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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
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)
