Stigma is the state of social devaluation due to a trait or group identity; weight and smoking-based self-, felt-, and enacted stigma may have detrimental health effects and pose barriers to smoking cessation. This study examined associations between stigma, discrimination, and health for people with overweight or obesity (body mass index [BMI] ≥ 25) who smoke cigarettes (cigarettes smoked/day ≥ 5) who reported interest in quitting smoking and minimizing weight gain. Participants (N = 63; predominantly women (81.0 %), White (63.5 %) or Black/African American (31.7 %), and heterosexual (85.7 %) with 50 % having a yearly income below $50,000) completed the measures of stigma (i.e., Weight Bias Internalization Scale and Internalized Stigma of Smoking Inventory), discrimination (i.e., Everyday Discrimination Scale), and symptoms of depression, weight, smoking, nicotine dependence, and concerns about gaining weight while quitting smoking were measured. Those who reported more internalization of weight bias and more everyday discrimination reported greater depressive symptomatology and greater concern about gaining weight while quitting smoking, with depressive symptomatology fully mediating both internalization of weight bias and everyday discrimination's relation with concern about gaining weight while quitting smoking. There was also an association of smoking felt-stigma, but not self- or enacted-stigma, with symptoms of depression. Stigma's associations with symptoms of depression and post-cessation weight concern suggest barriers to effective behavior change, and interventions may consider targeting processes for coping with stigma experienced by this population.

Adults with higher body weights experience weight stigma in healthcare, which can heighten concerns about treatment in these settings. This study investigates whether a specific strategy-using an identity-safety cue, or a cue which signals that one's social identity is valued-mitigates these concerns.

527 U.S. adults who self-identified as overweight were randomized to read about a hypothetical physician who endorsed a weight-inclusive clinical approach (identity-safety cue condition) or making health information accessible (control condition). Next, participants read a vignette where the physician attributed their persistent knee pain to their age (control diagnosis), lifestyle habits (ambiguous diagnosis), or body weight (stigmatizing diagnosis).

Exposure to the physician who employed the identity-safety (versus control) cue decreased weight stigma concerns, increased perceptions of physician allyship, and promoted identity-safety. While use of the identity-safety cue elicited benefits regardless of the physician's clinical diagnosis, viewing the identity-safety cue alongside the stigmatizing diagnosis increased perceptions that the physician's commitment to diversity was dishonest, which subsequently harmed feelings of safety.

Use of identity-safety cues in healthcare can effectively promote inclusion for adults with higher body weights. However, perceiving that the physician's pro-diversity efforts are dishonest can undermine inclusion.

To effectively promote inclusion for adults with higher body weights, physicians should employ cues which explicitly signal that their weight identity is valued.

To evaluate student attitudes toward nondiet, weight-neutral (NDWN) principles after reading Anti-Diet in a medical nutrition therapy (MNT) course.

A quasi-experimental design with no control group and a mixed-methods study approach.

Adult undergraduate students (n = 112) enrolled in an MNT course.

A traditional MNT course and reading Anti-Diet (January-May, 2021), which introduces multiple topics that support weight-inclusive approaches to health.

Change in student agreement with NDWN principles. Written reflections were collected to determine students' rationale for their level of agreement.

Likert scale responses (1-5) of student ratings were analyzed with multivariate linear regression, a linear mixed-effect model, and a Wilcoxon signed rank test with continuity correction. Reflections were analyzed using thematic analysis methods. The triangulation methods compared quantitative and qualitative data.

Students ratings shifted significantly away from dieting for weight loss and toward agreement with NDWN principles (99.7) = 7.35, P < 0.001; mean difference = 0.83 with 95% confidence interval, 0.61-1.05. Two main themes emerged: (1) NDWN topics led to critical analysis of weight-centric knowledge, and (2) specific topics were more effective at shifting weight-based attributions.

Incorporating specific NDWN principles in an undergraduate MNT curriculum can shift students' weight-based attributions. More systematic development and testing of anti-fat bias reduction curricula are needed to support broader dissemination and standardization in dietetics curricula.

Oppressed people face microaggressions in medicine. Extant discussions of microaggressions in medicine primarily focus on verbal and behavioural microaggressions, which typically have perpetrators. For example, in clinical medicine, acts of verbal and behavioural microaggressions can arise from patient-provider interactions, with healthcare providers such as physicians and nurses as perpetrators. However, in clinical medicine, patients can also be victims of environmental microaggressions, which typically are not acts and do not have perpetrators. My goal is to call attention to the existence of environmental microaggressions in medicine in the forms of ordinary medical objects and spaces, such as forehead thermometers that are more likely to miss fevers in black patients and medical imaging devices that do not fit the bodies of fat patients. With these examples, I argue that environmental microaggressions in medicine, in the form of oppressive medical objects and spaces, sustain oppression by shaping patterns of thought and action and exemplify a form of attributional ambiguity without any perpetrator.

To investigate the prevalence of non-person-first language (PFL) in neuro-ophthalmology referrals to a single tertiary ophthalmology clinic.

Retrospective cross-sectional study.

Participants included neuro-ophthalmology patients seen for their initial visit from July 2018 to December 2022. Ten randomly selected referrals from each day were screened. Non-PFL was further categorized as per American Medical Association and American Psychological Association guidelines. Associations between non-PFL and patient age and gender, referring provider gender and specialty, and year and length of referral, were evaluated using the χ2 test.

A total of 2105 referrals were included in the study and 81 (3.8%) used non-PFL, such as referring to a person with glaucoma as a "glaucoma patient". Error types included general (38.3%), stigma (25.9%), diabetes (19.8%), disability (13.6%), and obesity (2.5%). Non-PFL was significantly more likely in long referrals compared with medium and short referrals (9.9% vs 3.1% vs 1.3%; p < 0.001). Referral year was predictive of non-PFL (p = 0.0006), with a significant increase from 2018 (1.7%) to 2021 (6.1%) and decrease in 2022 (2.6%). Patient age was also predictive of non-PFL (p = 0.0359), with the highest prevalence among patients 40-69 years old (5.4%). Patient gender (p = 0.3350), referring provider gender (p = 0.3571), and referring provider specialty (p = 0.1280) were not predictive of non-PFL.

The highest proportions of non-PFL errors made were general and stigma errors. Non-PFL use was most prevalent in 2021, most commonly in referrals for patients aged 40-69 years. There exists a need for ongoing education and awareness around PFL use in physician-physician communication to enhance inclusive, nonstigmatizing care for neuro-ophthalmology patients.

Weight loss is often recommended as the primary intervention for infertility in individuals with high body mass index. However, focusing on body mass index might overlook other important factors like cardiometabolic health. This study aims to examine cardiometabolic health in patients seeking fertility treatment and its impact on reproductive outcomes.

A cross-sectional analysis of 800 systematically selected participants (400 couples) will be completed on a single visit to the study site. This session will involve taking blood samples to examine metabolic biomarkers, the completion of questionnaires assessing preconception health factors and an exercise 'step test' to assess cardiorespiratory fitness. Metabolic panels will be compared with target values and, where available, normative population data. Fitness data will be transformed into normative percentile values based on the participant's age and sex. Patients will be followed for 2 years to allow yearly data collection related to conception, gestation and parturition. Associations between cardiometabolic health during the preconception phase and reproductive outcomes will be examined.

The Newfoundland and Labrador Health Research Ethics Board has provided ethical approval for this study (HREB #20230825). Each patient will be required to give written consent prior to any data collection. We will share study findings at conferences and submit manuscripts to peer-reviewed journals. Additionally, we will create knowledge translation presentations for Newfoundland and Labrador Fertility Services and Family Practice Clinics.

Obesity stigmatization, defined as the social devaluation and denigration of individuals because of their excess weight, represents a significant barrier to effective healthcare delivery. This study aimed to investigate healthcare professionals' knowledge about obesity-related health impacts, attitudes regarding weight bias (negative or discriminatory attitudes toward individuals with obesity), and beliefs about the causes and nature of obesity.

This cross-sectional study was conducted among healthcare professionals between Jan, 2024 and Feb, 2024 in The Department of General Medicine, Chengdu Second People's Hospital, using a self-designed questionnaire.

A total of 388 valid questionnaires [303 (78.09%) female and a mean age of 37.71 ± 8.46 years] were included. The mean scores for knowledge, attitude, and belief were 6.70 ± 1.46 (possible range: 0-10), 38.41 ± 5.09 (possible range: 8-48), and 63.53 ± 15.35 (possible range: 0-120), respectively. Multivariate logistic regression analysis revealed that having body mass index ≥ 24.0 kg/m² (OR = 0.537, 95% CI: 0.331-0.873, P = 0.012) and nurse profession (OR = 0.546, 95% CI: 0.338-0.883, P = 0.014) were independently associated with knowledge. Knowledge (OR = 0.754, 95% CI: 0.600-0.949, P = 0.016), belief (OR = 0.915, 95% CI: 0.854-0.980, P = 0.011), and age (OR = 0.950, 95% CI: 0.906-0.995, P = 0.031) were independently associated with attitude. Moreover, structural equation modeling showed that knowledge had a significant direct effect on both belief (β = 0.845, P < 0.001) and attitude (β = -0.944, P < 0.001), as well as belief on attitude (β = -0.550, P < 0.001).

Healthcare professionals exhibited insufficient knowledge, negative attitude and belief toward obesity stigmatization. A pressing necessity arises for the implementation of targeted educational interventions and awareness programs within healthcare settings.

To use vignettes to facilitate exploration of the internal dialogue and clinical reasoning processes of general practice healthcare professionals (GPHCPs) during interactions with patients living with obesity.

This study used an exploratory qualitative research design. Data were collected using semistructured interviews. Interviews were transcribed verbatim, and data analysed using Framework Method analysis. Five vignettes were presented to participants, showing a patient's photograph, name, age and body mass index. Participants were asked to describe their first impressions of each fictionalised patient.

Interviews were conducted remotely via Skype between August and September 2019.

A convenience sample of UK GPHCPs was recruited via a targeted social media strategy, using virtual snowball sampling. 20 participants were interviewed (11 general practice nurses and 9 general practitioners).

Five themes were generated: visual assessment, assumed internal contributing factors, assumed external contributing factors, potential clinical contributing factors and potential clinical consequences. A pattern-recognition approach was identified, as GPHCPs' assumptions around patients' lifestyles, occupations and eating habits emerged as explanations for their weight, with a mixture of both objective and subjective comments.

While it is part of the diagnostic skill of a clinician to be able to form a clinical picture based on the information available, it is important to be aware of the potential for assumptions made within this process to contribute to unconscious bias/stereotyping. Healthcare professionals need to work to counteract the potential impact of internal bias on their consultations to provide fair and equitable care for people living with obesity, by exercising reflexivity within their clinical practice.

There is limited research on weight bias in diagnosing eating disorders (EDs), particularly among healthcare professionals (HCPs). This is especially true for atypical anorexia nervosa, a diagnosis recently described in the DSM that includes people with anorexia nervosa symptoms who are not clinically underweight.

Using a within-subjects design, we assessed diagnosis, diagnostic confidence, and ED-related medical knowledge among a sample of lay people and medical professionals. Participants read three clinical vignettes (counterbalanced to avoid order effects) of a woman with anorexia nervosa or atypical anorexia nervosa (described as obese) and were assessed on weight stigma and prior ED medical knowledge.

Both lay people and HCPs were less likely to diagnose atypical anorexia nervosa and were less confident in that diagnosis than in the anorexia nervosa vignette condition. Lay participants' diagnostic bias, but not HCPs', was impacted by weight stigma; HCPs' confidence was impacted by weight stigma. In both cases, participants high in weight stigma were more accurate (lay sample) or more confident (HCPs) in diagnoses. Last, greater ED medical knowledge improved accuracy of diagnosis of vignette cases for the HCP sample that included snowball sample recruitment and CloudResearch participants and lay people, but not for the HCP sample recruited via snowball sampling only.

These findings highlight the urgency for more public awareness and training for HCPs emphasizing that people of all sizes can present with restrictive eating disorders.

Obesity is a modifiable risk factor associated with hospital-associated complications. Recent studies show there is a high prevalence of patients with obesity presenting to hospital and evidence indicates that people living with obesity should receive diet advice from a dietitian; however, patients often do not receive this care in acute settings.

The primary aim of this study was to explore the experiences of dietitians caring for patients living with obesity in acute hospital settings.

A multi-site qualitative study was conducted from October 2021 to November 2023 in Melbourne, Australia. Constructivist grounded theory methodology informed sampling and data collection. Semi-structured interviews were undertaken with dietitians working in acute care. Data were analysed using open coding and constant comparison underpinned by Charmaz's framework.

Interviews were conducted with 25 dietitians working across four hospitals. The theory developed from the data describes an enculturated decision-making process whereby acute clinical dietitians are limiting acute nutrition care for people living with obesity in hospital. The theory includes five interdependent categories that influence clinical decision-making and practice: (1) culture of professional practice, (2) science and evidence, (3) acknowledgement of weight bias and stigma, (4) dietitian-led care and (5) hospital systems and environment.

The findings from this study provide new insights as to why dietitians may not be providing acute nutrition care for people living with obesity. Strategic leadership from clinical leaders and education providers together with the lived experience perspectives of people with obesity is needed to shift the culture of dietetic professional practice to consider all nutrition care needs of patients living with obesity who are accessing acute hospitals for health care.

To evaluate whether comorbidities (defined as both medical conditions and peripartum complications) are associated with inpatient postpartum permanent contraception by tubal surgery completion.

This is a secondary analysis of a multisite retrospective cohort study of patients who had documented plans for permanent contraception. Our primary outcome was inpatient completion of postpartum permanent contraception by tubal surgery. We used univariable and multivariable logistic regression analyses to examine associations between aggregate and individual comorbidities and the attainment of inpatient postpartum permanent contraception.

In this study of 2,226 pregnant people, 53.4% of patients received postpartum permanent contraception by the time of hospital discharge, and 70.8% of patients had documented comorbidities. Although patients with medical conditions initially had lower odds of permanent contraception completion compared with those without any comorbidities (adjusted odds ratio [aOR] 0.77, 95% CI, 0.64-0.93), this association was no longer significant after adjusting for multiple comparisons (adjusted P =.06). This association also was not significant for patients with peripartum complications (aOR 0.86, 95% CI, 0.64-1.16, adjusted P =.42). Similarly, when individual comorbidities were assessed, patients with hypertension (aOR 0.80, 95% CI, 0.65-0.97, adjusted P =.06), mental health diagnoses (aOR 0.80, 95% CI, 0.66-0.96, adjusted P =.06), and elevated body mass index (BMI, 40 or higher) (aOR 0.77, 95% CI, 0.63-0.95, adjusted P =.06) had no significant differences in odds of immediate permanent contraception attainment after adjusting for multiple comparisons.

Though the balance of risks and benefits is imperative for surgical care, it is imperative that modifiable barriers to desired permanent contraception are mitigated. There were no statistically significant differences in inpatient postpartum permanent contraception attainment for patients with medical conditions in our study; however, further study is needed to better elucidate the complex relationships between medical comorbidities and contraception.

Obesity is a leading cause of morbidity and mortality with health consequences that crosscut most medical specialties. Despite the emergence of effective and promising new therapies, many impediments to comprehensive obesity care remain. As part of their commitment to improving obesity care, the American College of Physicians (ACP) and its Council of Subspecialty Societies (CSS) held a summit on 24 October 2023 to identify barriers to and opportunities for collaborative action in the domains of physician education, health care policy and care delivery, and addressing weight bias. This report summarizes the summit proceedings and provides a postsummit synthesis from ACP and CSS. Key themes were centered on knowledge, advocacy, action, and compassion, including the need for culture change, paradigm shifts, and stakeholder engagement and collaboration; a focus on empowerment of both clinicians and patients; the importance of knowing patients as people to help address social determinants of health; the need to address learned helplessness; and the importance of embracing artificial intelligence and technology as disruptive innovations. Recommendations for next steps for collaborative action include leveraging and improving already available educational and clinical resources, developing obesity education and care standards that incorporate patients' perspectives and address social determinants of health, developing community and public-private partnerships to improve access and public awareness, and coordinating messaging and policy advocacy efforts that align with mitigating the longstanding obesity epidemic.

Identifying and managing malnourished emergency general surgery (EGS) patients can be difficult. There are many tools available, a range of barriers to overcome and variety of guidelines at a surgeon's disposal. This study aimed to determine the impact of key variables on surgeon preference to start nutritional support in EGS.

A discrete choice experiment was used to determine the impact of six variables on surgeons' treatment preferences for commencing nutritional support in EGS. Twenty-five hypothetical scenarios regarding a patient with adhesional small bowel obstruction were disseminated electronically. Binomial logistic regression was used to identify significant associations. Ethical approval was obtained (UREC 050436).

In all, 148 participants responded providing 3700 scenario responses. Completion rate was 52.1% (148/284) with an approximately even split of consultants and non-consultants (50.7% vs. 49.3%) and intestinal failure (IF) experience (46.6% experienced vs. 53.4% not experienced). Consultants favoured starting nutritional support (77.7%; 1443/1875) more often than non-consultants (71.8%; 1310/1825). Forming an anastomosis, hypoalbuminaemia, underweight (body mass index <18.5 kg/m2), unintentional weight loss (>10%), ≥5 days without oral intake until now and ≥5 days likely to be without oral intake from now were statistically more likely to be associated with treatment preference, but obesity (body mass index >30 kg/m2) was not. Overall, experience of IF (OR 1.093, 95% CI 0.732-1.631; P = 0.663) and seniority of surgeon (OR 0.711, 95% CI 0.473-1.068; P = 0.100) significantly influenced the results.

There are many variables that impact the decision to start nutritional support in EGS, but seniority of the surgeon and IF experience do not.

Understanding the lived experience of obesity, just like any other chronic outcome, is essential to addressing deep routed inequalities and stigma associated with obesity, as well as creating more inclusive and effective policies and healthcare. The psychosocial aspects of obesity are vast and as such the lived experience of obesity differs between individuals and groups. However, there are consistent psychosocial issues identified within empirical studies as well as lived experience accounts that require consideration and potential adaption in the design and delivery of care including weight management and obesity services. Improving perceptions and understanding of the lived experience can also foster empathy which appears to be lacking based on research examining everyday encounters, media portrayal of people living with obesity, and in healthcare settings. Stigma and discrimination are consistent and, in some instances, occur daily in many societal settings leading to mental and physical health concerns, social disengagement and dysfunctional relationships with significant others, as well as avoidance of health promoting activities and settings. Using a narrative review approach, our aim was to examine the empirical evidence generated in countries across the world, reporting on the real-life experiences of people living with obesity. Our search strategy was informed by existing empirical evidence of the psychosocial aspects of obesity and an in-depth interview exploring the lived experience of obesity specifically conducted to inform this article. In doing so, we highlight key psychosocial aspects and provide a voice for a personal account of the challenges experienced in child and adulthood. Recommendations are offered for stakeholders including policymakers and practitioners that aim to address these real-life challenges experienced by people living with obesity. PLAIN LANGUAGE SUMMARY: In this publication, the authors provide a detailed review of the lived experiences of people living with obesity with a focus on the psychological and social factors and experiences across the life course. The paper also uniquely presents real-life experiences from Sarah, who identifies as living with obesity. In doing so, the authors highlight exposure to and experiences of weight management related behaviours and weight stigma from an early age. Experiences of weight stigma and feelings of being excluded from social settings and more generally society are evidenced throughout. Indeed, Sarah's accounts support the research evidence presented, where for instance, she highlights feeling excluded as a younger person when not being able to purchase "trendy" clothing and as an adult when buying clothing for work, experiences of weight stigma in workplaces and issues related to travelling as well as the actions she takes to avoid imposing on other people. The key lived experiences, both from the research evidence and Sarah's accounts, provide insights about the link between obesity and mental health, where for instance, the experiences of weight stigma and feeling excluded from society are associated with mental health outcomes including reduced self-worth and self-esteem, increased depression and increased risk of self-harming. The authors provide a list of ways to address weight stigma in society as well as in healthcare, a setting where weight stigma is often reported by people living with obesity, and calls for greater involvement of people living with obesity in policy, healthcare development and practice, as well as the need to address the widespread weight stigma and discrimination. [Plain language summary added March 2025, after original online publication].

Individuals with obesity often experience weight bias in healthcare, which may negatively impact health outcomes. Weight bias (WB) can be reduced by provider participation in weight bias interventions. This mixed-methods study investigated the sustainability of reduced WB in those who received a weight bias intervention.

Registered nurses (RNs) who completed a weight bias intervention during their nursing education and those who did not were recruited to complete an online survey. WB scores and approaches towards caring for patients with obesity were compared.

Eighty-four RNs (50 intervention; 34 control) participated. Reduced WB was sustained over 4 and 6 years compared to pre-intervention scores (p < 0.001). No significant WB differences were found between the groups (p = 0.501). Thematic analysis identified three overarching themes: physical care differences, recognition of obesity's causality and controllability, and equal treatment of all patients.

Weight bias intervention effects were sustained, but non-intervention nurses had comparable WB scores, indicating multifaceted influences on WB in clinical practice. In order for nurses to provide unbiased care for individuals with obesity, it is important to develop and implement both high-impact educational interventions that support reduced weight bias and organizational and structural supports in the practice environment.

Due to the lack of a validated instrument to measure fatphobia, its epidemiology in India remains unknown. This study aimed to culturally adapt and validate the Fat Phobia Scale-Short Form (FPS-SF) in Hindi.

A cross-sectional study using a purposive sampling technique was conducted in the metabolic surgery clinic of a tertiary care teaching institution. We followed the World Health Organization's procedure for cultural adaptation and validation of an instrument. The study was biphasic. The phase-1 entailed forward translation, formation of an expert panel, backward translation and cognitive interviewing with the two groups of seven individuals, each with severe obesity. During phase-2, 175 participants (students [n = 120], patients [n = 55]) were recruited after written informed consent. Hindi-FPS-SF was administered to students twice, 1 week apart. All participants completed Hindi-FPS-SF, Modified Weight Bias Internalization Scale (Hindi-WBIS-M), Patient Health Questionnaire (Hindi-PHQ-9) and Generalised Anxiety Disorder Questionnaire (Hindi-GAD-7). Statistical analysis was done.

Several items of forward-translated Hindi-FPS-SF underwent culture-specific modifications in Phase-1. Content or curricular validity and face validity were assessed. In Phase-2, the reliability and validity of Hindi-FPS-SF were evaluated. The internal consistency (Cronbach's alpha), intra-class correlation type-A coefficient (ICC) and cross-cultural reliability were α =0.902 (P < 0.001), 0.799 (95% CI = 0.753-0.840) (P < 0.001) and (ICC: 0.865-0.992) (P < 0.001), respectively. The convergent-construct validity assessed by correlations between total scores of Hindi-WBIS-M and Hindi-FPS-SF was significant. Criterion validity measured through correlations with original FPS-SF, Hindi-WBIS-M, PHQ-9 and GAD-7 was significant.

The Hindi-FPS-SF demonstrated good psychometric properties and may be used to measure fat phobia and its correlates in India for epidemiological purposes.

Semaglutide, sold under the brand names of Ozempic, Rybelsus and Wegovy, is one of the most popular drugs on the market. Manufactured by Novo Nordisk, semaglutide is the newest in a family of glucagon-like peptide-1 receptor agonists used most commonly to treat type II diabetes. To date, the results of semaglutide for the treatment of type II diabetes have been overwhelmingly positive. It is for the drug's effects on appetite suppression and weight loss, however, that have led its surge in popularity, with many hailing semaglutide as the new 'miracle drug for weight loss'. Despite its popularity, both the governmental and popular reception to the drug has largely been mixed. In this paper, we address a range of ethical concerns and argue that while many are legitimate, they do not provide conclusive reason not to prescribe semaglutide for weight loss.

Most healthcare providers exhibit weight bias (i.e., negative assumptions, beliefs, or discriminatory acts toward someone based on their weight/body size) in their interactions with patients with obesity. Such bias can be exacerbated in medical training and may lead to reduced healthcare utilization and worsened patient outcomes. This study explored reflections of pre-clinical medical students on formative experiences they perceived to be related to their newly identified implicit weight bias.

Seven hundred and sixteen second-year medical students completed the Weight Implicit Association Test (IAT) between April 2019-April 2022 and were instructed to write a reflective response based on their results. Of this sample, 212 students described experiences from childhood in their reflections, and these participant quotes were pulled for analysis. Inductive coding techniques were used to identify themes that were generated from medical students' reflections on formative experiences using the software program Dedoose Version 8.3.35.

The identified themes highlighted medical students' own struggles with weight management and body dissatisfaction in childhood, a fear of having obesity, the prioritization of a "healthy" (i.e., thin) body and the stigmatization of larger bodies, and the influence of culture of origin on thin-ideal internalization. Results recognize the manifold experiences that these medical students have before entering their formalized medical training.

Despite the proven negative impact on patient care caused by clinician weight bias there is a paucity of medical training programs that address weight bias. This research highlights the need for a more intentional educational curriculum to counteract the deeply rooted implicit weight bias existent in some future healthcare providers.

Although biases are a natural part of the human experience, left unchecked, they can lead to considerable harm in the context of healthcare. Weight Bias and Stigma (WBS) is a pervasive bias rooted in the negative attitudes and perceptions of individuals in large bodies. WBS can result in poor health outcomes of large-bodied patients due to weight distraction, delaying or avoiding seeking care, and the presumption of non-compliance. As high-volume carers, Medical Radiation Technologists (MRTs)/Radiographers are a central pillar in the healthcare system; responsible for caring for a multitude of patient populations. The purpose of this study was to explore MRTs perceptions and attitudes regarding large-bodied patients, and to identify subsequent practice implications and areas for improvement.

The study included ten practicing MRTs with a range of clinical experience from hospitals across Ontario, Canada. Data were collected using semi-structured interviews (pilot tested) conducted in person and online and analyzed using Braun and Clark's approach to thematic analysis.

Four main themes were identified by analyzing the interview responses including hospital resources, patient care, attitudes and perspectives, and education for future practice. Deficit language and responses provided evidence of WBS not only in the sample population but also within hospitals across Ontario, Canada, as revealed by recounts of stories and comments made by other healthcare professionals. Evidence of empathy and advocacy for large-bodied patients was also found.

WBS influences the provision of care in medical radiation sciences. This study found both implicit and explicit WBS, as well as demonstrations of empathy and compassion for large-bodied patients. The emergent themes identified in this study demonstrate the need for improvement in hospital resources and equipment, as well as improvements in education and training of MRTs and other healthcare professionals working with large-bodied patients.

New portable health technologies may offer solutions to challenges in current maternity care, but little is known about their current usage, existing problems, or areas of unmet needs.

To better understand the use of health technology in community midwifery care in the UK.

Midwives with current or recent experience working in community settings were recruited using social media. Semi-structured interviews were undertaken. These were transcribed and thematically analyzed.

Thirteen midwives were interviewed between October 2021 and March 2022. The main themes and subthemes were: (1) Problems with current equipment: (a) Issues in the context of remote working, b) Concerns regarding accuracy, and c) Midwives' perceptions of service user experiences. (2) Equipment challenges working within the UK National Health Service: (a) Lack of availability of appropriate equipment, and (b) Lack of autonomy in how to utilize equipment. 3) Areas of unmet needs.

This study has shown that there are several areas of unmet needs for community midwives that should be investigated. However, and arguably more pressing, is improving the availability and quality of health technologies and other equipment that is already widely used. Midwives were interested in technologies that support decision making, reduce the number of hospital visits for their patients, improve their workload, and reduce medicalisation. At the same time, there is fear that technology may displace midwives' wisdom. Where new technologies are introduced, support and training should be provided to address potential resistance.

Obesity has emerged as a significant public health concern in Saudi Arabia, with rising prevalence rates contributing to an increased risk of chronic diseases such as diabetes and cardiovascular disorders. Community pharmacists, as accessible healthcare providers, hold the potential to play a critical role in weight management. This study aimed to explore the beliefs, practices, and barriers encountered by community pharmacists in Saudi Arabia regarding weight management.

A cross-sectional survey was conducted among community pharmacists to gather data on their perceptions, practices, and barriers related to obesity management. The data obtained were subjected to descriptive and inferential analysis using a multinomial regression model with the help of SPSS-IBM 2025.

Findings revealed that while a significant majority (73%) recognize obesity as a pressing health issue, only 31% reported receiving formal education on weight management, which impedes their ability to provide effective counseling. The demographic profile of respondents showed a predominance of male pharmacists (91%) aged between 31 and 40 years, which reflects broader societal trends in healthcare professions in the region. Furthermore, barriers such as inadequate staffing (39%), lack of private consultation spaces (37%), and the necessity for additional payment for weight management services (49%) were identified, underscoring the need for targeted support. Pharmacists showed a strong dedication to helping patients adopt healthier lifestyles. Specifically, 76% of pharmacists provided advice on following low-calorie diets, and 83% encouraged patients to increase their physical activity. However, only 33% regularly dispensed weight loss products, indicating a gap in practice.

Enhanced education and supportive policies are crucial for pharmacists in obesity management. Future research should focus on developing tailored training programs to fill the knowledge gaps and explore financial incentives to optimize pharmacists' roles in public health initiatives aimed at combating obesity and chronic diseases in Saudi Arabia. By addressing these barriers, community pharmacists can significantly contribute to obesity management and improve health outcomes in their communities.

Despite extensive efforts to standardize definitions of obesity, clinical practices of diagnosing obesity vary widely. This study examined (1) discrepancies between biometric body mass index (BMI) measures of obesity and documented diagnoses of obesity in patient electronic health records (EHRs) and (2) how these discrepancies vary by patient gender and race and ethnicity from an intersectional lens.

Observational study of 383,380 participants in the National Institutes of Health All of Us Research Program dataset.

Over half (60 %) of participants with a BMI indicating obesity had no clinical diagnosis of obesity in their EHRs. Adjusting for BMI, comorbidities, and other covariates, women's adjusted odds of diagnosis were far higher than men's (95 % confidence interval 1.66-1.75). However, the gender gap between women's and men's likelihood of diagnosis varied widely across racial groups. Overall, Non-Hispanic (NH) Black women and Hispanic women were the most likely to be diagnosed and NH-Asian men were the least likely to be diagnosed.

Men, and particularly NH-Asian men, may be at heightened risk of underdiagnosis of obesity. Women, and especially Hispanic and NH-Black women, may be at heightened risk of unanticipated harms of obesity diagnosis, including stigma and competing demand with other health concerns. Leveraging diagnosis and biometric data from this unique public domain dataset from the All of Us project, this study revealed pervasive disparities in diagnostic attribution by gender, race, and ethnicity.

This study aimed to examine the association of body mass index (BMI, kg/m2) with time to fetal expulsion for individuals undergoing medication abortion over 13 weeks.

This is a retrospective cohort study of singleton pregnancies undergoing medication abortion >13 weeks at a single academic medical center between 2020 and 2024. Our primary outcome was time to fetal expulsion. We categorized BMI into three groups (>25, 25-29.9, and ≥30) and compared median time to fetal expulsion. We used multivariable logistic regression models to assess the association of BMI with time to delivery ≥24hours.

Of the 428 charts reviewed, 382 patients met the inclusion criteria with an average gestational duration of 25.0 weeks. Of these, 162 (42.4%) had a BMI >30 kg/m2; 120 individuals fell into the BMI 25 to 29.9 group (31.4%), and the remaining 100 individuals made up the BMI <25 group (26.2%). The median time to expulsion differed significantly among BMI categories (12 hours for BMI <25 [IQR 8-18], 14 hours for BMI 25-29.9 [IQR 8-22], 20 hours for BMI ≥30 [IQR 12-28], p < 0.001). After adjusting for gestational duration, history of cesarean section, or prior vaginal deliveries, individuals with a BMI ≥30 had 6.62 times the odds (95% CI 3.27-13.44) of having a time to expulsion ≥24 hours compared to BMI <25.

Individuals with a BMI >30 had significantly longer second and third trimester time to fetal expulsion. Induction protocols and counseling may need to be adjusted based on body size.

Individuals with a BMI >30 undergoing a medication abortion >13 weeks have longer time to fetal expulsion than those with a BMI <25. More research is needed to optimize induction protocols and abortion care for high BMI individuals.

People with larger bodies face discrimination in accessing health care, including equitable contraceptive care. Conscientious provision of person-centered contraception counseling is consistent with principles of the Health at Every Size and the Reproductive Justice movements. One facet of this care includes integration of evidence around unique considerations for steroid hormone efficacy and safety for patients with bigger bodies. Ultimately, this information should be used to empower and support reproductive decision making amongst patients of larger body sizes.

Weight bias, often known as fat phobia or weight stigma, refers to unfavorable attitudes and stereotypes that are associated with, and applied to, larger bodies. Fat phobia can include an unreasonable and abnormal dread of being overweight or being associated with obese people. Currently, there is no validated tool available to measure fat phobia in Arabic. Measuring fat phobia in Arabic-speaking populations is crucial, because cultural attitudes toward body weight can be quite negative and discriminatory; these negative attitudes can negatively impact mental health. The current study aimed to adapt, translate, and assess the structural validity of the Fat Phobia Scale-Short Form (F-Scale 14) in Arabic.

The gold standard approach to translation was used. Forward translation involved translation from the English language to the Arabic language by independent translators. Subsequently, a back-translation review was performed on the translated Arabic version for comparison with the original language. A cross-sectional study was conducted online that included 1246 participants from 22 Arabic countries, of whom 74% were female, 66% single, 83% university graduates, with a mean age of 35 ± 6 years.

The F-Scale 14 demonstrated good reliability in the Arabic language, with a Cronbach's α of 0.82 (95% CI 0.80-0.83), comparable to the original scale. The test-retest reliability of the scale was 0.92 (95% CI 0.90-0.94). According to the fit indices, the F-Scale 14 demonstrated a satisfactory level of structural validity in Arab cultures. Fit indices are statistical measures used in confirmatory factor analysis (CFA) to assess how well a proposed model fits the observed data. The scale showed a small improvement in factorial structure after the removal of some items. The two items removed were self-indulgent versus self-sacrificing and disliking food versus likes food. The correlation between F-Scale 14 and the figure rating scale was r = 0.76 (p < 0.001), suggesting adequate convergent validity.

The F-Scale 14 is a crucial indicator of attitudes and opinions concerning obese or overweight individuals. Based on increased internal consistency reliability and the problematic cultural relevance of two items, we recommend adopting a 12-item version of the scale for better cultural relevance in Arabic populations. It is anticipated that the Arabic F-Scale-12 will be highly useful for research and clinical purposes. Future research should test and adapt the Fat Phobia Scale for diverse Arabic populations to ensure its cultural relevance. Exploring its application in clinical settings will enhance our understanding of weight stigma and inform targeted interventions that promote body positivity. By addressing these areas, we can develop effective strategies to foster healthier attitudes toward body image in Arabic communities.

Evidence obtained from a cross-sectional descriptive study.

Individuals with marginalised social characteristics (e.g. by race/ethnicity, gender, body weight) report experiencing eating disorder (ED) symptoms but do not proportionally access treatment. There may be unique factors experienced by individuals with multiple marginalised social characteristics which are not included in our current understanding of help-seeking for EDs. The present review sought to examine the extent of evidence exploring help-seeking and service utilisation for (EDs) by people with more than one marginalised social characteristic or identity. MAIN: A systematic scoping review was conducted in accordance with the Joanna Briggs Institute guidelines for scoping reviews. Four databases (PsycINFO, PubMED, Embase, Medline) were searched for papers explicitly examining help-seeking or service utilisation for people with more than one marginalised social characteristic or identity (e.g. race/ethnicity, sexual orientation, weight status). Included studies underwent qualitative synthesis employing an existing model of help-seeking adapted for this review. The most common ED investigated was binge eating disorder (BED) and the most frequently reported marginalised characteristics were overweight/obesity and race/ethnicity. Other intersectional characteristics identified included socioeconomic status (SES), gender, and sexual orientation. People with marginalised social identities such as race/ethnicity or gender were more likely to seek help for BED when they also experienced a higher BMI. There was consensus across studies included in this review that help-seeking rates are low for people with an ED.

Mental health literacy and cultural beliefs about help-seeking are important factors affecting the experiences of people with intersectional identities and this may impact their likelihood to seek help. Results suggest that future studies should consider the interaction between social characteristics and identities in their analyses of outcomes in EDs as this is an emerging area of research, extension of our findings is also needed. The protocol for this review is registered via PROSPERO number CRD42024525849.

Due to the rising prevalence of obesity and its impact on healthcare, patient-specific context is needed to optimize weight management with an emphasis on reducing health care-associated weight stigma. Our survey aimed to explore institution-specific patient experiences of weight stigma and preferences for patient-centered language use regarding weight management care.

This cross-sectional analysis adopted a concurrent mixed methods design with a sample of individuals who opted in to complete patient experience surveys after receiving care at a large academic medical center in the United States (U.S.). Categorical and continuous variables were assessed using Chi-squared and analysis of variance. We used classical content analysis to qualitatively analyze free-text data for thematic coding.

After a 1-week survey fielding period, 3,219 of 16,758 patients completed the survey, yielding a response rate of (19.2%) with 2,816 having available electronic health record body mass index (BMI) data. Patients were comfortable discussing weight with their primary care providers but showed variation in the preferred approach and terms. Female patients with higher BMIs reported higher rates of delayed and canceled care due to prior weight stigma (25.6% and 12.2% for patients with class 3 obesity), and preferred a slower, gentler, and less direct approach with term preferences for "healthy eating plan" and against "obesity." Qualitative analysis yielded 27 themes grouped into three domains: Emotional Hinderances, Perceptual Hinderances, and Perceived Helpfulness.

Findings from our large single institution cohort expand on the existing weight stigma literature by identifying patient language preferences and healthcare experiences according to patient weight class and sex. Given the potential impact of understanding context-specific patient language use preferences to reduce weight stigma, we recommend other healthcare systems use a similar process to address weight stigma as part of a coordinated health system improvement initiative to enhance patient-centered weight management care.

Patients with obesity seeking bariatric surgery undergo an extensive evaluation by a multidisciplinary team of healthcare professionals' (HCPs) to assess patient compliance among other factors and determine their eligibility for surgery. However, the HCPs' assessments are not devoid of bias that may affect eligibility and preoperative decisions. This study aimed to investigate team members' ability to predict patient outcomes following bariatric surgery.

HCPs and other clinic staff at an academic institution completed a survey on postoperative outcomes prediction of adult patients seeking bariatric surgery from 2019 to 2020. HCPs and staff predictions for weight loss at 6 mo and 1 y, 30-d complications, and comorbidity resolution were compared with actual patient outcomes. Linear and logistic regression models were used, adjusting for preoperative body mass index, American Society of Anesthesiologists classification, and procedure type.

1503 predictions on 618 patients were collected, of whom 293 underwent surgery with at least 6 mo of follow-up. On adjusted analysis, the predictions on weight loss were not associated with body mass index reduction at 6 mo or 1 y (1-y data available for 155 patients). However, HCPs accurately predicted the length of stay (LOS) (coeff = 0.24, 95% CI = 0.07-0.41) and comorbidity resolution (aOR = 1.68, 95% CI = 1.21-2.33), while clinic staff only predicted the LOS (coeff = 0.30, 95% CI = 0.08-0.53).

While HCPs predicted the resolution of comorbidities and LOS, their predictions failed to correlate with weight loss outcomes following bariatric surgery. Additionally, there was no association between predictions and 30-d complications, readmissions, or emergency department visits. The HCPs' perspectives during patients' preoperative supervised weight loss program, while important, should not bias the decision-making process, particularly proceeding with surgery.

Differences in breast cancer recurrence and survival occur by body size; the role of treatment differences in these disparities has been underexplored. Our objective was to evaluate differences in treatments received, patient experiences of care, and treatment decision-making processes among breast cancer survivors by body size.

We used data from the Share Thoughts on Breast Cancer study. Participants (n = 1198) completed a survey that included information on demographics, treatments received, quality of care, and decision-making. We used descriptive statistics to evaluate differences in survey response by BMI category, and multivariable-adjusted multinomial and logistic regression to examine associations of BMI with treatments received.

Those with higher BMI were more likely to be older, report fair/poor health, not have a college-level education, be non-white, not be insured, have an income under $50,000, be unemployed, and report a history of several chronic diseases. Although there were unadjusted associations, after adjustment, women with obesity were not significantly less likely to receive mastectomy [OR 0.79 (0.50, 1.26) and OR 0.66 (0.38, 1.16), for BMI 30-35 and 35+ kg/m2 respectively] or contralateral prophylactic mastectomy [OR 0.92 (0.59, 1.44) and OR 0.80 (0.46, 1.39)] than those without obesity. Similarly, we found no association of BMI with reconstructive surgery [OR 0.97 (0.58, 1.60) and OR 0.58 (0.30, 1.11)] after adjustment. Women with obesity were less likely to report that their breast cancer care was excellent or very good (p = 0.026).

We observed no differences in breast cancer treatments received by BMI after adjustment for key covariates in this study sample. Further research is necessary to determine why quality of care may be perceived as lower among women with obesity.

The negative impacts of perceived discrimination on health have been documented, but how perceptions of discrimination vary by sex among people with obesity (PWO) is not well understood. This study assessed sex differences in perceived discrimination among PWO. This cross-sectional study analysed self-reported data from racially/ethnically diverse PWO attending an academic obesity program. The primary outcome was perceived discrimination, assessed by the Major Experiences of Discrimination (MED) and Everyday Discrimination Scale (EDS). Sex differences were evaluated by univariate and multivariable regression analysis adjusted for key descriptive variables. The final analytical sample included 60 PWO (62% female, 61% non-Hispanic white (NHW), 12% Hispanic, 39% non-Hispanic black (NHB), mean age 53 years, mean BMI 34 kg/m2). Women experienced everyday discrimination 59% less than men but this was not significant (OR 0.41; 95% CI 0.08-2.16; p = .29). Participant highest BMI was correlated with acute discrimination (total MED score) (r = 0.39; p = .0024) and chronic discrimination (total EDS score) (r = 0.28; p = .03). Most participants reported more chronic discrimination compared to acute discrimination (85% vs. 48%). Mean MED (β -0.18; 95% CI -0.93 to +0.56; p = .62) and EDS scores (β -0.25; 95% CI -3.37 to +2.87; p = .87) were not significantly different between women and men. Perceived discrimination was common and experienced equally between men and women with obesity. Incorporating discrimination experiences into obesity care models may be an important step to improving quality of care and outcomes.

Recent studies show a high prevalence in hospital populations and best practice evidence indicates that people living with obesity should receive dietetic advice. However, patients often do not receive this care in acute settings. Understanding the experiences of people living with obesity is crucial to designing successful strategies for management.

This qualitative study aimed to understand the experience of nutrition care for patients living with obesity in the acute hospital setting and to redesign an optimised patient journey using a design approach. Using patient journey mapping, nutrition care across the inpatient admission was explored. A lived experience perspective was applied to reflect on the patient journey and interactions of patients with dietetic services in the acute setting. A co-creation session was conducted with dietitians and consumers to redesign the patient journey.

The patient journey revealed that for patients living with obesity, discussions about weight were absent from the journey from all healthcare professionals. For patients receiving dietetic care, the Nutrition Care Process was followed; nutrition intervention focused on acute nutrition issues with increased energy and protein prescription: a lack of goal setting and absence of discharge planning. The redesign of the nutrition care journey identified pivot points in the pathway to support engagement in obesity-related care.

The findings from this study provide new insights into current nutrition care for people living with obesity in the acute setting. These findings can inform future education, research and advocacy for practice changes to improve dietetic care for people living with obesity.

GPs have a complex role in obesity management due to patients' individualized experience of living with obesity, coupled with the challenge to deliver healthcare messages in non-stigmatizing ways. This study aimed to explore who initiates the topic of weight and how weight was discussed in real-world GP-patient consultations.

A multi-disciplinary team, including obesity lived experience experts, undertook a secondary data analysis of 43 Australian video recorded consultations and patient surveys from The Digital Library using descriptive content analysis.

17/43 consultations included the topic of weight in the discussion. 15 were initiated by the GP and 2 by the patient. 14/17 used a structured approach. All GPs asked for consent to discuss weight or gave patients space to decline the discussion. No overt stigmatizing language was identified. A post-consultation survey found 15/17 patients (2 unanswered) felt listened to and respected during consultations.

This study identified the intricate ways GPs approach weight discussions in consultations. GPs navigated weight discussions in ways that made patients feel respected and listened to and related weight to health concerns relevant to each patient.

The findings in this study can serve as a foundation for establishing education and training resources for GPs and can be utilized as a way of continuing professional development. Any future communication technique resources for GPs should be co-designed with obesity lived experience experts to ensure appropriateness and avoid potential stigma and harm.

Weight bias is characterised by negative attitudes towards people with a higher weight and is widespread in healthcare. Primary care professionals sometimes avoid discussing weight with patients due to concerns about upsetting them, insufficient training, resources, or referral pathways. There is, however, a responsibility for primary care professionals to address the health needs of patients, which may require discussing weight.

The current study aimed to understand primary care professionals and trainee perceptions of the appropriateness of weight-centric, weight-inclusive/holistic, and avoidant approaches for discussing weight with higher weight individuals when patients were and were not seeking weight management advice.

Mixed methods design.

Primary care professionals and trainees (N = 112) within Australia.

Participants first completed an online survey and provided demographic data and completed measures of implicit and explicit weight bias. Secondly, participants viewed simulated patient consultations, reflecting each of the three approaches (weight-centric, weight-inclusive/holistic, and avoidant) in a weight-related and non-weight related context. Participants then evaluated the appropriateness of the language and strategies used.

The participants showed, on average, low to moderate levels of explicit weight bias but high levels of implicit weight bias. For the consultations, language and strategies of the holistic approach were considered the most appropriate in both contexts. In the weight-related consultation, language used in the weight-centric and avoidant approaches were deemed equally inappropriate. However, weight-centric strategies were considered more appropriate than avoidant strategies. In the non-weight related consultation, the language and strategies of the avoidant approach were considered more appropriate than those of the weight-centric approach.

Primary care professionals and trainees favoured the holistic approach to discussing weight when patients presented with weight-related or non-weight related concerns. These findings have potential practical implications for health professional education.

We do not know if patients find the coordinated treatment of comorbid obesity and low back pain acceptable in clinical practice. The primary purpose of this study is to evaluate patient-level interest in a combined back pain and obesity specialty treatment clinic.

A survey was sent to patients over 18 with a diagnosis of back pain and a BMI over 30 through their electronic medical records. Statistical analysis was carried out to examine the role of weight and pain stigma in mediating beliefs about weight and back pain on interest in a combined clinic.

1290 people responded. Respondents reported moderate levels of experienced stigma relating to pain (9.4 ± 6.6) using the 32-point Stigma Scale for Chronic Illness and obesity (3.5 ± 1.1) using the 6-point Weight Bias Internalization Scale. Respondents expressed a moderate belief that back pain and weight were related (70.8% ± 21.7). Most patients (69.2%) were interested in a joint clinic.

In a target population of patients with obesity and back pain, a combined clinic treatment plan is desirable. These results support the need to explore the feasibility and sustainability of innovative, combined, holistic care clinics to treat people with obesity and back pain.

Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting 10-13% of reproductive-aged women. Lifestyle management through diet and physical activity changes can improve reproductive, metabolic, and psychological comorbidities. The aim of this systematic review is to understand the barriers and facilitators to lifestyle changes from the perspective of people with PCOS and health care professionals (HCP) using the theoretical domains framework and capability, opportunity, motivation, and behavior model. Six databases were systematically searched for qualitative, quantitative, and mixed-methods studies to 22nd September 2022. Quantitative outcomes from quantitative and mixed-methods studies were narratively synthesized and all studies were thematically analyzed. Sixty-eight papers met the eligibility criteria. HCP education on lifestyle management in PCOS was viewed by all to be inadequate, impacting the quality of care and health outcomes. Lifestyle advice delivered by a multidisciplinary team, including dietitians, was identified as a key component for change. All agreed that there was a need for individualized and PCOS-specific lifestyle advice. Weight stigma was identified as negatively impacting both those in larger and smaller bodies with PCOS, reducing the quality of care and affecting self-perception and mental health. People with PCOS perceived that lifestyle management was overly focused on weight loss and fertility, independent of their own personal motivations and goals. Systemic changes, including increasing HCP education on lifestyle management and multidisciplinary collaboration, focusing on lifestyle advice that meets individual needs, and reducing the use of weight-centric care are necessary for long-term sustainable changes and improvements in health outcomes in people with PCOS.

We conducted a systematic review and meta-analysis to determine the efficacy of interventions aimed at reducing weight bias in healthcare students, and to explore factors that may impact intervention success. A systematic review and random-effects meta-analyses were conducted by including studies that examined the efficacy of weight bias reduction interventions for healthcare students. Of the 3463 journal articles and dissertations screened, 67 studies (within 64 records) met inclusion criteria, with 35 studies included in the meta-analyses (explicit = 35, implicit [and explicit] = 10) and 32 studies included in the narrative synthesis (explicit = 34, implicit [and explicit] = 3). Weight bias interventions had a small but positive impact, g = -0.31 (95% CI = -0.43 to -0.19, p < 0.001), in reducing students' explicit weight bias but there was no intervention effect on implicit weight bias, g = -0.12 (95% CI = -0.26 to 0.02, p = 0.105). There was considerable heterogeneity in the pooled effect for explicit bias (I2 = 74.28, Q = 132.21, df = 34, p < 0.001). All subgroup comparisons were not significant (p > 0.05) and were unable to explain the observed heterogeneity. Narrative synthesis supported meta-analytic findings. The small but significant reduction of explicit weight bias encourages the continued testing of interventions, irrespective of variation in individual intervention components. Contrarily, reductions in implicit weight bias may only be possible from a large societal shift in negative beliefs and attitudes held towards people living in larger bodies.

This review integrates new developments in psychology with updated physiological insight on the complex relationships among chronic psychological stress (arising from weight stigmatization and body shaming), food composition, physical activity and metabolic health for the example of diabetes. We address how visual measures of health, such as body mass index (BMI) and waist-to-hip ratio, do not adequately capture metabolic health and can instead contribute to weight stigmatization, chronic stress, and system-wide impairment of metabolic health. We also emphasize the importance of food composition over calorie counting. We summarize how chronic stress interacts with nutritional deficiencies and physical inactivity to disrupt the stress response, immune response, gut microbiome, and function of fat depots. We specifically address how interactions among lifestyle factors and the gut microbiome regulate whether fat stored around the waist has a negative or positive effect on metabolic health. We aim to provide a resource and updated framework for diabetes prevention and health promotion by (i) highlighting metabolic imbalances triggered by lifestyle changes during the transition to industrialized society and (ii) detailing the potential to support metabolic health through access to modest, but comprehensive lifestyle adjustments.

Previous health communication research has demonstrated the negative psychological and health effects of depicting thin-sized models in mass media advertisements including on social media sites such as Instagram. However, gym advertisements are one common source for the presentation of lean and thin-sized models on Instagram. Therefore, the current study guided by social comparison theory and signaling theory aimed to experimentally examine the effect of thin-sized models relative to plus-sized models as well as slogan-type (health and wellness versus physique-based) on women's appearance comparison, body satisfaction, perceived gym fit, and intentions to join the gym. A sample of 217 undergraduate students who identified as women were randomly assigned to one of four Instagram gym advertisement conditions varying in model body-size and slogan-type. Appearance comparisons, perceived gym fit, and intentions to join the gym were measured post advertisement exposure and body satisfaction was measured pre-and-post advertisement exposure. As expected, exposure to Instagram gym advertisements featuring thin-sized models resulted in greater appearance comparisons and lower body satisfaction than exposure to Instagram gym advertisements featuring plus-sized models. Moreover, the combination of plus-sized models with health and wellness slogans in Instagram gym advertisements resulted in greater gym fit perceptions although there was no effect of model body-size and slogan-type on intentions to join the gym. This study supports social comparison theory, signaling theory, and practically the findings indicate that Instagram gym advertisements that depict plus-sized models (versus thin) with health-and-wellness slogans (versus physique) generate fewer body image concerns and lead to greater gym fit perceptions.

Objective: The study assessed perceived health, health behaviors and conditions, and medical care utilization among students of different weight categories. Participants: Participants were college students (n = 37,583) from 58 institutions who responded to a national survey of student health behaviors. Methods: Chi-squared and mixed model analyses were completed. Results: Compared to healthy weight students, those with obesity were less likely to report excellent health and meet dietary and physical activity recommendations, and more likely to have obesity-related chronic conditions and to have attended a medical appointment in the prior 12 months. Students with obesity (84%) and overweight (70%) were more likely to be attempting weight loss compared to students of healthy weight (35%). Conclusions: Students with obesity have poorer health and health behaviors relative to students of healthy weight; students with overweight were in between. Adapting and implementing evidence-based weight management programs within colleges/universities may be beneficial for student health.

To highlight recent evidence of the impact of weight bias and stigma on healthcare access and utilization.

Healthcare access for patients with obesity is limited by weight-discriminatory policies such as body mass index cutoffs and weight loss requirements. These policies are based on flawed justifications without demonstrated medical benefits. Healthcare providers continue to hold negative views of patients with obesity, but recent evidence does not suggest that providers' weight-stigmatizing attitudes affect obesity treatment referrals. With the rise of new anti-obesity medications, more research is needed to understand how weight stigma may or may not affect providers' prescribing behavior and patients' access to this form of treatment. Experienced, anticipated, and internalized weight stigma is associated with patients' avoidance of healthcare and reduced utilization. Weight bias and stigma limit healthcare access and utilization. Structural changes are needed to remove weight-discriminatory barriers to care.

To examine survivors' experiences of discharge information including risk communication after hospitalisation for a stroke and the characteristics associated with receiving information in accordance with their preferences.

With advances in acute stroke care and an ageing population, the number of survivors of stroke is increasing. It is important that healthcare providers ensure patients have adequate information after a stroke-related hospitalisation.

Cross-sectional study.

Adults recently discharged after a stroke from eight Australian hospitals were mailed a survey. Items examined risk and discharge care information, with participants asked to indicate both their preferences for and receipt of the information. Concordance with preferences was calculated, and characteristics associated with information preference concordance were assessed with binomial logistic regression. Study reported in accordance with STROBE Checklist.

Of 1161 eligible patients invited, 403 (35%) completed the survey. All items were endorsed by 80% or more of respondents as being wanted. However, for all items, fewer respondents reported the care as received. Only 28% of participants received information on all five items according to their preferences. Hospital site, Body Mass Index and age were statistically significantly associated with participants receiving information in accordance with their preferences.

Most participants indicated a preference to receive recommended discharge information. Findings suggest that patients may benefit from increased information provision prior to hospital discharge after stroke.

Nurses have an important role in the provision of stroke care and information. The findings of this study may be used to improve the provision of post-hospital discharge care and support for survivors of stroke, and assist in identifying patients at lower odds of experiencing information aligned with their preferences and who may benefit from support.

Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.

No patient or public contribution.

The present study examined how individuals who have been clinically diagnosed as obese explain their decision to undergo bariatric surgery and how they deal with the stigmatization that such a decision may entail. A total of 23 participants (15 women and 8 men) who were awaiting bariatric surgery within the Spanish healthcare system, were interviewed about their weight trajectory and their decision to undergo this surgery. In order to examine the participants' stories, a narrative analysis of the interviews was conducted, with attention to both content (what they told) and structure (how they told) and examining the stories in line with the socially and culturally available narratives that they had access to, and the context in which the stories were produced. The participants explained their weight trajectory through the origin of their weight, the failure to control it, and their decision to have surgery to solve the weight problem. The narrative of a sick body that needs to be restored appeared to function as a schema or script through which participants attempted to defend themselves from anti-fat narratives that assume personal failure while at the same time presenting themselves as deserving to be operated on. Through their narratives, they positioned themselves as undeserving of stigma but did not challenge the stigma itself.

Glucagon-like peptide-1 (GLP-1) agonist medications are receiving high levels of attention because of their dramatic efficacy in causing weight loss. This commentary discusses several ways that those in behavioral medicine and health psychology might think about these medications-whether they should be fully in support of them or whether they pose a risk. The positive aspects of GLP-1s include their great promise in improving health independent of weight loss and the perspective that their efficacy frees individuals from the difficulties of behavioral weight maintenance and the associated stigma of "failing" to lose weight. However, GLP-1 agonist medications also risk medicalizing weight and increasing weight stigma (in addition to those on GLP-1 medications being stigmatized for taking the "easy way out"). From a social identity perspective, GLP-1 medications could even be perceived as a tool to eradicate an entire social group-those that identify as higher weight. In terms of clinical care, a patient-centered, weight-inclusive approach will allow for individuals to receive the treatment that fits with their own social and health context. In terms of research, behavioral medicine should shift away from weight loss interventions simply to lower body mass index, and instead intervene on actual health markers, disease endpoints, or healthy behaviors. Doing so will improve health regardless of a person's weight or whether they are on GLP-1 agonist medications.

It is standard practice for healthcare providers to give weight loss advice or counseling to higher-weight patients (ie, those with a BMI ≥ 30 kg/m2), but the immediate psychological consequences of this practice have rarely been examined.

We hypothesized that receiving weight loss advice from a healthcare provider might lead people to feel both motivated to engage in healthy behaviors and stigmatized for their weight.

Participants with higher weight (N = 294) were randomly assigned to read one of two doctor-patient interaction scenarios, and they were asked to imagine that they were the patient receiving advice. The scenario either involved the doctor giving behavioral weight loss advice (ie, standard diet and exercise recommendations) or control advice, which did not address weight or weight loss. Immediately after reading, participants reported their levels of behavioral motivation and weight-based identity threat.

Participants who received weight loss (versus control) advice reported significantly greater motivation for healthy eating and greater weight-based identity threat (Ps < .001, ds from 0.42 to 0.64). There were no significant group differences in perceptions of provider empathy or willingness to engage with the healthcare system in the future (Ps > .1, ds from 0.13 to 0.2).

As hypothesized, receiving weight loss advice made participants feel motivated to engage in healthy eating behavior, but it also made them feel stigmatized. These findings suggest that the standard practice of delivering weight loss advice should be reexamined, as it may harm higher-weight people and perpetuate inequity.