"Thin and muscular": A cross-sectional mixed methods study of people's descriptions of health

As weight status is frequently associated with health and the COVID-19 pandemic has raised attention to weight status, we used a cross-sectional mixed-methods design to explore how weight status or body size is described when defining health. We recruited 288 participants who were 18 years and older and living in the United States to complete a study about health and health behaviors during the pandemic. First, we used directed content analysis to explore if and how weight status/body size is described when asked to define health. Next, we used intensity sampling and a constant comparison approach to assess whether descriptions of health differed by diagnosis of a chronic disease, sex, and weight bias internalization. Seventy percent (n = 202) of participants described an aspect of weight, body size, or shape when defining health, the majority of which (65%) indicated someone could be unhealthy due to their weight or size. Only 29% (n = 84) of participants implied or directly stated a person could be healthy regardless of weight or size. There were no significant differences in the description of health by chronic disease status or weight bias internalization. Women included health behaviors more frequently than men. Our findings indicate that weight was inextricably linked with health among most adults in the United States. To promote health and reduce the damaging effects of weight stigma, it is imperative that preventive interventions and policies include weight-inclusive messages that underscore the importance of the multiple indicators of health, beyond weight and size. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Norms and attributions about weight gain during the COVID-19 pandemic.

Objective. Weight gain was common during the first year of the COVID-19 pandemic, potentially creating a new descriptive norm about weight gain. The unique context of a global pandemic may have influenced situational attributions for weight gain that were not typical prior to the pandemic. We examined the effects of the new norm on people's views about responsibility and blame for weight gain.Methods. In two preregistered surveys, we aimed to manipulate the salience of weight gain during COVID-19, and measured views about responsibility and blame for weight gain.Results. Among participants who gained weight, the more common they perceived weight gain to be, the more they felt their own weight gain was understandable (b = 0.09, se = 0.04, p = 0.02), but perceived commonness didn't relate to their feelings of responsibility and blame for weight gain. For participants who didn't gain weight, the perceived commonness of weight gain was associated with less blame towards people who gained weight (b = 0.11, se= 1.46, p = 0.044), but not with responsibility for weight gain.Conclusion. Participants believed weight gain was common during COVID, but this descriptive norm had mixed associations with attributions for one's own and others' weight gain.

Associations of Problematic Internet Use, Weight-Related Self-Stigma, and Nomophobia with Physical Activity: Findings from Mainland China, Taiwan, and Malaysia.

Insufficient physical activity is a common problem for university students because they may engage in sedentary lifestyle owing to excessive time spent on their smartphones and social media use. This may result in problematic internet use (PIU) and nomophobia (fear of not having a mobile phone). Moreover, prior evidence shows that weight-related self-stigma is an important factor contributing to low physical activity. Therefore, the present study examined the associations between PIU, nomophobia, and physical activity among university students across mainland China, Taiwan, and Malaysia. Participants (3135 mainland Chinese, 600 Taiwanese, and 622 Malaysian) completed the Bergen Social Media Addiction Scale (BSMAS), Smartphone Application-Based Addiction Scale (SABAS), Nomophobia Questionnaire (NMPQ), Weight Self-Stigma Questionnaire (WSSQ), and International Physical Activity Questionnaire Short Form (IPAQ-SF). The measurement invariance of the assessed questionnaires was supported across the three regions. The present findings analyzed using partial least squares structural equation modeling showed that (i) greater nomophobia was associated with higher levels of physical activity, (ii) greater weight-related self-stigma was associated with higher levels of physical activity, and (iii) greater nomophobia was associated with greater weight-related self-stigma. Although the present findings suggest the possibility that experiencing some level of nomophobia or weight-related self-stigma appears to help improve physical activity, it is not recommended that these be encouraged, but reducing PIU should be targeted as a means to improve physical activity.

“Thin and muscular”: A cross-sectional mixed methods study of people’s descriptions of health

As weight status is frequently associated with health and the COVID-19 pandemic has raised attention to weight status, we used a cross-sectional mixed-methods design to explore how weight status or body size is described when defining health. We recruited 288 participants who were 18 years and older and living in the United States to complete a study about health and health behaviors during the pandemic. First, we used directed content analysis to explore if and how weight status/body size is described when asked to define health. Next, we used intensity sampling and a constant comparison approach to assess whether descriptions of health differed by diagnosis of a chronic disease, sex, and weight bias internalization. Seventy percent (n = 202) of participants described an aspect of weight, body size, or shape when defining health, the majority of which (65%) indicated someone could be unhealthy due to their weight or size. Only 29% (n = 84) of participants implied or directly stated a person could be healthy regardless of weight or size. There 4 were no significant differences in the description of health by chronic disease status or weight bias internalization. Women included health behaviors more frequently than men. Our findings indicate that weight was inextricably linked with health among most adults in the United States. To promote health and reduce the damaging effects of weight stigma, it is imperative that preventive interventions and policies include weight-inclusive messages that underscore the importance of the multiple indicators of health, beyond weight and size.

The trajectory of psychological distress and problematic Internet gaming among primary school boys: a longitudinal study across different periods of COVID-19 in China

Background: Children are a vulnerable population in terms of the impact of COVID-19 on their psychological well-being. When restricted to their homes, children are susceptible to problematic Internet gaming (PG). Primary school boys are particularly at risk of PG, which may lead to negative psychological effects, such as distress. Emerging research has identified perceived weight stigma (PWS) as a variable closely associated with both PG and psychological distress, particularly during the COVID-19 pandemic. The purpose of this study was to evaluate the trajectory of psychological distress among this vulnerable population from a longitudinal perspective, evaluating the role of PG and PWS. Methods: Self-report measures were used to assess psychological distress, PG, and PWS among primary school boys (grades 4 to grade 6; N = 283). Data were collected across three waves: before the pandemic, during school closure, and following the lifting of restrictions. Results: The trajectory of psychological distress among primary school boys was concave, indicating their mental health was negatively impacted during home restriction but recovered after the lockdown ended (linear change = 0.98, p < 0.01; quadratic change = -0.19, p < 0.01). PG was a significant covariate in terms of the trajectory of psychological distress (b = 0.02, p < 0.01). Moreover, baseline values for PWS were shown to have a negative direct effect on mental health before the pandemic (b = 0.05, p < 0.01), and moderated the time factor for boys' psychological distress over time (b of PWS × linear change = 0.04, p = 0.006; b of PWS × Quadratic change was negative at -0.01, p = 0.002). Conclusions: Although mental health gradually improved as home restrictions subsided, future studies are required to address changes in mental health upon return to school for students reporting higher levels of weight stigma.

Interrupting the cycle of weight stigma and unhealthy behavior: The potential of self-affirmation and self-compassion exercises

Weight stigma, the derogation and devaluation of people with overweight, is pervasive in the US today, and women are disproportionately the targets. Paradoxically, experiencing weight stigma leads to less healthy eating that contributes to weight gain. This experience may also promote avoidance of important weight-related health information. However, no studies have explored strategies to reduce the harmful effects of weight stigma. The present study tests whether writing self-affirmation and/or self-compassion reflections, interventions that have been shown to protect against threats to self-worth, can mitigate the impact of a minor episode of weight stigma on women's eating cognitions and willingness to learn weight-related health information. Women with overweight or obesity (ages 18-45) completed the experiment online. First, they were randomly assigned to experience weight stigma through a ball-tossing computer game called Cyberball, in which they were represented by a larger avatar and were excluded (i.e., not passed the ball) by three other "players" represented by lean, female avatars. Women in the inclusion (i.e., comparison) condition were included during the game and were represented by an avatar the same size as the other players'. Following the Cyberball game, women were randomly assigned to complete a self-affirmation, self-compassion, or neutral writing exercise. Women then completed a post-manipulation survey in which they self-reported several eating cognitions and their current inclination to avoid information about their weight. There were no effects of weight stigma through Cyberball and no effects of the writing exercises on any measures of unhealthy eating cognitions or information avoidance. Weight stigma through Cyberball also did not influence fundamental need satisfaction or mood, despite past research showing that any type of exclusion through Cyberball consistently affects these outcomes. Unfortunately, the manipulation may have been ineffective in the online study format, which was necessary because of the COVID-19 pandemic. In the absence of a valid weight stigma manipulation, the current data can neither support nor refute the study hypotheses asserting a causal effect of weight stigma and protective effects of the writing exercises. I discuss the methodological limitations of the current study and provide directions for future research on this important topic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Links between obesity, weight stigma and learning in adolescence: a qualitative study.

BACKGROUND: Educational attainment is a key social determinant of health. Health and education are linked by multiple pathways, many of which are not well understood. One such pathway is the association between being above a healthy weight and lower academic achievement. While various explanations have been put forward to explain this relationship, evidence for causal pathways is sparse and unclear. This study addresses that evidence gap. METHODS: We interviewed 19 adults (late 20s; 14 female, 5 male) and one young person (14 years, male) from the UK in 2019/2020. Participants were recruited from the ALSPAC 1990s birth cohort, sampled to ensure diversity in socio-economic status and educational attainment, and a community-based weight management group for young people. Interviews focused on experiences of being above a healthy weight during secondary school and how this may have affected their learning and achievement. Interviews were face-to-face, digitally recorded, and transcribed verbatim. We analysed the data thematically. RESULTS: We identified key pathways through which higher body weight may negatively impact educational performance and showed how these are linked within a novel theoretical model. Because larger body size is highly stigmatised, participants engaged in different strategies to minimise their exposure to negative attention. Participants sought to increase their social acceptance or become less socially visible (or a combination of both). A minority navigated this successfully; they often had many friends (or the 'right' friends), experienced little or no bullying at school and weight appeared to have little effect on their achievement at school. For most however, the behaviours resulting from these strategies (e.g. disruptive behaviour, truanting, not working hard) or the physical, social or mental impacts of their school experiences (e.g. hungry, tired, self-conscious, depressed) made it difficult to concentrate and/or participate in class, which in turn affected how teachers viewed them. CONCLUSIONS: Action to combat weight stigma, both within schools and in wider society, is urgently required to help address these educational disparities that in turn can impact health in later life.

"Are people thinking I'm a vector because I'm fat?": Cisgender experiences of body, eating, and identity during COVID-19.

While a range of studies have shown the negative impact of COVID-19 on disordered eating and body image, few have engaged with how identity and social context interact with these domains. The current study used inductive codebook thematic analysis to understand experiences of body and eating during the pandemic among a diverse (sub)clinical sample of individuals with self-reported disordered eating. We interviewed 31 cisgender participants (18/31 Black Indigenous People of Color (BIPOC), 24/31 women) with a history of disordered eating (diagnosed and undiagnosed). Five themes were identified: Body Surveillance and Dissatisfaction, Movement and Intake Fixation, Food Scarcity and Resource Concerns, Changes in Visibility of Body and Eating, and Bodies Are Vulnerable. We examined the extent to which themes pertained to certain identities over others. Notably, BIPOC, large-bodied, queer participants more commonly spoke to body vulnerability than White, small/medium-bodied, straight participants. BIPOC and large-bodied participants also particularly spoke to feeling relief from discrimination as social distancing and mask wearing reduced their public visibility. Participants related these themes to changed body and eating experiences that spanned distress and resilience. Our analysis offers insight into multifaceted and contextual impacts of COVID-19 on experiences of body, eating, and identity.

Adolescents' Exposure to and Experiences of Weight Stigma During the COVID-19 Pandemic.

OBJECTIVE: The COVID-19 pandemic has increased attention to the proliferation of pediatric obesity amidst significant changes in weight-related health functioning (e.g., compromised physical activity, limited food access, increased stress). The present cross-sectional study investigated adolescents' feelings about their bodies and perceived changes in weight stigma from peers, parents, and social media during the pandemic. METHODS: Four hundred fifty-two adolescents (11-17 years old) completed an online survey during the Fall of 2020. Measures assessed perceived changes in exposure to weight stigmatizing social media content (stress eating jokes, weight gain memes) and experiences of weight stigma (weight-based bullying, teasing, hurtful comments) by parents and peers, as well as body dissatisfaction, during the COVID-19 pandemic. Weight status and gender were examined as individual difference variables. RESULTS: The majority (53%) of adolescents reported increased exposure to at least one form of weight stigmatizing social media content during the pandemic. Additionally, pandemic-related increases in body dissatisfaction were prevalent (41%), especially among girls with higher body mass index (≥85th percentile; 67%). On average, the extent to which adolescents experienced weight-based mistreatment from parents and peers remained consistent with their pre-pandemic experiences. CONCLUSIONS: Overall, these findings highlight changes in the social messages that adolescents receive about their bodies, as well as their subjective body satisfaction, during the pandemic. Results underscore the need for healthcare providers and mental health professionals to be aware of the potential rise in weight stigma during the pandemic, and encourage families and schools to engage in supportive, rather than stigmatizing, weight-related communication with youth.

Problematic Use of Internet-Related Activities and Perceived Weight Stigma in Schoolchildren: A Longitudinal Study Across Different Epidemic Periods of COVID-19 in China.

Background: Social distancing and school suspension due to the coronavirus pandemic (COVID-19) may have a negative impact on children's behavior and well-being. Problematic smartphone use (PSU), problematic social media use (PSMU) and perceived weight stigma (PWS) are particularly important issues for children, yet we have a poor understanding of how these may have been affected by lockdowns and physical isolation resulting from COVID-19. This research aimed to understand how these psychosocial and behavioral variables may be associated with psychological distress, and how these associations may have changed during the COVID-19 pandemic. Methods: A total of 489 children completed a three-wave longitudinal study from January 2020 to June 2020. The first wave was conducted before the COVID-19 outbreak. The second wave was conducted during the outbreak. The third wave was conducted during post-COVID-19 lockdown. Questionnaires measured psychological distress, PSU, PSMU, and PWS. Results: PSU, PSMU, PWS and psychological distress were all significantly associated with each other. PSU was significantly higher during outbreak. PWS was significantly higher before outbreak. We found an increased association between PSMU and PWS across three waves in all three models. The association between PSU and depression/anxiety decreased across three waves; however, association between PSMU and depression/anxiety increased across three waves. Conclusions: COVID-19 initiated school suspension and associated lockdowns appear to have exacerbated PSU and depression among children. However, PWS was reduced during this period. Children should use smartphones and social media safely and cautiously, and be aware of the potential exposure to weight stigmatization.

#quarantine15: A content analysis of Instagram posts during COVID-19.

There has been a surge in "quarantine15" social media posts during the self-isolation and lockdowns associated with the COVID-19 global pandemic. Given the influence of other body and weight-centered social media content (e.g., Fitspiration, Fatspiration) on body image and weight stigmatizing thoughts and attitudes, characterizing the features of quarantine15 content is an imperative first step towards understanding its impact on those who view it. Therefore, the present study is a content analysis of quarantine15 content on Instagram. A total of 668 posts were sampled using the hashtag quarantine15, and systematically analyzed for features related to positive and negative body image, as well as weight stigma. The results showed that the posts containing human figures (57.5 %) showcased individuals who were perceived as lower-weight (88.8 %), White (70.3 %), and women (87 %). Approximately one-third (34.4 %) of the images containing individuals were considered objectifying. Posts also perpetuated the controllability of weight through diet (51.5 %) and physical activity (27.5 %), while 46.9 % expressed dislike towards higher-weight bodies. Future experimental research in this area will be important for understanding both the acute and long-term effects of viewing quarantine15 content on body image, weight stigmatizing attitudes and thoughts, and internalized weight stigma.

Weight Bias During the COVID-19 Pandemic.

PURPOSE OF REVIEW: This review explores potential sources of weight bias and stigma during the COVID-19 pandemic, including "quarantine-15" messages and discussion of obesity in media and public health campaigns. We examine evidence of the effects of weight bias on well-being during the pandemic and highlight unanswered questions to be addressed in future research. RECENT FINDINGS: Studies that have investigated weight change during stay-at-home orders have yielded mixed findings and relied predominantly on self-reported retrospective recall, thus providing weak evidence of a widespread "quarantine-15" effect. No studies to date have evaluated the effects on weight stigma and health of obesity-focused COVID-19 media and public health messages. Individuals with a history of experiencing weight bias may be more vulnerable to binge eating and psychological distress during the pandemic. Weight bias and stigma during the COVID-19 pandemic, and their effects on health and well-being, warrant greater investigation and consideration in public health efforts.