Weight Stigma in Healthcare & Education: Impact on Children & Families

Angela Alberga, PhDPostdoctoral Fellow

Brenndon GoodmanPublic Engagement Committee

Disclosure

• Name: Dr. Angela Alberga, Mr Brenndon Goodman

• Relationships with commercial interests:Grants/Research Support: CIHR, University of Calgary (AA)Speakers Bureau/Honoraria: N/AConsulting Fees: N/AOther: N/A

Potential for conflict(s) of interest: N/A

Weight Stigma in Healthcare & Education: Impact on Children & Families

Angela Alberga, PhDPostdoctoral Fellow

Marathon RunnerOrganized

KnitterJunk FoodCanoeing

Good LeaderSocially Awkward

Erin Cameron, PhD, Memorial University

•Negative attitudes, beliefs & views about obesity and people with obesityWeight Bias

•Labeling, stereotyping•Damaged identities •Deeply rooted in societyWeight Stigma

•Verbal, physical, relational•Subtle and overt

actions/expressions Weight Discrimination

Bias

Stigma

Discrimination

Ximena Ramos-Salas, University of Alberta, Canadian Obesity Network

• Implicit (i.e. unconscious)• Internalized (i.e. belief that the stigma is deserved)• Explicit (i.e. overt)

• Can be subtle, overt, verbal, physical or relational forms:1. Verbal teasing (e.g., name calling, derogatory

remarks, being made fun of) 2. Physical bullying and aggression (e.g., hitting,

kicking, pushing, shoving) 3. Relational victimization (e.g., social exclusion, being

ignored or avoided, the target of rumors).

(Puhl & Brownell, 2007. Weight bias in Health Care Settings. Rudd Center For Food Policy & Obesity)

Weight bias: Forms

TV shows

Social media

http://talfonso.hubpages.com/hub/hardshipsofweightbiaspart1

Public ‘health’ campaigns

Weight bias: Prevalence• Between 1995-2008, weight bias increased by 66%

(Andreyeva, Puhl, & Brownell, 2008)

• Weight-based teasing from peers:– 30% of girls and 24% of boys– 63% of girls and 58% of boys with obesity

(Neumark-Sztainer et al., 2002)

• Children as young as 3 yrs old (Harriger et al., 2010)

• Children 10-11 yrs ranked overweight children as least likeable(Richardson et al., 1961)

• Adults describe parents and teachers as the most frequent source of weight bias (Puhl et al., 2008)

Weight-based bullying

• Most prevalent reason for youth bullying

• US, Canada, Iceland & Australia (N=2866)

(Puhl et al., 2015)

▪ Lazy▪ Awkward▪ Sloppy▪ Less intelligent▪ Non-compliant▪ Unsuccessful▪ Lacking the self-discipline and

self-control necessary to manage their weight

(Puhl & Heuer, 2009; Puhl et al., 2014)

Weight bias in education & healthcare

Teachers regard students with obesity as:▪ Lazy▪ Untidy▪ More emotional▪ Less intelligent▪ Less likely to succeed at

work▪ Have lower expectations of

them

(Puhl, 2011; Walter et al., 2013)

Health professionals regard patients with obesity as:

Most stigmatizingFatMorbidly obese

Most motivatingUnhealthy weightOverweight

Puhl, Peterson, Luedicke, 2013

Terminology

Least stigmatizingWeightUnhealthy weightHigh BMI

Least motivatingFatMorbidly obeseChubby

Health consequences of weight bias

Puhl et al. Clin Diabetes 2016;34:44-50

Lack of training • Weight is a conversation stopper Professionals report inadequate training

(Jay et al., 2009)

Shift training curricula to provide the necessary understanding of obesity

(Brown & Flint, 2013; Freedhoff et al., 2013)

• Lack of training in HCP training programs Health promotion at community/individual levels Nutrition and lifestyle contributors No systematic training in weight bias

(Russell-Mayhew, Nutter, Alberga et al., 2016)

Systematic review: Weight bias reduction interventions among HPs

Interventions addressing weight bias:— Few studies exist (N=17)— Mixed samples (n=15 students in training, n=2 practicing HCPs)

• No magic way to address weight bias• Need to move beyond awareness and information to raise

skills and competencies in health professionals• Requires a change in social norms & ideologies about body

weight

Alberga et al. Clinical Obesity 2016

Systematic Review: Key Messages

1. Presenting facts aboutuncontrollable &non-modifiable causesof obesity

i.e. genetics, biology, environment, sociocultural influences

This approach by itself is NOT sufficient to reduce weight biasAlberga et al. Clinical Obesity 2016

Systematic Review: Key Messages

2. Evoking empathy by positive contact with patients living with obesity

Perfect At Any Size Image Bank

Systematic Review: Key Messages

3. Peer-modeling, shadowing with empathic experts

Systematic Review: Key Messages

4. Repeated exposure with patients over the long term

Weight bias reduction intervention among BEd students

▪ After the PD workshop, BEd students:

— Confidence to teach health, physical education, & weight-related curriculum to their students

— Weight biased attitudes (implicit and explicit)

(Russell-Mayhew et al., 2015)

So what can WE all do about this?

You can’t be what you can’t see

-Marian Wright Edelman

Let’s check-in with ourselves

Self-reflection Weight Implicit Association Test (IAT)

https://implicit.harvard.edu/implicit/

Choose your resources

Choose your resources

Examples of positive resources

What can you do or say?

Movies & attractions

Stop using negative imagery

Use positive imagery

Use positive imagery

Conclusion• Prevalence & consequences of weight bias are widespread• Lack of training in obesity & weight stigma• We need better weight bias reduction interventions• Choose resources to promote body diversity & positive imagery• Beware of fat talk & stigmatizing terminology

Acknowledgements

Mr. Brenndon Goodmankey14key14@gmail.com

Dr. Angela Albergaaalberga@ucalgary.ca@DrAlberga

MSc & PhD Human Kinetics, Exercise Physiology(Ottawa, Ontario)

BSc Exercise ScienceMajor Exercise Science, Minor Psychology (Montreal, Quebec)

Postdoctoral FellowshipDepartments: Education, Psychology, Medicine(Calgary, Alberta)

Health Care Sector: Key Messages

We must STOP:— Discussing healthy weights without consideration of diversity— Insensitivity when considering taking a weight measurement E.g., measuring scale in the hallway for all to see/hear

— Literature with negative weight bias and thin-ideal messages E.g., magazines in waiting room, posters,

— Laughing at fat jokes, step in

Health Care Sector: Key Messages

We must START to:— Increase training on the complexity & UNcontrollable causes of

obesity— Question personal assumptions about body size & shape— Emphasize HEALTH & quality of life not weight— Consider environmental surroundings & appropriately sized

equipment— Expose HCPs to standardized patients living with obesity,

increase empathy & communication skills

Key Messages for the School Sector

We must STOP:— Discussing weight in schools— Weighing and measuring in schools

(NO BMI/FITNESS report cards)— Literature with negative weight bias and thin-ideal messages

(e.g., school textbooks; movies) (Glessner, Hoover, & Hazlett, 2006)

— Weight-based teasing

Key Messages for the School Sector

We must START to:— Question personal assumptions about body size & shape— Emphasize HEALTH/WELLNESS & quality of life not weight— Consider environmental surroundings (i.e., include larger-

sized chairs and desks, allow students to move while learning, gym uniform sizes etc.)

— Consider weight bias a social justice issue - cannot discriminate based on race, gender, ability - why is it acceptable to discriminate based on weight?

— Coordinate change across levels of education (i.e., K-12, post-secondary, educational ministries) to address weight bias in educational settings

Puhl & Heuer, 2010; Puhl & Heuer, 2009; Modified from Provincial Health Services Authority, 2013

Maladaptive eating patterns

Avoidance of medical care

Stress induced pathophysiology

Avoidance of physical activity

Poor body image & body dissatisfactionLow self-esteem

Low self-confidenceLoneliness

Sense of worthlessnessDepression, anxiety and other psychological disorders

Suicidal thoughts & acts

Consequences of weight bias

Health Champions Conference

Session Topic Emphasis

Body Image Media, thin ideal, weight bias, body satisfaction, self-compassion

Physical Literacy Benefits of movement & how to incorporate it daily in classrooms

Mental Health Eating disorders, depression, & teachers’ roles in mental health

Comprehensive School Health

Four pillar approach and application in practice, pivotal role of teachers

Resource Fair Displays with health and wellness resources for schools, teachers and classrooms

Social media

Weight-related barriers

• Inaccessible equipment & facilities • Embarrassment about being

weighed• Unsolicited advice about losing

weight (Puhl & Heuer, 2009)

• Reduced time spent with patients• Patient avoidance of the

healthcare system(Drury & Louis, 2002)

• ‘Doctor shopping’(Gudzune et al., 2014)