Future Research in Weight Bias: What Next? - Wiley Online Library

Obesity

Perspective

Future Research in Weight Bias: What Next? Angela S. Alberga1, Shelly Russell-Mayhew1, Kristin M. von Ranson2, Lindsay McLaren3, Ximena Ramos Salas4, and Arya M. Sharma5

The 2015 Canadian Weight Bias Summit disseminated the newest research advances and brought together 40 experts, stakeholders, and policy makers in various disciplines in health, education, and public policy to identify future research directions in weight bias. In this paper we aim to share the results of the Summit as well as encourage international and interdisciplinary research collaborations in weight bias reduction. Consensus emerged on six research areas that warrant further investigation in weight bias: costs, causes, measurement, qualitative research and lived experience, interventions, and learning from other models of discrimination. These discussions highlighted three key lessons that were informed by the Summit, namely: language matters, the voices of people living with obesity should be incorporated, and interdisciplinary stakeholders should be included. Obesity (2016) 24, 1207–1209. doi:10.1002/oby.21480

Introduction The increasing frequency and intensity of weight bias, stigma, and discrimination (1) against people living with obesity has become a great concern. Experiencing weight-based discrimination is associated with significant detrimental physical and psychological consequences including symptoms of depression, anxiety, disordered eating, and lower self-esteem (2), avoidance of both physical activity (3) and preventive healthcare (4), and increased mortality risk (5). Despite a solid foundation of evidence showing the prevalence of weight bias among health professionals, employers, educators, interpersonal relationships, and the media and its adverse consequences (6), research on how to reduce weight bias and stigma is limited (7). More robust research is needed to reduce stigma and ultimately improve the quality of care and quality of life for individuals living in large bodies.

2015 Canadian Weight Bias Summit The aims of the 2nd Canadian two-day Summit, held in March 2015, were to 1) disseminate the newest research advances on the effects of weight bias and interventions targeting its reduction among health professionals, policy makers, educators, the media, and the general public, and 2) bring together expert stakeholders from across Canada for a facilitated discussion to identify future research directions on how to reduce weight bias. The goals of this paper are to share the results of the Summit and to encourage international and interdisciplinary research collaborations in weight bias reduction.

The planning and organization of the 2nd Canadian Weight Bias Summit were led by researchers in the Werklund School of Education and departments of Psychology and Community Health Sciences at the University of Calgary. We partnered with researchers at the University of Alberta, and the Canadian Obesity Network as the Primary Knowledge User, in acquiring federal (Canadian Institutes of Health Research), provincial (Campus Alberta Health Outcomes and Public Health), and local (University of Calgary) funding to host this invite-only Summit. This enabled us to host approximately 40 guests representing education, healthcare, and public policy sectors in Alberta, British Columbia, and Ontario. There were roughly 14 researchers, 11 practitioners, and 15 policy makers, although some participants represented multiple perspectives. Representatives attended from the University of Calgary, the University of Alberta, Alberta Health Services, Alberta Health, Alberta Education, Alberta Public Health Association, Alberta Innovates–Health Solutions, Ever Active Schools, Be Fit for Life, Calgary Board of Education, the University of Ottawa, the University of Toronto, and the British Columbia Provincial Health Services Authority. More details on the 2015 Weight Bias Summit, including summary reports and the event program, which includes a list of participants and their biographies, can be found at http://www.obesitynetwork.ca/Full-Report-Now-AvailableWeight-Bias-Summit-2015-Ucalgary-Canadian-Obesity829 On the first day, speakers from across Canada disseminated their research on the prevalence and consequences of weight bias, as well as on interventions to reduce weight bias in the education, healthcare, and public policy arenas. These daytime sessions concluded with an evening public outreach event in the form of an expert round table

1

Werklund School of Education, University of Calgary, Calgary, Alberta, Canada. Correspondence: Angela S. Alberga ([email protected]) Department of Psychology, University of Calgary, Calgary, Alberta, Canada 3 Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 4 Canadian Obesity Network, University of Alberta, Edmonton, Alberta, Canada 5 Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada

2

Funding agencies: Dr. Alberga currently holds a Banting Canadian Institutes of Health Research (CIHR) Postdoctoral Fellowship and was previously funded by an Eyes High Postdoctoral Fellowship from the University of Calgary. The 2015 Canadian Weight Bias Summit was supported by a Planning and Dissemination Grant (FRN# 138852) from the CIHR (Institute of Nutrition, Metabolism and Diabetes), a Meeting Grant from Campus Alberta Health Outcomes & Public Health and part of a Powerful New Ideas grant from the Werklund School of Education at the University of Calgary. The Canadian Obesity Network (CON) is funded through government and private sector grants. Disclosure: The authors declare no conflict of interest. Received: 6 December 2015; Accepted: 27 January 2016; Published online 30 April 2016. doi:10.1002/oby.21480

www.obesityjournal.org

Obesity | VOLUME 24 | NUMBER 6 | JUNE 2016

1207

Obesity

Future Research in Weight Bias Alberga et al.

TABLE 1 Proposed future research directions in weight bias

Research area 1 2

Costs Causes

3

Measurement

4

Interventions

5

Qualitative research & lived experience Learning from other models of discrimination

6

Description The socioeconomic and personal costs of weight bias require further attention. More research is needed to identify the root causes and definitions of weight bias through qualitative and quantitative research. For example, social psychology experiments could be conducted to better understand the beliefs and attitudes of Canadians who have greater weight bias and to identify and isolate attitudes and behaviors that might be amenable to change. Are our current measures adequate? Evaluation of the validity and reliability of current measures of weight bias is warranted, particularly in the Canadian context. In addition to measuring changes in attitudes and beliefs, it was also suggested that future research consider measurement of whether changes in beliefs and attitudes translate into changes in practice and behavior in different sectors (i.e., fewer discriminatory actions against people with obesity in health and education settings). What strategies help reduce weight bias? For example, rigorous weight bias reduction interventions for health and education student trainees are needed to increase competency and skills related to health and obesity. Designing and evaluating social marketing campaigns using celebrity advocates of body diversity were also suggested as a potential research avenue. How do individuals with lived experience view weight bias? More qualitative research of experiences of stigma is needed. How do definitions of stigma differ across cultures, populations, and sectors? Other forms of discrimination (e.g., racial discrimination) may provide researchers in weight bias insight into important changes that have occurred to increase respect and acceptance for other marginalized groups, including changes over time.

Note: More examples of potential research directions, methods and partnerships in weight bias can be found in the full Summary Report of the 2015 Weight Bias Summit at http://www.obesitynetwork.ca/Full-Report-Now-Available-Weight-Bias-Summit-2015-Ucalgary-Canadian-Obesity829.

titled “Fear of Fat: Promoting health in a fat phobic culture” at a local community center with 100 attendees. The second day consisted of a round table of facilitated discussions to identify what research question(s), if answered, would make the greatest impact on weight bias reduction efforts in Canada. Due to the limited 2-day time frame, many research areas were broached, but group consensus and solutions were not necessarily identified. The following key lessons emerged.

Language matters Participants agreed that we need to identify common language to use in the field of weight bias. Previous research has shown that certain words, such as “fat,” “obese,” and “morbidly obese,” were stigmatizing and less desirable than other terms, such as “weight” and “unhealthy weight” (8). However, consensus on language does not exist in the field of weight bias (Nutter S, Russell-Mayhew S, Alberga AS, et al., Referring to “fat/obese” persons in research and practice: Watch your language. Poster presentation at the 3rd Annual International Weight Stigma Conference. 2015: Reykjavik, Iceland, unpublished). For example, in the fields of medicine, psychology, and epidemiology, typically person-first language (i.e., “person living with obesity”) and identity-first language (i.e., “obese persons”) are utilized. However, in feminist and fat studies literature, the term “fat person” is much preferred, whereas the term “obesity” is highly disliked. Participants agreed that common language is important so people across fields of study can communicate clearly and respectfully about how weight bias is defined and measured. One example that surfaced in the discussions was creating a consensus statement of agreements about language across scientific journals and different organizations across fields of education, healthcare, and public pol-

1208


icy. However, given the limited time of the Summit and the currency, complexity, and controversy of the issue of language in the field of obesity, we were unable to identify what terms would be universally accepted in a Canadian context and how consensus can be reached.

Incorporate the voices of people living with obesity “Nothing about us without us.” Further research in the field of weight bias should involve individuals living with obesity in all aspects of the research process including design, methods, and knowledge dissemination. Although some work has examined personal experiences of weight stigma (9), more qualitative research on the lived experience, the sharing of personal stories, and the personal human cost of weight bias across settings is warranted. For example, some participants suggested that Canadian scoping reviews are needed to better understand the lived experience of weight bias in healthcare and that stigma reduction interventions need to include the voices and perspectives of people living with obesity before implementation. Leveraging provincial and national patient engagement strategies was suggested as a way to give individuals with obesity a voice in healthcare and education research.

Include interdisciplinary stakeholders Because of the complexity of obesity and the pervasiveness of weight bias across multiple sectors of society, interdisciplinary collaborations are necessary to make inroads into weight bias reduction and the maintenance of behavior and practice changes. The results of this Summit highlighted the importance of collaborations and partnerships between sectors (healthcare, education, and public policy)


Perspective

and stakeholders (research, practitioners, individuals with obesity, and policy makers) to advance the field of weight bias. Future research priorities included examining clinical practice guidelines and licensing examinations in healthcare, evaluating policies and educational material from regulatory bodies of professionals in healthcare and education, and evaluating the effects of long-term weight bias reduction interventions. For example, research is needed to scrutinize existing policies of Canadian professional health and education regulatory bodies to better understand how they are written and what their implications are for practicing professionals with respect to weight bias. Other ideas that arose were the need for weight sensitivity training for health and education students and the need for collaboration between the health and education sectors so that efforts are coordinated and messaging about health is consistent. Regulating the use of images and language about obesity in the media was also suggested as a future policy direction. An environmental scan of current Canadian policies that protect people with obesity from weight-based discrimination in healthcare, education, and employment is also needed. Policies and laws prohibiting weight-based discrimination should also outline specific legal punishment for those who break these policies and laws in various sectors.

Future research directions Participants identified research directions by considering the perspectives and needs of each sector. Expert stakeholders from various disciplines expressed demand for future research in six areas. Table 1 summarizes these novel future research directions in the field of weight bias. Given the key lessons that surfaced from this Summit, it is clear that policy should be infused throughout, and individuals living with obesity should be included in all steps of the research process.

Conclusion These three key lessons and future research directions warrant the attention of researchers, practitioners, and policy makers globally


Obesity

with the ultimate goal of improving quality of care and quality of life of individuals living in large bodies. This paper is a call to action to encourage international and interdisciplinary collaboration to take weight bias seriously and undertake more research with the goal of implementing sustainable policy changes.O

Acknowledgements We gratefully acknowledge the Canadian Obesity Network (CON) (Primary Knowledge User), all the participants who contributed their thoughts and expertise at the 2015 Weight Bias Summit, and the graduate students and postdoctoral fellows who volunteered their time at the Summit from the Werklund School of Education, Faculties of Arts and Kinesiology, and the Cumming School of Medicine at the University of Calgary. C 2016 The Obesity Society V

References 1. Andreyeva T, Puhl RM, Brownell KD. Changes in perceived weight discrimination among Americans, 1995-1996 through 2004-2006. Obesity (Silver Spring) 2008;16: 1129-1134. 2. Friedman KE, Ashmore JA, Applegate KL. Recent experiences of weight-based stigmatization in a weight loss surgery population: psychological and behavioral correlates. Obesity (Silver Spring) 2008;16:S69-S74. 3. Vartanian LR, Novak SA. Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise. Obesity (Silver Spring) 2011;19:757-762. 4. Drury CA, Louis M. Exploring the association between body weight, stigma of obesity, and health care avoidance. J Am Acad Nurse Pract 2002;14:554-561. 5. Sutin AR, Stephan Y, Terracciano A. Weight Discrimination and Risk of Mortality. Psychol Sci 2015;26:1803-1811. 6. Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity (Silver Spring) 2009;17:941-964. 7. Danielsdottir S, O’Brien KS, Ciao A. Anti-fat prejudice reduction: a review of published studies. Obes Facts 2010;3:47-58. 8. Puhl RM, Peterson JL, Luedicke J. Motivating or stigmatizing? Public perceptions of weight-related language used by health providers. Int J Obes (Lond) 2013;37: 612-619. 9. DePierre JA, Puhl RM. Experiences of weight stigmatization: a review of selfreport assessment measures. Obes Facts 2012;5:897-918.


1209