Cross-national perspectives about weight-based bullying in youth: nature, extent and remedies.

BACKGROUND: No cross-national studies have examined public perceptions about weight-based bullying in youth. OBJECTIVES: To conduct a multinational examination of public views about (i) the prevalence/seriousness of weight-based bullying in youth; (ii) the role of parents, educators, health providers and government in addressing this problem and (iii) implementing policy actions to reduce weight-based bullying. METHODS: A cross-sectional survey of adults in the United States, Canada, Iceland and Australia (N = 2866). RESULTS: Across all countries, weight-based bullying was identified as the most prevalent reason for youth bullying, by a substantial margin over other forms of bullying (race/ethnicity, sexual orientation and religion). Participants viewed parents and teachers as playing major roles in efforts to reduce weight-based bullying. Most participants across countries (77-94%) viewed healthcare providers to be important intervention agents. Participants (65-87%) supported government augmentation of anti-bullying laws to include prohibiting weight-based bullying. Women expressed higher agreement for policy actions than men, with no associations found for participants' race/ethnicity or weight. Causal beliefs about obesity were associated with policy support across countries. CONCLUSIONS: Across countries, strong recognition exists of weight-based bullying and the need to address it. These findings may inform policy-level actions and clinical practices concerning youth vulnerable to weight-based bullying.

A multinational examination of weight bias: predictors of anti-fat attitudes across four countries.

BACKGROUND/OBJECTIVES: As rates of obesity have increased throughout much of the world, so too have bias and prejudice toward people with higher body weight (that is, weight bias). Despite considerable evidence of weight bias in the United States, little work has examined its extent and antecedents across different nations. The present study conducted a multinational examination of weight bias in four Western countries with comparable prevalence rates of adult overweight and obesity. METHODS: Using comprehensive self-report measures with 2866 individuals in Canada, the United States, Iceland and Australia, the authors assessed (1) levels of explicit weight bias (using the Fat Phobia Scale and the Universal Measure of Bias) and multiple sociodemographic predictors (for example, sex, age, race/ethnicity and educational attainment) of weight-biased attitudes and (2) the extent to which weight-related variables, including participants' own body weight, personal experiences with weight bias and causal attributions of obesity, play a role in expressions of weight bias in different countries. RESULTS: The extent of weight bias was consistent across countries, and in each nation attributions of behavioral causes of obesity predicted stronger weight bias, as did beliefs that obesity is attributable to lack of willpower and personal responsibility. In addition, across all countries the magnitude of weight bias was stronger among men and among individuals without family or friends who had experienced this form of bias. CONCLUSIONS: These findings offer new insights and important implications regarding sociocultural factors that may fuel weight bias across different cultural contexts, and for targets of stigma-reduction efforts in different countries.

Obesity and psychosocial impairment: mediating roles of health status, weight/shape concerns and binge eating in a community sample of women and men.

OBJECTIVES: We examined the relative importance of physical health status, weight/shape concerns and binge eating as mediators of the association between obesity and psychosocial impairment in a community sample of women and men. METHODS: Self-report measures of eating disorder features, perceived physical health and psychosocial functioning were completed by a general population sample of women and men classified as obese or non-obese (women: obese=276, non-obese=1220; men: obese=169, non-obese=769). Moderated mediation analysis was used to assess the relative importance of each of the putative mediators in accounting for observed associations between obesity and each outcome measure and possible moderation of these effects by sex. RESULTS: Weight/shape concerns and physical health were equally strong mediators of the association between obesity and psychosocial impairment. This was the case for both men and women and for each of three measures of psychosocial functioning-general psychological distress, life satisfaction and social support-employed. The effects of binge eating were modest and reached statistical significance only for the life satisfaction measure in men. CONCLUSIONS: A greater focus on body acceptance may be indicated in obesity prevention and weight-management programs.

Obesity discrimination: the role of physical appearance, personal ideology, and anti-fat prejudice.

OBJECTIVE: Self-report measures of anti-fat prejudice are regularly used by the field, however, there is no research showing a relationship between explicit measures of anti-fat prejudice and the behavioral manifestation of them; obesity discrimination. The present study examined whether a recently developed measure of anti-fat prejudice, the universal measure of bias (UMB), along with other correlates of prejudicial attitudes and beliefs (that is, authoritarianism, social dominance orientation; SDO, physical appearance investment) predict obesity discrimination. METHOD: Under the guise of a personnel selection task, participants (n=102) gave assessments of obese and non-obese females applying for a managerial position across a number of selection criteria (for example, starting salary, likelihood of selecting). Participants viewed resumes that had attached either a photo of a pre-bariatric surgery obese female (body mass index (BMI)=38-41) or a photo of the same female post-bariatric surgery (BMI=22-24). Participants also completed measures of anti-fat prejudice (UMB) authoritarianism, SDO, physical appearance evaluation and orientation. RESULTS: Obesity discrimination was displayed across all selection criteria. Higher UMB subscale scores (distance and negative judgement), authoritarianism, physical appearance evaluation and orientation were associated with greater obesity discrimination. In regression models, UMB 'distance' was a predictor of obesity discrimination for perceived leadership potential, starting salary, and overall employability. UMB 'negative judgement' predicted discrimination for starting salary; and authoritarianism predicted likelihood of selecting an obese applicant and candidate ranking. Finally, physical appearance evaluation and appearance orientation predicted obesity discrimination for predicted career success and leadership potential, respectively. CONCLUSION: Self-report measures of prejudice act as surrogates for discrimination, but there has been no empirical support for the validity of explicit measures of anti-fat prejudice. Here, the UMB, authoritarianism, and physical appearance investment predicted obesity discrimination. The present results provide support for the use of these measures by researchers seeking to assess, understand, and reduce anti-fat prejudice and discrimination.

Impulsivity in restrained eaters: emotional and external eating are associated with attentional and motor impulsivity.

The current study examined the relationships of motor, nonplanning, and attentional impulsivity to external and emotional eating among restrained eaters. Data were collected from a female college sample of restrained eaters (N=90). Aspects of impulsivity and disordered eating were assessed using the Barratt Impulsiveness Scale, Version 11, the Attentional Control Scale and the Dutch Eating Behavior Questionnaire. Significant correlations emerged between eating disturbances and different types of impulsivity. The results indicated that restrained eating is associated with motor and attentional forms of impulsivity. Emotional eating appears to be linked to both attentional and motor impulsivity whereas external eating seems to be linked only to motor impulsivity. Future studies should explore which aspects of disinhibited eating among restrained eaters are best predicted by a tendency to act impulsively.

Treatment seeking and barriers to weight loss treatments of different intensity levels among obese and overweight individuals.

Obesity is a major health concern for a large proportion of the population, yet many obese individuals do not receive weight loss treatment. The present study investigated weight-loss treatment seeking and barriers that may prevent treatment seeking. A community sample of overweight or obese participants (N=154; Mean BMI=33.3 kg/m2) completed an Internet survey assessing treatment seeking behaviors across three categories: Treatments Sought, Treatments Desired, and Treatments Planned. Seven treatments of different intensity levels and five barriers to treatment seeking were evaluated. The weight-loss treatment most frequently sought, desired, and planned was treatment "on own." Higher BMI was correlated with greater number of treatments sought. However, 10% of respondents reported zero treatments sought, and over 25% reported zero treatments desired or planned. Perceived barriers may explain reluctance to seek treatment. The top two barriers for all treatments were lack of money and time. Higher BMI was correlated with more total perceived barriers, and specifically with the barriers "I feel/think I am too heavy" and "I am afraid people will treat me unfairly or badly." More barriers were reported for more intensive treatments such as treatments from a doctor, another professional, or a commercial program. A majority of participants reported zero barriers to less-intensive treatments. These results suggest that many obese individuals who might benefit from weight loss treatment nevertheless do not plan or desire to seek treatment and perceive multiple barriers to treatments. However, these individuals could be encouraged to consider the less intensive treatments that are seen as more barrier-free.

Objective and subjective bulimic episodes in the classification of bulimic-type eating disorders: another nail in the coffin of a problematic distinction.

We sought to further explore the validity of the distinction between objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) in the study of bulimic-type eating disorders. Drawing on data obtained at the second, interview phase of a large-scale epidemiological study, we identified mutually exclusive subgroups of women with bulimic-type eating disorders who engaged in regular OBEs but not SBEs (n = 37) or regular SBEs but not OBEs (n = 52). These subgroups were compared on a wide range of outcomes, including socio-demographic characteristics, current levels of eating disorder psychopathology, general psychological distress and impairment in role functioning, current and lifetime impairment in quality of life specifically associated with an eating problem, (self)-recognition of an eating problem, health service utilization and use of psychotropic medication. The only difference between groups was that participants who reported regular OBEs were heavier than those who reported regular SBEs. The findings converge with those of previous research in suggesting that bulimic-type eating disorders characterized by regular SBEs, but not OBEs, do not differ in any clinically meaningful way from those characterized by regular OBEs, but not SBEs. Inclusion of bulimic-type eating disorders characterized by regular SBEs as a provisional category requiring further research in DSM-V appears warranted.

Unprompted generation of obesity stereotypes.

Prejudice towards obese people is widespread and has negative consequences for individuals with obesity. The present study covertly examined whether participants spontaneously generate different written transcript content (i.e., more negative stereotypes) when presented with a picture of an obese person or a normal-weight person. Two pictures of young women were computer generated to appear identical in all features except for body shape, which was either obese or normal-weight. Forty-nine women blind to the nature of the study were randomized to receive either the obese or normal-weight picture and asked to write a free-response description of a typical "day in the life" of the woman depicted. Independent coding of the transcripts revealed more frequent negative stereotypes and more negative valence generated by participants asked to describe a typical day of the obese target. These differences are consistent with the prevalent negative stereotypes of obese individuals.

Weighing obesity stigma: the relative strength of different forms of bias.

OBJECTIVE: To compare the strength of weight bias to other common biases, and to develop a psychometrically sound measure to assess and compare bias against different targets. SUBJECTS: A total of 368 university students (75.4% women, 47.6% white, mean age: 21.53 years, mean body mass index (BMI): 23.01 kg/m(2)). MEASUREMENTS: A measure was developed to assess bias against different targets. Three versions of the universal measure of bias (UMB) were developed and validated, each focusing on either 'fat,' 'gay' or 'Muslim' individuals. These were administered to participants, along with two established scales of bias against each target and a measure of socially desirable response style. RESULTS: The UMB demonstrated good internal consistency, appropriate item-total and inter-item correlations, and a clear factor structure suggesting components of Negative Judgment, Distance, Attraction and Equal Rights. Construct validity was indicated by strong correlations between established measures of bias and each corresponding version of the new scale. In contrast to previously established measures of weight bias, the new measure was independent of socially desirable response style. Although homosexual orientation was associated with lower gay bias (P<0.05), greater BMI was not associated with any decrease in weight bias. When comparing the relative strength of bias against different targets, weight bias was significantly greater than bias against both gays and Muslims (P<0.001). CONCLUSION: Weight bias is significantly stronger than other major targets of bias. This is the first study to develop a universal measure to assess bias against different targets. The excellent psychometric properties of this measure will permit further investigation into the relative severity of different types of prejudice over time and across samples. The present findings suggest that the pervasive discrimination against obese individuals may be more socially acceptable than discrimination against other groups.

Self-help and long-term behavior therapy for obesity.

The Trevose Behavior Modification Program, a self-help group offering continuing care for obesity, has recently been shown to produce large long-term weight losses. The present study aimed to replicate this finding across different settings and participants, assessing the weight losses and attrition rates of 128 participants in three Trevose program satellite groups that used the same treatment procedures and manual as the central Trevose group. The satellite groups' results closely paralleled those of the Central Group. Mean intent-to-treat weight loss, or final losses recorded for all participants regardless of their treatment termination date, was 13.7 +/- 0.7% of initial body weight (1.8 +/- 0.7 kg). At two years, 43.8% of participants remained in treatment, having lost a mean of 19.0 +/- 0.8% of their body weight (16.2 +/- 1.0 kg); at five years, 23.4% remained, having lost 18.4 +/- 1.1% of body weight (15.6 +/- 1.5 kg). These results demonstrate that the Trevose model of weight control, combining self-help and continuing care, can be extended and disseminated to other settings, with potentially significant public health consequences.

Self-help in the long-term treatment of obesity.

Despite the short-term success of professional behavioural techniques for obesity, weight losses are typically regained following treatment. The long-term maintenance of treatment effects will probably require ongoing, continuing care. Continuing care may be economically feasible when administered through self-help treatment modalities. Self-help confers a number of psychological benefits, such as self-reliance and an increased sense of empowerment. The effectiveness and cost-effectiveness of various modalities of self-help are reviewed, including purely self-prompted help, self-administered manuals, computer-assisted therapy, professionally assisted correspondence courses, and non-profit and commercial self-help groups. Stepped-care models suggest using a combination of these approaches when appropriate. However, logistical difficulties present themselves in stepped-care approaches with obesity, such as the complicating effects of severity and comorbidity on stepped-care status. Self-help groups are a promising venue for the provision of continuing care and as an adjunct to more intensive, specialty therapies.

Effective long-term treatment of obesity: a continuing care model.

BACKGROUND: Despite the well-documented success of behavioral techniques in producing temporary weight loss, treatment is typically followed by weight regain. The maintenance of treatment effects may therefore be the greatest challenge in the long-term management of obesity, and continuous care may be necessary to achieve it. OBJECTIVE: To describe the design and evaluate the effectiveness of the Trevose Behavior Modification Program, a potentially widely replicable self-help weight loss program offering continuous care. DESIGN: A description of the course of all subjects (n=171) who entered the Trevose program during 1992 and 1993. SUBJECTS: One hundred and forty-six women aged 44.1+/-11.7 y with a body mass index (BMI, kg/m2) of 33.2+/-4.4, and 25 men aged 49. 0+/-19.6 with a BMI of 35.1+/-5.2 enrolled in the Trevose program during 1992-1993. RESULTS: Mean duration of treatment was 27.1 months, with 47.4% of members still in treatment at 2 y and 21.6% at 5 y. Mean intent-to-treat weight loss was 13.7+/-0.5% of initial weight, or 12.8+/-0.5 kg. As long as they remained in treatment, almost all participants lost at least 5% of their initial weight and at least 83% lost more than 10%. Members completing 2 y of treatment lost an average of 19.3% of their initial body weight (17.9 kg); at 5 y the loss was still 17.3% (15.7 kg). After leaving the program, subjects regained weight but remained 4.7% (4.5 kg) below their pretreatment weight. CONCLUSION: A low-cost program offering treatment of indefinite duration produced large long-term weight losses and may be suitable for widespread replication.

Cognitive-behavioral therapy and nutritional counseling in the treatment of bulimia nervosa and binge eating.

The goals of manual-based cognitive-behavioral therapy (CBT) and nutritional counseling for eating disorders are similar, namely, eliminating dysfunctional patterns of eating. Modifying these behaviors requires specific therapeutic expertise in the principles and procedures of behavior change that is not typically part of the training of nutritionists and dieticians or mental health professionals without specific expertise. We discuss ways in which principles of behavior change can be applied to eating disorders by non-CBT experts. Specific nutritional rehabilitation programs have the potential to augment CBT in addressing the array of appetitive abnormalities present in eating disorder patients. The dysfunctional appetitive, hedonic, and metabolic characteristics of patients with bulimia nervosa (BN) and binge eating disorder are reviewed. These abnormalities constitute potential target areas that might be more fully addressed by nutritional interventions designed to restore normal appetitive function.

The effects of a high-carbohydrate, high-protein or balanced lunch upon later food intake and hunger ratings.

This study compared the satiating properties of three liquid lunches (450 kcal each), one dominant in protein (71.5% of energy), a second in carbohydrates (99% of energy) and a third containing an equal mixture of the first two formulations, in a within-subjects, repeated measures design. At an ad libitum dinner meal, 12 women consumed 31% more kilocalories in the high-carbohydrate lunch condition than in the high-protein lunch condition and 20% more kilocalories than in the mixture lunch condition. Similar results emerged for the amounts of protein and fat ingested at dinner. Subjects also reported significantly greater pre-dinner hunger and excitement about eating in the carbohydrate lunch condition than in the protein lunch condition. Greater enjoyment of dinner was also found after the carbohydrate lunch than after the mixture and protein lunches.