity‐related stressors. commentshow to join pubmed commonshow to cite this comment:Ncbi > literature > pubmed. advancements in research have occurred since the 2001 review of literature on weight bias. in addition, when participants were provided with information emphasizing internal, controllable causes of obesity, negative attitudes worsened further (124). a further study on a number of health problems including obesity found perceptions of level of severity and behavioral causation of these conditions to predict greater social rejection [7]. both studies found there to be a strong implicit antifat bias among clinicians and researchers specializing in obesity. in a third experiment, the social consensus approach remained predictive of positive attitude change for participants (n = 200) when this method was compared to other stigma‐reduction interventions (such as providing causal information about obesity). are several possible explanations for links observed between obesity and lower educational attainment, one of which is weight bias. regarding causal attribution as a potential origin of stigmatizing attitudes towards obesity, this review shows that causes that are within the individual's control are named most frequent in population surveys and yield high agreement rates. Rick astley college paper

Mental Health, Wellness, and Childhood Overweight/Obesity

., laziness, lack of willpower) stem from perceptions that the causes of obesity are within personal control, more empirical work is needed to test whether, and in what circumstances, strategies targeting causal attributions can effectively reduce bias. in light of the immense burden of obesity on health care systems [14, 15], prevention efforts that are accepted and potentially subsidized by the public are crucial to obviate a further rise in obesity prevalence rates. one study has reported that fitness professionals generally consider counseling obese patients for weight loss to be professionally gratifying (50), most studies demonstrate that health professionals feel that treating obesity is professionally unrewarding (32,33,34,37,54). rosenberger and colleagues examined correlates of childhood weight‐based teasing in 174 bariatric surgery candidates, and found no differences in the frequency of binge‐eating or dietary restraint among patients who reported a history of weight‐based teasing in childhood vs.. gov'treviewmesh termsadolescentadolescent behavior/psychologyadultattitudechildchild behavior/psychologychild welfare/psychology*child, preschoolfemalehealth status*humansmaleobesity/psychology*prejudice*social behaviorlinkout - more resourcesfull text sourcesamerican psychological associationovid technologies, inc. despite this rise in awareness and willingness to accept obesity as a chronic condition of clinical significance, obese individuals are subject to a high level of stigmatization resulting in discrimination [3]. is also possible that other social factors can help explain the relationship between obesity and educational attainment. review was prepared according to the systematic literature review guidelines of the centre for reviews and dissemination [20] and follows prisma (preferred reporting items for systematic reviews and meta-analyses) suggestions [21]. this study seeks to answer how representative samples of the lay public perceive people with obesity or overweight status (stigmatizing attitudes); what these samples attribute obesity to (causal attribution) and what types of interventions are supported by the lay public and which factors determine that support (prevention support). since the previous review on this topic in 2001, the growing literature indicates that weight bias remains persistent in settings of employment, health care, and education. in one united kingdom study, gps (n = 89) reported a victim‐blaming approach toward obesity, deeming the individual responsible for both the cause (e. these findings suggest that it is not just the history of being overweight in childhood that is important, but that weight‐based teasing may play a key role in vulnerability to depression. stigma of obesity in the general public and its implications for public health - a systematic reviewclaudia sikorski1, 2email author, melanie luppa2, marie kaiser3, heide glaesmer3, georg schomerus4, hans-helmut könig5 and steffi g riedel-heller2bmc public health201111:661doi: 10. furthermore, residents who felt unqualified to treat obese patients were more likely to agree that behavioral factors were the primary cause of obesity (56). support for preventive measures was highest for childhood prevention and informational campaigns (89. therefore, when female obesity was not the norm in the educational setting, obese women experienced greater educational disadvantages. participants also discussed concerns about the stigmatized nature of obesity and expected to face negative stereotypes in primary care, however, mentioned the possibility of nurse‐led support groups as an avenue for improving health‐care services (61). and physical health consequences of weight biasgiven the accumulation of literature documenting weight bias in multiple domains of living, it is critical to determine its impact on emotional and physical health outcomes for overweight and obese individuals. puhl and heuer (2010) review a number of studies showing that perceived stigmatization and discrimination results in unhealthy eating behavior, potential eating disorders and lower levels of physical activity, all leading way to further weight gain [16]. it is also important to determine the relative contribution of weight bias compared to other social and economic factors that can potentially explain the relationship between obesity and educational success. the aim of this article is to provide an update of scientific evidence on weight bias toward overweight and obese adults through a systematic review of published literature since the 2001 article by puhl and brownell. together, these factors provide basis for a further rise in obesity prevalence rates [4]. the societal side of stigma consequence, according to attribution theory [7], the attribution of obesity to internal factors leads to negative reactions and less empathy and willingness to help the affected individual. puhl and heuer (2010) review a number of studies showing that perceived stigmatization and discrimination results in unhealthy eating behavior, potential eating disorders and lower levels of physical activity, all leading way to further weight gain [16].%) agreed a bad food environment to be one possible cause of obesity. Screwtape letters book report

The stigma of obesity in the general public and its implications for

coverage of obesity has increased dramatically in recent years (130), and studies show that coverage of the personal causes and solutions to obesity significantly outnumber other societal attributions of responsibility (128). together, these factors provide basis for a further rise in obesity prevalence rates [4]. attribution: 3 scales covering behaviour, environment and heredity[23]oliver & lee, 2005;usa909nationally representative;rdd-sampling; american attitudes towards obesity (aato) survey. one prospective study of 5,467 individuals in scotland found that family and neighborhood factors explained much of the association between lower educational attainment and bmi, which was independent of childhood intelligence (93). for obesity, the negativity of attributes can be explained by the influence of causal beliefs and responsibility. despite feeling unprepared to treat obesity, 60% of the gps set stricter weight loss standards for their patients than recommended guidelines (32). instruments applied in the investigations were primarily constructed by the authors themselves and were based on previous research and current literature. especially women seem to acknowledge this circumstance, seeing the food environment as an important contributor to the obesity problem. the authors suggested that discrimination in training opportunities may explain some of the obesity wage penalty, although it should be noted that they did not test for employer‐based discrimination. these findings parallel previous work documenting improved attitudes following an intervention that highlighted external, noncontrollable reasons for obesity (123). mediathe framing of obesity in the news media is integral to the public's understanding of obesity. examined the relationship between obesity and emotional well‐being in a nationally representative sample of 3,353 american adults (161). in addition, coping strategies emerged as the only significant predictor of self‐esteem, even after controlling for current and previous weight, age, and beliefs about obesity. a systematic literature search available on the electronic databases medline, web of science, psyndexplus, embase and cochrane library was conducted in february 2011. this study seeks to answer how representative samples of the lay public perceive people with obesity or overweight status (stigmatizing attitudes); what these samples attribute obesity to (causal attribution) and what types of interventions are supported by the lay public and which factors determine that support (prevention support). attribution described in 7 specific metaphors:obesity as sinful behaviour; a disability; a form of eating disorder; a food addiction; a reflection of time crunch; a consequence of manipulation by commercial interests; as result of a toxic food environmentfor what percentage of overweight americans does [metaphor] account for? yet, the number of studies testing bias‐reduction strategies pales in comparison to the amassing literature documenting weight stigma in multiple settings. there is some concern that the americans with disabilities act could create additional stigma and backlash by suggesting that obesity is a disabling condition (193). further variables predicting higher stigmatizing attitudes were less education, not seeing obesity as an illness, older age and fewer causal attribution of obesity to heredity. especially the review of sociodemographic influences on prevalence of stigmatizing attitudes, causal attribution and prevention support was restricted by the scarce number of studies. in addition, issues pertaining to measurement of weight stigmatization, and demographic variables affecting vulnerability to weight bias such as gender, age, race, and body weight are not addressed in this review. although nurses were aware that obesity is a stigmatized condition and were careful to avoid weight‐based stereotypes, some expressed frustration with patients' noncompliance and wanting an “easy way out”. review shows that reliable, population-based studies on the stigma of obesity are not yet sufficient in number and comparability. it seems, however, that the public acknowledges the multicausality of obesity to some extent. similar findings have been documented for bariatric patients, where teasing history was associated with lower levels of self‐esteem, after controlling for age of obesity onset (156), and among bulimia nervosa patients (154). Six sigma essay paper

Obesity Stigma: Important Considerations for Public Health

Moving Beyond the Stigma: Systematic Review of Video Games and

assessed support of three categories of prevention efforts (information, regulation and childhood prevention). although much research is needed to address this health crisis, it is important to approach childhood obesity with an understanding of the social stigma that obese youths face, which is pervasive and can have serious consequences for emotional and physical health. this review expands upon previous findings of weight bias in major domains of living, documents new areas where weight bias has been studied, and highlights ongoing research questions that need to be addressed to advance this field of study. and methodological limitationsbuilding upon the evidence reviewed by puhl and brownell (2), recent studies confirm that obese patients encounter prejudice, ambivalence, and oftentimes unsatisfactory treatment in health care. one study provided participants with written information that emphasized biological, genetic, and noncontrollable causes of obesity, which significantly improved participants' attitudes compared to a control group. report results of agreement with different perceived causes of obesity that were allocated to underlying factors [2]. 2001, puhl and brownell published the first comprehensive review of several decades of research documenting bias and stigma toward overweight and obese persons (2). health professionals also report feeling professionally unprepared to treat obesity. information1rudd center for food policy & obesityyale university, new haven, ct 06520-8369, usa. without sufficient attention to this issue in the obesity field and in larger society, it is likely that weight bias will remain both a social injustice and a public health issue, impairing the quality of life for both present and future generations of obese individuals. a british qualitative study, primary care physicians (n = 21) reported beliefs that obesity was caused by an unhealthy diet and lack of exercise and that it was the responsibility of the patients themselves to manage their weight. professionals' attitudes toward obese patientsin recent years, increasing research in the united states and abroad demonstrate that health‐care providers in a range of specialty areas endorse stereotypical assumptions about obese patients and attribute obesity to blameworthy causes. given that empathy induction has been demonstrated to be an effective strategy for promoting positive attitudes toward other stigmatized groups (186), it may be that certain forms of bias, such as obesity, are resistant to these strategies. (2009) by assessing perceived causes of obesity with metaphors, both, metaphors displaying high individual blame (obesity as a sinful behavior, an addiction) and metaphors with low individual blame (industry manipulation, toxic food environment) are seen as important or very important explanations [22]. in their 2007 review, puhl and latner examine research demonstrating that teachers report stigmatizing attitudes toward obese students (8). one indicator of such an association might be that this review shows highest support rates for childhood prevention but lowest rates for an increase in taxes and other regulative measures. stigma of obesity in the general public and its implications for public health - a systematic reviewclaudia sikorski1, 2email author, melanie luppa2, marie kaiser3, heide glaesmer3, georg schomerus4, hans-helmut könig5 and steffi g riedel-heller2bmc public health201111:661doi: 10. childhood obesity has become a top priority in efforts to improve our nation's public health. this report reviews existing research on weight stigma in children and adolescents, with attention to the nature and extent of weight bias toward obese youths and to the primary sources of stigma in their lives, including peers, educators, and parents. and thompson conducted qualitative interviews of 15 primary care nurses in england concerning their attitudes and beliefs toward obesity management. alternative approach for protection under the americans with disabilities act involves proof that the plaintiff's obesity is perceived by others (e. nurses with lower bmis expressed more negative perceptions of obesity. research on public attitudes toward and perception of overweight and obesity is urgently needed to depict the prevailing degree of stigmatization. as researchers and health‐care providers in the obesity field working to improve the lives of obese individuals, we cannot ignore the importance of addressing weight bias in these efforts, which must be considered alongside goals for effective prevention and treatment of obesity. physicians also viewed obesity as largely a behavioral problem caused by physical inactivity and overeating (30).

Weight Bias in the Workplace: A Literature Review | Open Access

of obesity to internal causes still seems a major source of stigmatization and discrimination of obese individuals which provides an ideal starting point for intervention approaches: introducing a multidimensional concept of the etiology of obesity to the public ought to help reduce stigmatization. research shows that the news media often frames obesity in terms of personal responsibility (127,128,129), focusing on individual causes of obesity (e. several studies have documented significant, positive associations between experiences of weight stigma and body dissatisfaction, among both nonclinical samples (160,163) and clinical samples of obese persons (152,153,164), and even after controlling for a range of variables such as bmi, gender, age, obesity onset (152,156). fifty‐six percent of residents did not feel qualified to treat obese patients and one‐third believed that treating obesity was futile. there was not a direct association between weight stigma and self‐reported exercise behaviors, which may be attributed to the low levels of obesity among sample participants. as this review shows, prevalence of stigmatizing attitudes is rather high. as with the 2001 article, this review also provides an update on legal initiatives to combat weight discrimination, and outlines specific questions for future research. a 2006 review of research focusing on nurses' attitudes toward adult overweight and obese patients reported that nurses consistently express biased attitudes toward obese patients, reflecting common weight‐based stereotypes that obese patients are lazy, lacking in self‐control, and noncompliant (41). the authors also examine the literature on psychosocial and physical health consequences of childhood obesity to illustrate the role that weight stigma may play in mediating negative health outcomes. the authors suggest that the strong association between self‐reported health status and patient satisfaction in the study may have masked a relationship between obesity and lower satisfaction (62). since obesity is a widespread condition, representative research is needed in order to come to reliable conclusions. literature sourcescos scholar universemedicalobesity - genetic alliancechildren's health - medlineplus health informationobesity in children - medlineplus health informationobesity - medlineplus health informationpubmed commons home. gps ranked patient noncompliance and lack of motivation as the most important problems they experienced in treating obesity (33). linking obesity to a bad food environment which, as mentioned before, might be a factor associated with internal control, positively predicts prevention support. crandall & moriarty conclude from their study that the more a disease is perceived as under volitional control, the more it is stigmatizing - with obesity generally being perceived as highly under control [10, 11]. results of the systematic literature search are shown in figure 1. this article instead primarily reviews the evidence of specific areas where weight bias occurs toward adults and its consequences for those affected. study aimed at reviewing a) prevalence of stigmatizing attitudes, b) causal attribution of obesity of the lay public and its predictors as well as c) determinants of prevention support. hague and white tested an educational intervention delivered through an online course, which covered topics including the causes of obesity, consequences of weight stigma, social pressures to be thin, strategies to reduce weight bias in school settings, and ways to help students cope with stigma (189). only a handful of experimental studies targeting bias‐reduction have been published, yielding mixed findings (refer to (8) for review of bias‐reduction studies targeting youth). this focus on personal responsibility eclipses other important dimensions of the obesity epidemic and often unfairly blames obese individuals, potentially reinforcing weight bias. one indicator of such an association might be that this review shows highest support rates for childhood prevention but lowest rates for an increase in taxes and other regulative measures. entered into a regression equation with stigmatizing attitudes as the dependent variable, causal attribution of obesity to behavior (internal) contributed to the explanation of variance the most (r2 = 0. students indicated that their denigration of obese patients was due to both the assumption that patients were to blame for their condition and because patients' obesity caused extra work for students. despite this rise in awareness and willingness to accept obesity as a chronic condition of clinical significance, obese individuals are subject to a high level of stigmatization resulting in discrimination [3].

Disease and Stigma: A Review of Literature

Stigmatisation and obesity: literature update

studies have examined the effect of obesity or weight stigma on sexual relationships. research on public attitudes toward and perception of overweight and obesity is urgently needed to depict the prevailing degree of stigmatization for several reasons. systematic literature search of studies published between january 2000 and may 2008 was undertaken on computerized psychological, medical, social science, sport, and education databases including psycinfo, pubmed, scopus, eric, and sportdiscus. a further study on a number of health problems including obesity found perceptions of level of severity and behavioral causation of these conditions to predict greater social rejection [7]. support (11, information-based campaigns, regulatory measures and childhood-focused measures):rating of support. indeed, research has documented increases in physiological stress and cardiovascular reactivity in response to racial discrimination (181,182), as well as increased vulnerability to abdominal obesity and glucose intolerance among dominican women who internalize negative racial stigma (183). review shows that reliable, population-based studies on the stigma of obesity are not yet sufficient in number and comparability. further variables predicting higher stigmatizing attitudes were less education, not seeing obesity as an illness, older age and fewer causal attribution of obesity to heredity. a systematic literature search available on the electronic databases medline, web of science, psyndexplus, embase and cochrane library was conducted in february 2011. similarly, some research suggests that physicians and patients have different perceptions about the causes of obesity, which may influence endorsement of weight stigma. through an analysis of 751 articles on obesity published in the new york times between 1990 and 2001, boero demonstrated that obesity was presented as a moral panic through which blame is placed on individuals. experimental studies have attempted to improve attitudes among adults by addressing attributions about the causality of obesity. attribution: 3 scales covering behaviour, environment and heredity[23]oliver & lee, 2005;usa909nationally representative;rdd-sampling; american attitudes towards obesity (aato) survey. support (11, information-based campaigns, regulatory measures and childhood-focused measures):rating of support. a recent review by puhl & heuer (2009) finds disadvantages for obese people in numerous areas, including employment, health care settings as well as in interpersonal relationship aspects [4]. gps also considered “eating too much' as the most important risk factor for obesity, ranked above genetic and environmental factors. however, in schools where female obesity was more prevalent, obese students had the same chance of attending college as nonobese students. for example, recent research shows that primary care physicians (n = 620) felt ill‐equipped to treat obesity and believe that treatment is futile. reference lists of retrieved articles and books were also reviewed, and manual searches were conducted in the databases and journals for authors who had published in this field.-utilitiesjournals in ncbi databasesmesh databasencbi handbookncbi help manualncbi newspubmedpubmed central (pmc)pubmed clinical queriespubmed healthall literature resources. most studies retrieved for this review were published in the united states. retrospective research has demonstrated that a history of appearance‐based teasing in childhood was associated with depression among adult women with binge‐eating disorder (bed) (153,154), and among patients with bulimia nervosa (154). other research indicates that weight‐based teasing in adulthood may be particularly relevant in predicting body dissatisfaction compared to weight‐based teasing in childhood, which has not been found to be associated with body image among clinical samples of obese women (164,165,166). addition, considering that providers' often report blameful explanations for the causes of obesity, one key educational component may be to increase providers' awareness about the complex etiology of obesity and the difficulties involved in obtaining significant and sustainable weight loss. in a first experiment, participants (n = 60) who received favorable consensus feedback (suggesting that others held more favorable beliefs about obese people than they did) reported fewer negative attitudes and more positive attitudes toward obese persons, and attributed obesity less to personal control compared to their reported attitudes prior to feedback.

Stigma, obesity, and the health of the nation's children.

unfortunately, such offensive rhetoric is not unusual in media portrayals of obesity, which help shape social norms and negative attitudes about weight (122). differences in perceived motivation or causes of obesity between doctor and patient may hinder positive communication regarding weight management or healthy lifestyle changes (43). these findings are supported by another study demonstrating that the relationship between obesity and lower academic achievement was stronger in schools with a lower average body size among students (88). on a theoretical level, being perceived as a somewhat voluntary condition, the societal function of obesity stigma can be explained by a model of phelan and colleagues [36]. bertakis and azari, using a prospective design, investigated the impact of obesity on primary care by analyzing videotapes of 506 first‐time patient visits with 105 physicians (58). a recent review summarizes discrimination and stigmatizing attitudes [4], so far, causal beliefs on obesity have not been summarized in a comprehensive review yet. on a theoretical level, being perceived as a somewhat voluntary condition, the societal function of obesity stigma can be explained by a model of phelan and colleagues [36]. during the early 2000s only 2 to 3 per cent of the population considered obesity to be one of the most important health issues [1], while nowadays the majority in e. additional research is needed to test whether weight stigma impacts exercise behaviors at higher levels of obesity. assessed support of three categories of prevention efforts (information, regulation and childhood prevention). in recognition of evidence demonstrating that stigma‐induced stress may mediate the relationship between obesity and health, some researchers have proposed that psychological stress induced by weight stigma, in particular, may be a specific etiologic agent in the pathophysiology of obesity (184). aim of this systematic review was to provide an update of the existing evidence concerning weight bias and stigmatization toward overweight and obese adults in important domains of living., it does not appear that the increasing prevalence of obesity has attenuated negative societal attitudes toward obese people. chen and colleagues assessed the degree to which elevated depressed mood was associated with weight‐based stigma among surgery seeking obese patients (n = 60), and found that experiences of weight stigma contributed unique variance to depressed mood above and beyond bmi, gender, age of onset of obesity, physical disability, and binge‐eating status (155). annis and colleagues demonstrated that overweight women (n = 58) with more frequent experiences of weight stigmatization in childhood, adolescence, and adulthood were more likely to report depressive symptoms (160). however, it has been suggested that weight stigmatization may be one of these factors (150), and that weight‐based teasing may be a plausible mediator in the relationship between obesity and depression (151). introducing a multidimensional concept of the etiology of obesity to the lay public might be a starting point in stigma reduction. to this date, prevalence rates of obesity are still rising. for obesity, the negativity of attributes can be explained by the influence of causal beliefs and responsibility. despite there being no gender differences for age of onset of overweight, teasing experiences, self‐esteem or depression, findings indicated that childhood teasing about weight was a significant predictor of body dissatisfaction for women, but not for men. regarding causal attribution as a potential origin of stigmatizing attitudes towards obesity, this review shows that causes that are within the individual's control are named most frequent in population surveys and yield high agreement rates. the following keyword combinations were used: weight, obese, obesity, overweight, bmi, fat, fatness, size, heavy, large, appearance, big, heavyweight, bias, biased, discrimination, discriminatory, discriminate, stigma, stigmatized, stigmatization, prejudice, prejudicial, stereotype(s), stereotypical, stereotyping, victimization, victimize(d), blame(d), blaming, shame(d), shaming, teasing, tease(d), unfair, bully, bullying, harassment, assumptions, attributions, education, health, health care, sales, employment, wages, promotion, adoption, jury, customer service, housing, media, television. additional research is needed to determine the nature and extent of weight bias in social relationships, and to better understand how weight bias mediates the relationship between obesity and dissatisfaction in interpersonal relationships. 2000, two studies have employed the implicit association test to assess implicit antifat bias among health professionals who specialize in treating obesity. this study seeks to answer (a) how representative samples of the lay public perceive people with obesity or overweight status (stigmatizing attitudes); (b) what these samples attribute obesity to (causal attribution) and (c) what types of interventions are supported by the lay public and which factors determine that support (prevention support).

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