Living while fat: Development and validation of the Fat Microaggressions Scale.

Fat microaggressions are microlevel social practices in the form of commonplace everyday indignities that insult fat people and have been documented anecdotally and qualitatively. However, no psychometrically validated scale exists for measuring fat microaggressions, despite decades of microaggression research demonstrating their negative health associations. This research describes the development and construct validation of the Fat Microaggressions Scale across four studies. Study 1 focused on item development through a systematic review, qualitative analysis of Tweets using #fatmicroaggressions, and a Delphi review. Study 2 (N = 343) determined that a four-factor structure was appropriate in an online community sample of fat adults. Study 3 (N = 410) confirmed the factor structure in a new online sample of fat adults and provided initial evidence of construct validity. Study 4 (N = 197) found evidence of test-retest reliability and demonstrated additional construct validity. Our findings offer a newly validated quantitative measure of fat microaggressions and an initial framework for naming and categorizing these experiences, which may be used to advance the study of fat microaggressions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A systematic review of ecological momentary assessment studies on weight stigma and a call for a large-scale collaboration.

BACKGROUND: Weight stigma is associated with poor mental health correlates in cross-sectional research. Researchers are increasingly using Ecological Momentary Assessment (EMA) methods, collecting comprehensive within-person data to understand the temporal nature of weight stigma and its biopsychosocial correlates. AIM: To systematically review EMA studies on the effect of weight stigma on biopsychosocial correlates and integrate the findings. METHOD: PsycINFO, CINAHL, Embase, Medline Complete, and Web of Science were searched and studies were doubled screened (H.B. and X.P.G.). RESULTS: Twelve studies (N = 615) met our inclusion criteria. For both between- and within-subject effects, experienced and internalized weight stigmas were associated with negative correlates/outcomes (e.g., higher disordered eating and lower positive mood). However, studies differed in the correlate measures assessed, EMA methods used, and participant instructions provided. Given these inconsistencies, comparison across studies was difficult, and findings could not be reliably integrated. CONCLUSIONS: Consistent with previous research, studies from this review suggest weight stigma leads to adverse outcomes. EMA has the potential to overcome many of the limitations present in cross-sectional research on weight stigma and provide more ecologically valid and reliable results. We argue for a collaborative data-sharing consortium with standardized EMA methodologies, so researchers worldwide can contribute to and make use of a large, collective dataset on weight stigma and health correlates (see osf.io/s5ru6/).

Challenging oppression: A social identity model of stigma resistance in higher-weight individuals.

Many higher-weight individuals have internalised societal weight stigma, devaluing themselves because of their weight. Rejecting and challenging societal devaluation is generally associated with superior outcomes compared with stigma internalisation or inaction; however, stigma resistance has not been studied in higher-weight individuals, despite ubiquitous weight stigma in daily life. Applying a social identity framework, we utilised decision tree analysis to explore predictors of responses to weight stigma in 931 self-classified higher-weight individuals. While ingroup identification with the group 'Fat' was the major predictor of stigma resistance (versus internalisation), perceived illegitimacy of societal weight stigma defined a subgroup of resisters even in the absence of group identity. Interventions focusing on the illegitimacy of unequal social status and treatment may be effective at reducing internalisation and fostering resistance in a population with characteristically low ingroup identity.

Stigmatizing effects of weight status on lay perceptions of eating disorder-related distress.

The present study examined how weight status would affect lay perceptions of a White female student presenting signs of eating disorder-related distress. We recruited a mixed-gender, weight-diverse U.S. community sample through Mechanical Turk (N = 130; 49.2% female) to complete an online survey. Participants were randomly assigned to one of two conditions in which they read a personal statement section of a college application revealing eating disorder-related distress from a student who was either 'overweight' or 'underweight.' Participants evaluated the student on need for support, behavioural prescriptions for eating and exercise, and personal qualities. Although participants recognized a serious mental health concern in both conditions, they were more likely to prescribe eating disorder behaviors to the higher weight student. Findings suggest that weight stigma may bias lay perceptions of and even reinforce an eating disorder when exhibited by higher weight individuals.

"Negative Things That Kids Should Never Have to Hear": Exploring Women's Histories of Weight Stigma in Physical Activity.

Scholars have proposed that cumulative experiences of anti-fat bias and stigma contribute to detrimental physical activity experiences, as well as social and health inequities. The objective of this research was to explore how enacted weight stigma experiences are constructed and impact women's physical activity experiences long term. Eighteen women who identified as having had negative experiences related to their body weight, shape, or size in physical activity contexts participated in semistructured interviews. Using reflexive thematic analysis, four themes were identified: (a) norms of body belonging, (b) distancing from an active identity, (c) at war with the body, and (d) acts of resistance. These findings deepen understandings of how historical experiences of weight stigma can have longstanding consequences on physical activity cognitions, emotions, and behaviors. To equitably promote physical activity, it is imperative that movement spaces (e.g., fitness centers, sport organizations) both target anti-fat stigma and adopt weight-inclusive principles.

"What can her body do?" Reducing weight stigma by appreciating another person's body functionality.

OBJECTIVE: Weight stigma is prevalent across multiple life domains, and negatively affects both psychological and physical health. Yet, research into weight stigma reduction techniques is limited, and rarely results in reduced antipathy toward higher-weight individuals. The current pre-registered study investigated a novel weight stigma reduction intervention. We tested whether a writing exercise focusing on body functionality (i.e., everything the body can do, rather than how it looks) of another person leads to reductions in weight stigma. METHOD: Participants were 98 women (Mage = 23.17, Range = 16-63) who viewed a photograph of a higher-weight woman, "Anne," and were randomised to complete a writing exercise either describing what "Anne's" body could do (experimental group) or describing her home (active control group). Facets of weight stigma were assessed at pretest and posttest. RESULTS: At posttest, the experimental group evidenced higher fat acceptance and social closeness to "Anne" compared with the active control group. However, no group differences were found in attribution complexity, responsibility, and likeability of "Anne". CONCLUSIONS: A brief body functionality intervention effectively reduced some, but not all, facets of weight stigma in women. This study provides evidence that functionality-focused interventions may hold promise as a means to reduce weight stigma.

Experiences of weight stigma in everyday life: An ecological momentary assessment study.

Weight stigma and discrimination have been linked to negative health outcomes. Most research on this topic is retrospective, which may not accurately capture day-to-day experiences. The current used ecological momentary assessment to examine weight stigma and discrimination in everyday life. Participants answered ecological momentary assessments about the nature, frequency, and contextual details of weight stigma and discrimination. Over the course of the study, only eight episodes of weight stigma and discrimination were reported. Given that prior ecological momentary assessment studies reported substantially more frequent weight stigma and discrimination, possible explanations for the findings and implications for future research are discussed.

Internalized weight stigma and the progression of food addiction over time.

Food addiction is associated with elevated levels of eating pathology, body image concerns, and internalized weight stigma. The role of internalized weight stigma in the progression of addictive-like eating has not been explored. This longitudinal study explored the relative contributions of weight-related self-devaluation and fear of being stigmatized by others in predicting changes in addictive-like eating behavior over time. 305 young adults (Mage = 18.7 years, SD = 1.1, range 18-28, MBMI = 21.9 kg/m2, SD =3.7 kg/m2, range 13.7-38.9 kg/m2) completed online measures of "food addiction," weight-related self-devaluation, and fear of stigma from others at two time points (follow-up M = 280 days, SD = 30, range 155-474). At baseline, 7.9 % exhibited clinically relevant addictive-like eating behavior, 40.3 % self-classified as being "addicted to food", and 51.8 % neither. Using cross-lagged modelling, fear of being stigmatized, but not self-devaluation, was a predictor of worsening "food addiction" status over time. Fear of weight stigma, rather than weight-related self-devaluation per se, may be an important predictor of problematic eating behavior. As weight stigma is prevalent in Western populations, these findings have potential implications for the development of problem eating behaviors in non-clinical samples.

Technical note on the administration of intravenous contrast media in hybrid imaging.

This article summarises the proceedings of a continuing professional development session on the use of intravenous contrast media in hybrid imaging for radiographers, technologists, and nurses. The session was jointly organised by the British Nuclear Medicine Society Radiographer, Technologist, and Nurses Group and the Society of Radiographers at the 47th Annual Spring Meeting of the British Nuclear Medicine Society held in Oxford, UK, on 1-3 April 2019.

A bifactor analysis of the Weight Bias Internalization Scale: What are we really measuring?

Internalized weight stigma (IWS) has been linked with disordered eating behavior, both directly, and as a mediator of the relationship between experienced weight stigma and maladaptive coping. However, the construct of IWS is highly correlated with the related constructs of body image and global self-esteem, and the three constructs may better be represented by underlying trait self-judgment. This overlap is not generally accounted for in existing studies. The present study investigated the shared variance between self-esteem, body image, and IWS in an international sample of higher-weight individuals. Bifactor analysis confirmed that the intermediary role of IWS in the relationship between experienced stigma and self-reported eating behavior was largely accounted for by aspects of body image and global self-esteem. Greater conceptual clarity in the study of IWS is needed to understand the mechanisms via which societal weight stigma impacts on individuals' self-directed judgments and downstream health-related behaviors.

Internalised Weight Stigma Moderates the Impact of a Stigmatising Prime on Eating in the Absence of Hunger in Higher- but Not Lower-Weight Individuals.

A considerable body of evidence links internalised weight stigma with higher levels of disordered eating behaviour and cognitions in both normative- and higher-weight populations. However, to date, the impact of internalised weight stigma on objectively measured food intake has not been explored. In the present study, a weight-diverse sample of 158 non-smoking adults (BMI ≥ 25 kg/m2 n = 72, BMI < 25 kg/m2 n = 86) were recruited to a study on "The effects of hunger and satiety on information processing." Participants first completed a series of online questionnaires, then attended a lab visit in a fed state. Participants were randomised to read a sham news article on the negative consequences of either weight (stigma condition) or smoking (control condition) and answer some questions about the article. Then, under the pretence of a non-study-relevant break, participants were exposed to a pre-weighed selection of sweet and savoury snacks for 15 min. Mood and hunger levels were assessed prior to and after reading the vignette, and after the break. In contrast to the relationship with self-report eating behaviour, internalised weight stigma was not a significant independent predictor of total energy intake and did not moderate the relationship between exposure to the stigma prime and calories consumed. However, differences emerged on the basis of participants' weight status. Higher-weight participants with high levels of internalised weight stigma consumed fewer snack calories following exposure to a weight-stigma prime compared with a neutral prime (B = -137, SE = 58, t = -2.35, p = 0.020, 95% CI -252, -22) whereas those with low levels of internalised weight stigma tended to eat more in the weight stigma condition (B = 118, SE = 62, t = 1.91, p = 0.059, 95% CI -4, 241). In normative-weight participants, no differences in energy intake by levels of internalised weight stigma were observed. These findings suggest differences in the relationships between internalised weight stigma and self-reported disordered eating behaviour versus eating in the absence of hunger (EAH) measured under laboratory conditions. Additionally, internalised weight stigma appears to have differential effects on response to stigma in higher-weight and normative-weight individuals.

The Multifaceted Nature of Weight-Related Self-Stigma: Validation of the Two-Factor Weight Bias Internalization Scale (WBIS-2F).

BACKGROUND: Internalized weight stigma (IWS) is generally operationalized as self-devaluation due to weight in higher-weight individuals. The most commonly used measure of IWS, the Weight Bias Internalization Scale (WBIS), was developed from an original pool of 19 items. Item selection was guided by statistical techniques based upon an a priori hypothesized unidimensional factor structure. The resulting 11-item scale mostly assesses appearance-related attitudes, fear of stigma, affect, and desire for change, all of which may be a natural response to societal weight stigma, even in the absence of self-devaluation. Items pertaining to self-blame, stigma awareness, perceived legitimacy of weight stigma, and most items pertaining to self-worth, were excluded from the final scale. It is unclear whether an a priori assumption of multi-dimensionality would have produced different results. METHODS: Exploratory and confirmatory factor analysis of the original 19-item questionnaire was conducted in 931 higher-weight individuals. RESULTS: A 13-item two-factor structure was identified. Factor 1 comprised seven items that could be loosely conceived as weight-related distress. Factor 2 comprised six items, all of which pertained to weight-related self-worth. Tested individually, the six items making up the self-devaluation factor were an excellent fit for the data on all fit indices. CONCLUSION: IWS is a multi-dimensional construct. The two-factor WBIS (WBIS-2F) provides options to explore the relationships between different aspects of IWS and upstream and downstream variables. The Self-Devaluation subscale is suitable for standalone use when weight-related self-devaluation per se is the construct of interest.

Predicting Determinants of Atrial Fibrillation or Flutter for Therapy Elucidation in Patients at Risk for Thromboembolic Events (PREDATE AF) Study.

BACKGROUND: Atrial fibrillation (AF) is the most common clinically significant cardiac rhythm disorder. There is considerable interest in screening for AF, as it is a leading cause of stroke, and oral anticoagulants (OACs) have been shown to significantly reduce the risk of stroke in patients with AF. Improved screening for AF with subsequent treatment may help improve long-term outcomes, but the optimal patient population and screening intensity are unknown. OBJECTIVES: In this study, we prospectively evaluated the use of the CHA2DS2-VASc score for the prediction of new-onset AF using insertable cardiac monitors (ICMs) and examined whether this screening led to the initiation of OAC therapy. METHODS: We enrolled 245 subjects with no history of AF and CHA2DS2-VASc score ≥2 to be screened for AF with an ICM. The ICMs were programmed to record AF episodes ≥6 minutes in duration. Subjects were followed for 18 months with monthly remote interrogations and all events adjudicated by cardiologists. In subjects diagnosed with AF, medical records were reviewed to determine subsequent care. RESULTS: During a mean follow-up of 451 ± 185 days, the incidence of AF was 22.4% (95% confidence interval 17.2%-27.7%) with a mean time to detection of 141.3 ± 139.5 days. Among subjects newly diagnosed with AF, 76.4% were prescribed anticoagulation with either a novel OAC (n = 38) or warfarin (n = 4). CONCLUSION: In this large prospective cohort of subjects with CHA2DS2-VASc scores ≥2, 22.4% were newly diagnosed with AF and the majority of these subjects were given OACs, suggesting a potential role of ICMs in AF screening.

Self-perceived food addiction: Prevalence, predictors, and prognosis.

Food addiction is controversial within the scientific community. However many lay people consider themselves addicted to certain foods. We assessed the prevalence and characteristics of self-perceived "food addiction" and its relationship to a diagnostic measure of "clinical food addiction" in two samples: (1) 658 university students, and (2) 614 adults from an international online crowdsourcing platform. Participants indicated whether they considered themselves to be addicted to food, and then completed the Yale Food Addiction Scale, measures of eating behavior, body image, and explicit and internalized weight stigma. Participants in the community sample additionally completed measures of impulsivity, food cravings, binge eating, and depressive symptomatology. Follow-up data were collected from a subset of 305 students (mean follow-up 280 ± 30 days). Self-perceived "food addiction" was prevalent, and was associated with elevated levels of problematic eating behavior, body image concerns, and psychopathology compared with "non-addicts", although individuals who also received a positive "diagnosis" on the Yale Food Addiction Scale experienced the most severe symptoms. A clear continuum was evident for all measures despite no differences in body mass index between the three groups. Multinomial logistic regression analyses indicated that perceived lack of self-control around food was the main factor distinguishing between those who did and did not consider themselves addicted to food, whereas severity of food cravings and depressive symptoms were the main discriminating variables between self-classifiers and those receiving a positive "diagnosis" on the Yale Food Addiction Scale. Self-perceived "food addiction" was moderately stable across time, but did not appear predictive of worsening eating pathology. Self-classification as a "food addict" may be of use in identifying individuals in need of assistance with food misuse, loss-of-control eating, and body image issues.

Social Dominance Orientation, Dispositional Empathy, and Need for Cognitive Closure Moderate the Impact of Empathy-Skills Training, but Not Patient Contact, on Medical Students' Negative Attitudes toward Higher-Weight Patients.

Anti-fat bias in healthcare providers and medical students has serious implications for quality of care of higher-weight patients. Studies of interventions aimed at reducing anti-fat attitudes in medical students have generally been disappointing, with little enduring effect. It is possible that some students may be more receptive to prejudice-reducing influences than others, due to underlying differences in their personal characteristics. It is also possible that attitudes toward patients, specifically, may differ from anti-fat attitudes in general, and prejudice-reduction effectiveness on patient-specific attitudes has not yet been evaluated. The present study explored the effect on general and patient-specific anti-fat attitudes of (1) contact with higher-weight individuals prior to and during medical school; and (2) training designed to increase medical students' empathy toward patients by encouraging them to take the patient's perspective during clinical encounters. The moderating role of individual difference factors on effectiveness of contact and student-reported hours of empathy training on patient-specific attitudes was assessed. A total of 3,576 students enrolled across 49 US medical schools completed an online survey at the start of their first year of medical school and at the end of their fourth year. Favorable contact experience with higher-weight patients predicted improved attitudes toward heavier patients after 4 years of medical school, and appeared sufficient to partially offset the effects of dislike of higher-weight individuals at baseline. The impact of favorable contact on general anti-fat attitudes was less strong, highlighting the importance of using target-specific outcome measures. The positive effects of favorable contact on attitudes toward higher-weight patients did not differ based on students' baseline levels of social dominance orientation, dispositional empathy, or need for cognitive closure. In contrast, the effectiveness of training did vary by student characteristics, generally being more effective in students who were more egalitarian and empathic at baseline, with little effect, or even adverse effects in students low in these traits. Overall, however, perspective-taking training produced only small improvements in attitudes toward higher-weight patients.