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Background: Physical activity (PA) seems to be important for long-term weight loss following bariatric surgery, however, studies provide evidence for insufficient PA levels in bariatric patients. Research found self-efficacy to be associated with PA and weight bias internalization, whose influence on mental and physical health has been shown in recent studies. Objectives: The purpose of the present study was to investigate the influence of general self-efficacy on PA, mediated by weight bias internalization. Setting: Consecutive multicenter registry study conducted in six German bariatric surgery centers. Methods: In N = 179 bariatric surgery candidates, general self-efficacy, weight bias internalization, and different intensities of PA were assessed by self-report questionnaires. Structural equation modeling was used to analyze the assumed mediational relationship. Results: After controlling for sociodemographic variables, weight bias internalization fully mediated the association between general self-efficacy and moderate-intense as well as vigorous-intense PA. Lower general self-efficacy predicted greater weight bias internalization, which in turn predicted lower levels of moderate-intense and vigorous-intense PA. Conclusions: The results suggest an influence of weight bias internalization on preoperative PA in bariatric surgery candidates. Subsequently, implementation of interventions addressing weight bias internalization in the usual treatment of bariatric surgery candidates might enhance patients’ preoperative PA, while longitudinal analyses are needed in order to further examine its predictive value on PA following bariatric surgery.

Individuals with overweight/obesity have been found to exhibit more negative attitudes toward health care and disproportionate rates of health care delay and avoidance, compared to their healthy weight peers. The present study sought to examine potential mechanisms through which weight status influences health care utilization and attitudes. Six hundred and thirty-three students completed a questionnaire measuring weight status, perceived weight bias, patient-provider relationship, and health care utilization and attitudes. Although the majority of the paths in the proposed theoretical mediation model were supported by the present findings, there was no support for the anticipated link between perceived weight bias and the patient-provider relationship or weight-related embarrassment. Overall, these results corroborated previous findings in a novel sample, but did not provide evidence that perceived weight bias mediates the relationship between weight status and health care outcomes. Possible explanations for these findings are deliberated.

More than two-thirds of Americans are obese or overweight. Obesity rates have risen to an epidemic level, contributing to health inequalities and leading to reduced health-related quality of life. When obese and overweight persons face weight bias by health care providers, fragmented care may occur. Ensuring positive relationships with healthcare providers is important in helping those who are obese or overweight. The purpose of this project was to understand the factors that contribute to negative weight bias in the provider-patient relationship and to identify the most effective interventions that would reduce stigmatizing attitudes and support self-awareness, acceptance, and resolution for both patient and provider. The theoretical foundations of cultural humility and self-appraisal in interpersonal relations were applied to inform this project. The Cochrane Handbook for Systematic Reviews framed this systematic literature review. Additionally, Melnyk's levels of evidence was used to evaluate each article. Articles for inclusion were limited to those published no earlier than 2013, full text available, English language, and peer-reviewed. The search identified 102 articles, of which 26 were selected for the final review. Five articles met the criteria for Level VII (opinions of experts), 18 were Level VI (qualitative studies), 1 was a Level V (qualitative review), and 2 were Level 1 (systematic review). The analysis of evidence clarified the issues related to weight bias and supported recommendations for nursing practice improvement in upholding the dignity of all persons with regard to weight. Nurses can pioneer positive social change by becoming role models who advocate for equality in healthcare delivery for persons who are obese or overweight.

Previous research has explored self-perception of weight and has established that women tend to overestimate their own weight while men tend to underestimate. New research has also begun to examine parental perceptions of their children's weight and has indicated that parents tend to be fairly inaccurate, particularly when it comes to recognizing overweight in their own children. No research has focused on the way in which we perceive the weight of the many other individuals we encounter on a daily basis. The present study was designed to investigate the way in which the weight of others is rated and the factors that affect the way in which these ratings are made. Undergraduate male (N = 140) and female (N = 193) students viewed a series of slides depicting male and female figures of varying levels of muscularity and adiposity. The race of the figures was also varied. Each figure was presented once in each racial category (Caucasian, Hispanic, and African American). Participants then filled out questionnaires assessing potential covariates: trait levels of body dissatisfaction, thin-ideal internalization, muscularity dissatisfaction, proximate social norms, appearance comparison, and social desirability. BMI was calculated from self-reported height and weight. The effects of target race, rater race, and rater gender on ratings were examined. Results indicated that the race of the figure affected the ratings given to the figure, though consistent patterns of influence were not identified. Males consistently rated the weight of the figures higher than females and African American raters consistently assigned lower weight ratings than did Caucasian raters. The analyses failed to identify consistent covariates of these effects. Results also provided tentative support for the hypothesis that, given two figures equal in adiposity, raters will provide a lower weight rating to the figure with more muscularity. Exploratory analyses also examined health and attractiveness ratings. The findings are discussed in the context of research on self-perception and the way in which the trends in perception of others differ from the trends seen in self-perception. Study limitations are discussed and possibilities for future research are offered.

abstract: There are multivariate factors that not only play a role in an individual's ability to lose weight, but may create barriers to his or her success. One such factor is internalized weight bias (IWB), which is inversely associated with weight loss outcomes and body satisfaction, and directly associated with psychosocial maladjustments such as depression and binge eating. This study examined the relationship between internalized weight bias and weight loss outcomes using a coding scheme developed for an online weight loss forum to see whether results would be consistent with self-administered surveys that measure IWB. The coding scheme was developed using an exploratory factor analysis of a survey composed of existing measures of IWB. Participants' posts within an online weight loss forum were coded and participants given a weekly IWB score that was compared to weekly weight loss using mixed model analysis. No significance was found between IWB and weight loss outcomes in this study, however, the coding scheme developed is a novel approach to measuring IWB, and the categories identified from latent constructs of IWB may be used in the future to determine the dimensions that exist within it. Ultimately, a better understanding of IWB could lead to the development of targeted weight loss interventions that address the beliefs and attitudes held by individuals who experience it. / Dissertation/Thesis / Masters Thesis Nutrition 2015

Americans hold negative and judgmental attitudes towards obese and overweight individuals and these anti-fat attitudes and weight stigma have become a damaging form of discrimination. The internalization of weight bias and anti-fat attitudes contributes to negative health outcomes including: feelings of devalue, self-hate, anxiety, depression, body dissatisfaction and eating disturbances. The purpose of this study was to investigate weight bias internalization in individuals who perceive themselves as overweight as well as to examine differences in anti-fat attitudes among normal and overweight individuals. A sample of 202 male and females completed an online survey that assessed anti-fat attitudes via the Anti-Fat Attitudes Scale (AFAS). Individuals classified as overweight also completed an assessment of bias via the Weight Bias Internalization Scale (WBIS). A one-way analysis of variance indicated no significant difference on the AFAS between individuals categorized as normal and overweight (p = 0.10). Follow-up analyses based on gender indicated a significant difference for females (p =0.004) but no difference for males (p = 0.93). Correlation analysis of BMI and WBIS scores among individuals categorized as overweight yielded a weak and nonsignificant correlation coefficient (p = 0.06) for the entire sample and separate analyses of males and females. Contrary to the study hypothesis, current findings indicated those who perceived themselves as overweight or obese, regardless of their BMI, internalized the weight bias stigma similarly, thus not supporting this study’s hypothesis. Evidence from this study suggests bias and anti-fat attitudes not only come from those who are underweight or normal weight, but that overweight and obese individuals have the same negative opinions, stereotypes and prejudice against their peers.

Eine Einführung in die Weight Bias Internalization Scale (WBIS) ist ein Selbstbeurteilungsfragebogen zur Erfassung negativer gewichtsbezogener Selbststereotypisierung, inklusive der deutschen Version der Skala.

Weight bias and weight stigmatization are independent risk factors for poor health, and are brought up within health promotion, as focus areas when it comes to interventions targeting body weight (WHO, 2017; Pearl, 2018). Discourses within the society, can either reinforce weight bias and weight stigmatization towards people in larger bodies, or disrupt them. A gap in the literature exists, when it comes to health professionals and their means of communicating health on social media platforms, such as Instagram. This gap was the inspiration for the present study. The study sought to critically examine the discourses communicated by doctors and registered dietitians on the social media platform Instagram. With the specific focus of examining their presentation of body weight and health, the manifestations of roles and the discourses presented. The study was based on the theory of social semiotics, using critical multimodal discourse analysis, that include elements from the critical discourse analysis framework, by Fairclough (2010) (Machin & Mayr, 2012). The study found that the chosen health professionals generally presented weight bias and presented body weight as a sum of individual choices, as well as body weight as a personal responsibility. The health professionals used both visual and verbal techniques, to establish authority and power, and were generally promoting health as a commodity, as well as using their own body to promote the thin ideal. The strongest discourses present were those of healthism, paternalism and aesthetics defining health, findings that are supported within the literature, when looking at other health promoting entities, such as personal trainers.  The study brought forth important implications within health communication on social media platforms, thus that healthism is an area that is important to educate health professionals within, as well as there being basis to further investigate this notion. The study also brought  forth important considerations for ethics and validity within this type of research.

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