Bright-siding stigma: Older adults' experiences at a higher weight in Atlantic Canada.

The lived experiences of higher-weight people vary; homogenous samples may fail to capture this diversity. This study develops an in-depth understanding of the lived experiences of higher-weight (Body Mass Index ⩾ 30) older adults (⩾60 years of age) in a Canadian Atlantic province. Participants (n = 11) were interviewed face-to-face using a semi-structured interview guide twice at 2-to-3-month intervals regarding their perceived treatment in social and health situations; how positive and negative healthcare experiences affected their health, lifestyles and healthcare seeking-behaviour; and recommendations in terms of patient experiences, access and inclusion. Participants infrequently reported negative experiences; however, participants' experiences were informed by uptake of moralistic, neoliberal discourses. Thematic content analysis identified two major themes: active citizenship (participants demonstrated internalisation of the imperative for weight loss, healthy lifestyles and active ageing) and bright-siding (participants expressed that a positive attitude could prevent/help cope with stigma). Results suggest that individualistic, rather than collective, political solutions to health and stigma have been taken up by higher-weight older adults in a Canadian Atlantic province, which may hinder attempts at structural reforms addressing stigma.

Drivers of medicalization in the Canadian Adult Obesity Clinical Practice Guidelines.

The new Canadian Adult Obesity Clinical Practice Guidelines frame higher body weight as a chronic, relapsing disease requiring comprehensive medical treatment pathways. In this commentary, we will demonstrate how a process called pharmaceuticalization is informing the new guidelines. We join those questioning the normalization of industry and medical collaboration and interrogate whether the new guidelines meaningfully address stigma.

RéSUMé: Les nouvelles Lignes directrices canadiennes de pratique clinique de l'obésité chez l'adulte présentent le poids corporel élevé comme une maladie chronique récurrente nécessitant un parcours de soins médicaux complet. Dans notre commentaire, nous montrerons que ces nouvelles lignes directrices sont éclairées par un processus de « pharmaceuticalisation ¼. Nous joignons notre voix aux personnes qui remettent en question la normalisation de la collaboration entre l'industrie et la médecine, et nous nous demandons si les nouvelles lignes directrices abordent utilement la stigmatisation.

Exploring attitudes toward taxation of sugar-sweetened beverages in rural Michigan.

BACKGROUND: While policies to address "obesity" have existed for decades, they have commonly focused on behavioral interventions. More recently, the taxation of sugar-sweetened beverages is gaining traction globally. This study sought to explore individuals' attitudes and beliefs about sugar-sweetened beverages being taxed in a rural Michigan setting. METHODS: This qualitative study was conducted using critical policy analysis. Data were collected in 25 semi-structured, audio-recorded interviews with adult Michiganders. Following data collection, transcripts were coded into themes using NVivo software. RESULTS: Four themes emerged in participants' perspectives regarding sugar-sweetened beverages being taxed: resistance, unfamiliarity, tax effects, and need for education. While some participants were unfamiliar with sugar-sweetened beverage taxes, many viewed taxation as a "slippery slope" of government intervention, which invoked feelings of mistrust. In addition, participants predicted a sugar-sweetened beverage tax would be ineffective at reducing intake, particularly among regular consumers, who were frequently perceived as mostly low income and/or of higher weight. CONCLUSIONS: Further research is needed to explore perceptions of sugar-sweetened beverage taxes in different geographic areas in the USA to examine how perceptions vary. Policymakers should be aware of the potential implications of this health policy with respect to government trust and stigma towards lower income and higher-weight individuals.

Patient Recommendations for Providers to Avoid Stigmatizing Weight in Rural-Based Women With Low Income.

PURPOSE: Weight stigma has become widespread within health care and disproportionately affects women, who are under greater appearance-based scrutiny than men. It is also well established that rural-based individuals with low incomes suffer greater health disparities compared with urban, higher-income counterparts, yet studies examining recommendations for nonstigmatizing health care among higher-weight women from low-income rural settings are lacking. This study examined the experiences and recommendations of higher-weight, low-income, rural women, with the aim of improving health care for similar populations. METHODS: In-depth, semi-structured interviews were conducted in a rural region of the Midwestern United States to explore participants' recommendations for redressing stigma within health care. All participants (n=25) self-identified as higher-weight, low-income, rural women. RESULTS: All participants experienced or were aware of weight stigma within health care. Themes identified from responses were understanding patients and their situations, offering options and supplemental information, communicating effectively, taking time, and having a positive attitude. Patient recommendations focused on correcting physician biases, rapport-building, and providing holistic care. CONCLUSIONS: The findings suggest that weight stigma is prevalent within health care provided to low-income women in rural U.S. Midwest and that there are specific communication and training approaches that may reduce the prevalence of weight stigma in health care.

The relationships between health-related behaviours in the Canadian adult population.

BACKGROUND: Health-related behaviours such as physical inactivity, low fruit and vegetable intake, smoking, alcohol use, and inadequate sleep are significant predictors of adverse health outcomes. Health promotion strategies often focus on one behavior, though research suggests health-related behaviours tend to co-occur. The purpose of this study is to describe the relationships between health-related behaviours in the Canadian adult population. METHODS: Data from cycles 3 (2012-2013) and 4 (2014-2015) of the Canadian Health Measures Survey were pooled to describe health-related behaviours (current smoking status, high-risk alcohol use, fruit and vegetable intake, inadequate sleep, and physical activity) among adults according to sex, age group, household education, and income adequacy. Logistic regression was used to test for relationships between health-related behaviours. RESULTS: Findings indicated that adverse health-related behaviours co-occur frequently, with approximately half of Canadians reporting two or more adverse health-related behaviours. Overall, Canadian men were more likely to report adverse health-related behaviours compared to women, with the exception of inadequate sleep. Smoking status, fruit and vegetable intake, sleep and physical activity exhibited an income and education gradient. Sex-based patterns in grouping of behaviours were present such that adverse health-related behaviours were associated with current smoking among men and with high-risk alcohol use among women. CONCLUSION: Our findings suggest that health-related behaviours should be considered in both isolation and combination when designing intervention strategies. Sex-specific patterns of how these behaviours co-occur must also be taken into account.

Health-related behaviours and their relationship with self-rated health among Canadian adults.

BACKGROUND: Self-rated health (SRH) is a commonly used survey measure as a substitute for a clinical measure of health, which has demonstrated validity and reliability in a variety of populations. The referents that individuals incorporate into their self-evaluations have been shown to include health-related behaviours, though these relationships are not static. Our purpose was to describe and test for relationships between health-related behaviours and SRH among Canadian adults. METHODS: We used pooled data from the Canadian Health Measures Surveys Cycles 3 (2012-13) and 4 (2014-15). All men and non-pregnant women aged 18 years and older were included (n = 6,789). We used binary logistic regression to test for relationships between health-related behaviours and SRH, including smoking status, adequate fruit and vegetable intake, inadequate sleep, alcohol use, and adequate physical activity. RESULTS: The majority of respondents rated their health as good, very good, or excellent, though differences in SRH were found according to age group, highest level of household education, and income adequacy. Inadequate sleep was most strongly associated with poorer SRH among men and women combined, as compared to other health-related behaviours. Among women only, those who report heavy episodic drinking (OR, 2.64) or daily drinking (OR, 3.51) rated their health better, as compared to women who report low-risk alcohol use. CONCLUSIONS: Sleep quality is an important predictor of SRH for both men and women. Second, sex/gender differences must be considered in strategies to address alcohol use, as we may not be fully appreciating potentially health-affirming qualities associated with alcohol use among women.

A systematic search and qualitative review of reporting bias of lifestyle interventions in randomized controlled trials of diabetes prevention and management.

BACKGROUND: Scholars have documented presumptions regarding the relationships between diet, exercise, weight, and type 2 diabetes. However, it is unclear to what extent researchers contribute to these presumptions, and how often these relationships are thoroughly delineated within the context of randomized controlled trials (RCTs). Thus, the aim was to conduct a systematic search and qualitative, thematic analysis of RCTs focusing on lifestyle interventions for diabetes prevention or management, to examine how researchers discuss body weight in 1) the rationale and design of their RCTs; and 2) their presentation and interpretation of their findings. METHODS: We completed an electronic search for records published between 2007 and November 2016. Selection criteria included: RCTs with a follow-up period of ≥12 months; adult participants with type 2 diabetes/pre-diabetes; lifestyle interventions classified as dietary, exercise, and/or behavioural; primary outcomes of incident diabetes and complications, mortality, cardiovascular disease, and quality of life; and secondary outcomes of glycemic control and blood pressure. Nineteen articles were identified for inclusion and subject to thematic content analysis. RESULTS: Obesity and weight loss figured prominently in the rationale and outcomes of the majority of the articles, despite intentional exclusion of "weight loss" and "obesity" as search terms. There was ambiguity over whether weight loss was classified as inclusive to the intervention, an outcome, or a measure of adherence. Results revealed that authors frequently engaged in "spin reporting" by pooling data from intervention and control groups to test the relationship between weight lost and outcomes and in their presentation of results. CONCLUSIONS: Researchers need to be aware of their biases and assumptions regarding body weight in designing, analyzing, and interpreting lifestyle interventions for diabetes prevention and management.

Obesity, bodily change and health identities: a qualitative study of Canadian women.

Medicalised concerns about an obesity crisis persist yet more needs to be learnt about everyday orientations to weight (loss). This article reports and analyses data generated using qualitative methods, including repeated interviews and fieldwork conducted over one year in Canada with women (n = 13) identifying as (formerly) obese. Three ideal types are explored using empirical data: (1) hopeful narratives; (2) disordered eating distress; and (3) weight-cycling or stagnation. Core themes include women's desire to embody a thin(ner) future and the good life, the harms of intentional weight-loss, and resignation to living as a fat woman whilst nonetheless challenging stigma. The article contributes to critical studies of weight/fatness, the sociology of bodily change and the embodiment of health identities. In concluding, we call for reflexive change in bodies of health knowledge, policy and practice.

Reproducing stigma: Interpreting "overweight" and "obese" women's experiences of weight-based discrimination in reproductive healthcare.

Amidst a barrage of policy documents, bio-medical research, and press items concerned with the "crisis" of obesity, a growing scholarship is concerned with what has come to be known as "obesity stigma." This scholarship hails from a range of sources including critical obesity scholars who problematize the idea of obesity as a health concern, as well as from "mainstream" organizations and researchers who, while maintaining obesity is a world-wide health problem, also argue that "obese" people are the targets of discrimination. In this paper, we analyze both interpretations of obesity stigma, particularly as that stigma applies to obese women's experiences of accessing and receiving reproductive care. We describe a qualitative study conducted with 24 overweight and obese women in 2 Canadian cities. Participants related overt and covert experiences of stigma when accessing reproductive care founded in healthcare practitioners' focus on fetal risk and "mother-blame" which, though partially evidence-based, was interpreted by participants as discriminatory. As such, we maintain that any true interruption of obesity stigma in the reproductive healthcare interaction requires a bridge between critical and mainstream scholarship, and careful attention to the risk-based foci in clinical settings which can be interpreted by clients as moralizing.

Obese persons' physical activity experiences and motivations across weight changes: a qualitative exploratory study.

BACKGROUND: Obese individuals are encouraged to participate in physical activity. However, few qualitative studies have explored obese individuals' motivations for and experiences with physical activity. METHODS: The physical activity experiences of self-identified obese or formerly obese persons (n = 15) were explored through in-depth, semi-structured, audio-taped, repeated interviews and ethnography over one year. Participant observation occurred at multiple sites identified by participants as meaningful to them as obese persons. Data from interview transcripts and fieldnotes were analyzed via thematic content analysis. RESULTS: Underlying goals for engaging in physical activity were diverse. Emergent motivation themes included: protection, pressure, and pleasure. Participants were protective of maintaining functional capacity, establishing fit identities, and achieving weight loss. Participants also discussed feelings of excessive pressure to continue progressing toward weight and fitness goals. Enjoyment in physical activity was often a by-product for all participants and could become a sought-after endpoint. Finding an environment in which participants felt safe, accepted, and encouraged to be active was extremely important for continual engagement. CONCLUSIONS: Obese individuals enjoyed physical activity and were concerned about maintaining functional fitness. Stigmatization and untenable goals and monitoring could disrupt physical activity.

The contribution of applied social sciences to obesity stigma-related public health approaches.

Obesity is viewed as a major public health concern, and obesity stigma is pervasive. Such marginalization renders obese persons a "special population." Weight bias arises in part due to popular sources' attribution of obesity causation to individual lifestyle factors. This may not accurately reflect the experiences of obese individuals or their perspectives on health and quality of life. A powerful role may exist for applied social scientists, such as anthropologists or sociologists, in exploring the lived and embodied experiences of this largely discredited population. This novel research may aid in public health intervention planning. Through these studies, applied social scientists could help develop a nonstigmatizing, salutogenic approach to public health that accurately reflects the health priorities of all individuals. Such an approach would call upon applied social science's strengths in investigating the mundane, problematizing the "taken for granted" and developing emic (insiders') understandings of marginalized populations.

Self-rated health and ethnicity: focus on indigenous populations.

OBJECTIVES: Self-rated health (SRH) is a commonly used measure in surveys to assess general health status or health-related quality of life. Differences have been detected in how different ethnic groups and nationalities interpret the SRH measure and assess their health. This review summarizes the research conducted on SRH within and between ethnic groups, with a focus on indigenous groups. STUDY DESIGN AND METHODS: A search of published academic literature on SRH and ethnicity, including a comprehensive review of all relevant indigenous research, was conducted using PubMed and summarized. RESULTS: A wide variety of research on SRH within ethnic groups has been undertaken. SRH typically serves as an outcome measure. Minority respondents generally rated their health worse than the dominant population. Numerous culturally-specific determinants of SRH have been identified. Cross-national and cross-ethnicity comparisons of the associations of SRH have been conducted to assess the validity of SRH. While SRH is a valid measure within a variety of ethnicities, differences in how SRH is assessed by ethnicities have been detected. Research in indigenous groups remains generally under-represented in the SRH literature. CONCLUSIONS: These results suggest that different ethnic groups and nationalities vary in SRH evaluations, interpretation of the SRH measure, and referents employed in rating health. To effectively assess and redress health disparities and establish culturally-relevant and effective health interventions, a greater understanding of SRH is required, particularly among indigenous groups, in which little research has been conducted.

A Kenyan newspaper analysis of the limitations of voluntary medical male circumcision and the importance of sustained condom use.

BACKGROUND: Since the completion of three clinical trials indicating that voluntary medical male circumcision (VMMC) is an effective method to reduce men's chances of acquiring HIV, use of the procedure has been advocated in Kenya. Media messages shape popular understandings of the benefits and limitations of male circumcision. The objectives of this study were to (1) investigate promotion messages in a popular online newspaper to determine how the limitations of male circumcision are represented, and whether condom use is still being promoted; and (2) gain insight into popular understandings of the limitations of this new procedure through newspaper reader comments. METHODS: A content analysis was conducted on 34 online media articles published by the Daily Nation between January 1, 2008 and December 31, 2010. Information about condom promotion, partial immunity, limitations and complications of the procedure, as well as emergent themes, were analyzed. RESULTS: Results demonstrated an irregular and occasionally misleading presentation of these topics and a perceived lack of objective information about the risks and limitations of VMMC. CONCLUSIONS: There is a need for governmental and non-governmental public health organizations to engage with the media to improve risk messaging.