Weight stigma in healthcare settings: the experience of Arab and Jewish bariatric surgery candidates in Israel.

BACKGROUND: Weight-related stigma and discrimination are prevalent in our society with adverse biopsychosocial outcomes to people with obesity and morbid obesity. Studies suggest that weight bias in healthcare settings are quite prevalent, but there have been, as far as we know, lack of studies examining prevalence and correlates of weight bias experiences among bariatric surgery candidates in Israel. We aim to understand the nature and prevalence of weight stigma among bariatric surgery candidates. To identify differences between Jewish and Arab candidates. To examine the impact of weight stigma experiences on weight bias internalization (WBI). METHODS: A cross-sectional study was performed among 117 adult bariatric surgery candidates from three hospitals in northern Israel (47.8% Jews, 82.4% females, average BMI 42.4 ± 5.2 Kg/meter2). Patients who agreed to participate completed a structured questionnaire on the same day that the bariatric surgery committee met. WBI was measured using a validated 10-item scale. Experiences of weight stigma were measured using items adapted from prior international studies. RESULTS: About two thirds of the participants had at least one experience of weight stigma (teased, treated unfairly, or discriminated against because of their weight). As many as 75% of participants reported that weight served as a barrier to getting appropriate health care and as many as half of participants felt in the last year that a doctor judged them because of their weight. No significant differences were found between Arabs and Jews in the prevalence of weight stigma experiences and WBI. However, a trend towards more stigma experiences among Jews was noted. WBI was predicted by female gender and experiences of weight stigma, both in general and within healthcare settings. CONCLUSIONS: Weight stigma towards bariatric surgery candidates in Israel is quite prevalent, and specifically in healthcare settings. It is important to adopt policy actions and intervention programs to improve awareness to this phenomenon among the general public and specifically among healthcare providers, as many healthcare providers may be unaware of the adverse effect of weight stigma and of ways in which they are contributing to the problem. Future studies may validate our findings using larger sample size and longitudinal design.

Addressing eating disorders through legislation: The Israeli 'Models' Law'-process, enactment, and dilemmas.

Preventing the onset of eating disorders and disordered eating pathology is crucial. While these conditions have a multi-factorial etiology, socio-cultural norms, particularly the media, contribute greatly. Policy and legislative action are warranted to change harmful media images. To the best of our knowledge, Israel was the first country to tackle the problem of unrealistic and unhealthy images in the media through legislation by initiating and passing an innovative law. The "Knesset," the Israeli Parliament, voted in December 2012 to pass new legislation that forbids the appearance of underweight models (BMI of 18.5 or less) in commercial advertising. The law further requires that if a graphic editing program has been used to reduce the dimensions of a model in advertising photographs, this fact must be clearly indicated. The purpose of this article is to describe the law; the process and obstacles to creating and passing the law in the Knesset; national and international reactions to this Israeli law; and the challenges of implementing (enacting and enforcing) this law in Israel. Given that other countries are implementing similar policies, additional legal approaches are described, including ideas for further research on how to enact, enforce, and evaluate the impact of such laws.