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BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Predictors of weight stigma experienced by middle-older aged, general-practice patients with obesity in disadvantaged areas of Australia: a cross-sectional study

Authors: Catherine Spooner, Upali W. Jayasinghe, Nighat Faruqi, Nigel Stocks, Mark F. Harris

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

Rates of obesity have increased globally and weight stigma is commonly experienced by people with obesity. Feeling stigmatised because of one’s weight can be a barrier to healthy eating, physical activity and to seeking help for weight management. The aim of this study was to identify predictors of perceived weight among middle-older aged patients with obesity attending general practices in socioeconomically disadvantaged urban areas of Australia.

Methods

As part of a randomised clinical trial in Australia, telephone interviews were conducted with 120 patients from 17 general practices in socioeconomically disadvantaged of Sydney and Adelaide. Patients were aged 40–70 years with a BMI ≥ 30 kg/m2. The interviews included questions relating to socio-demographic variables (e.g. gender, language spoken at home), experiences of weight-related discrimination, and the Health Literacy Questionnaire (HLQ). Multi-level logistic regression data analysis was undertaken to examine predictors of recent experiences of weight-related discrimination (“weight stigma”).

Results

The multi-level model showed that weight stigma was positively associated with obesity category 2 (BMI = 35 to < 40; OR 4.47 (95% CI 1.03 to 19.40)) and obesity category 3 (BMI = ≥ 40; OR 27.06 (95% CI 4.85 to 150.95)), not being employed (OR 7.70 (95% CI 2.17 to 27.25)), non-English speaking backgrounds (OR 5.74 (95% CI 1.35 to 24.45)) and negatively associated with the HLQ domain: ability to actively engage with healthcare providers (OR 0.12 (95% CI 0.05 to 0.28)). There was no association between weight stigma and gender, age, education or the other HLQ domains examined.

Conclusions

Weight stigma disproportionately affected the patients with obesity most in need of support to manage their weight: those with more severe obesity, from non-English speaking backgrounds and who were not in employment. Additionally, those who had experienced weight stigma were less able to actively engage with healthcare providers further compounding their disadvantage. This suggests the need for a more proactive approach to identify weight stigma by healthcare providers. Addressing weight stigma at the individual, system and population levels is recommended.

Trial registration

The trial was registered with the Australian Clinical Trials Registry ACTRN12640010216​2.
Literature
1.
Global Burden of Disease Risk Factors Collaborators, Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M, Burnett R, Casey D, Coates MM, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2015;386(10010):2287–323.CrossRef
2.
Ruhm CJ. Current and future prevalence of obesity and severe obesity in the United States. Forum Health Econ Policy. 2007;10(2):1–26.CrossRef
3.
4.
Australian Institute of Health and Welfare. A picture of overweight and obesity in Australia 2017. Cat. No. In: PHE, vol. 216. Canberra: AIHW; 2017.
5.
Grieve E, Fenwick E, Yang HC, Lean M. The disproportionate economic burden associated with severe and complicated obesity: a systematic review. Obes Rev. 2013;14(11):883–94.CrossRefPubMed
6.
Lewis S, Thomas SL, Blood RW, Castle DJ, Hyde J, Komesaroff PA. How do obese individuals perceive and respond to the different types of obesity stigma that they encounter in their daily lives? A qualitative study. Soc Sci Med. 2011;73(9):1349–56.CrossRefPubMed
7.
Spahlholz J, Baer N, Konig HH, Riedel-Heller SG, Luck-Sikorski C. Obesity and discrimination - a systematic review and meta-analysis of observational studies. Obes Rev. 2016;17(1):43–55.CrossRefPubMed
8.
Zwickert K, Rieger E. A qualitative investigation of obese women's experiences of effective and ineffective social support for weight management. Clin Obesity. 2014;4(5):277–86.CrossRef
9.
10.
11.
Puhl RM, Andreyeva T, Brownell KD. Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. Int J Obes. 2008;32(6):992–1000.CrossRef
12.
13.
14.
Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16(4):319–26.CrossRefPubMedPubMedCentral
15.
Campbell K, Engel H, Timperio A, Cooper C, Crawford D. Obesity management: Australian general practitioners’ attitudes and practices. Obes Rev. 2000;8(6):459–66.CrossRef
16.
Papadopoulos S, Brennan L. Correlates of weight stigma in adults with overweight and obesity: a systematic literature review. Obesity. 2015;23(9):1743–60.CrossRefPubMed
17.
Jackson SE, Beeken RJ, Wardle J. Obesity, perceived weight discrimination, and psychological well-being in older adults in England. Obesity. 2015;23(5):1105–11.CrossRefPubMedPubMedCentral
18.
Schmitt MT, Branscombe NR, Postmes T, Garcia A. The consequences of perceived discrimination for psychological well-being: a meta-analytic review. Psychol Bull. 2014;140(4):921–48.CrossRefPubMed
19.
Peerson A, Saunders M. Health literacy revisited: what do we mean and why does it matter? Health Promot Int. 2009;24(3):285–96.CrossRefPubMed
20.
Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107.CrossRefPubMed
21.
Kickbusch I, Pelikan JM, Apfel F, Tsouros AD, editors. Health literacy: the solid facts. Copenhagen: World Health Organization; 2013.
22.
Paasche-Orlow MK, Wolf MS. Evidence does not support clinical screening of literacy. J Gen Intern Med. 2008;23(1):100–2.CrossRefPubMed
23.
Parikh NS, Parker RM, Nurss JR, Baker DW, Williams MV. Shame and health literacy: the unspoken connection. Patient Educ Couns. 1996;27(1):33–9.CrossRefPubMed
24.
Wolf MS, Williams MV, Parker RM, Parikh NS, Nowlan AW, Baker DW. Patients’ shame and attitudes toward discussing the results of literacy screening. J Health Commun. 2007;12(8):721–32.CrossRefPubMed
25.
Hansson L, Stjernsward S, Svensson B. Changes in attitudes, intended behaviour, and mental health literacy in the Swedish population 2009-2014: an evaluation of a national antistigma programme. Acta Psychiatr Scand. 2016;134(Suppl 446):71–9.CrossRefPubMed
26.
O'Keeffe D, Turner N, Foley S, Lawlor E, Kinsella A, O'Callaghan E, Clarke M. The relationship between mental health literacy regarding schizophrenia and psychiatric stigma in the Republic of Ireland. J Ment Health. 2016;25(2):100–8.CrossRefPubMed
27.
Svensson B, Hansson L. How mental health literacy and experience of mental illness relate to stigmatizing attitudes and social distance towards people with depression or psychosis: a cross-sectional study. Nord J Psychiatry. 2016;70(4):309–13.CrossRefPubMed
28.
Bautista RE, Shapovalov D, Shoraka AR. Factors associated with increased felt stigma among individuals with epilepsy. Seizure. 2015;30:106–12.CrossRefPubMed
29.
Faruqi N, Stocks N, Spooner C, El-Haddad N, Harris MF. Research protocol: management of obesity in patients with low health literacy in primary health care. BMC Obesity. 2015;2(5):5.CrossRefPubMedPubMedCentral
30.
Chew LD, Griffin JM, Partin MR, Noorbaloochi S, Grill JP, Snyder A, Bradley KA, Nugent SM, Baines AD, VanRyn M. Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med. 2008;23(5):561–6.CrossRefPubMedPubMedCentral
31.
Australian Bureau of Statistics. Health literacy, Australia, 2006. ABS cat. No. 4233.0. Canberra: ABS; 2008.
32.
Kolotkin RL, Crosby RD. Psychometric evaluation of the impact of weight on quality of life-lite questionnaire (IWQOL-lite) in a community sample. Qual Life Res. 2002;11(2):157–71.CrossRefPubMed
33.
Kolotkin RL, Crosby RD, Kosloski KD, Williams GR. Development of a brief measure to assess quality of life in obesity. Obes Res. 2001;9(2):102–11.CrossRefPubMed
34.
Osborne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R. The grounded psychometric development and initial validation of the health literacy questionnaire (HLQ). BMC Public Health. 2013;13(1):1–17.CrossRef
35.
Elsworth GR, Beauchamp A, Osborne RH. Measuring health literacy in community agencies: a Bayesian study of the factor structure and measurement invariance of the health literacy questionnaire (HLQ). BMC Health Serv Res. 2016;16(1):508.CrossRefPubMedPubMedCentral
36.
Rasbash J, Browne W, Healy M, et al. A user's guide to MLwiN version 2.30. Bristol: Centre for Multilevel Modelling, University of Bristol; 2014.
37.
Murthy BN, Kandala N-B, Ezhil R, Kaur P, Sudha R. Statistical issues in studying the relative importance of body mass index, waist circumference, waist hip ratio and waist stature ratio to predict type 2 diabetes. J Appl Stat. 2011;38(9):2063–70.CrossRef
38.
Snijders TAB, Bosker RJ. Multilevel analysis: an introduction to basic and advanced multilevel modeling. 1st ed. London: Sage Publications; 1999.
39.
40.
von Wagner C, Steptoe A, Wolf MS, Wardle J. Health literacy and health actions: a review and a framework from Health Psychology. Health Educ Behav. 2009;36(5):860–77.CrossRefPubMed
41.
Malterud K, Ulriksen K. Obesity, stigma, and responsibility in health care: a synthesis of qualitative studies. Int J Qual Stud Health Well-being. 2011;6(4):8404–15.CrossRef
42.
Wadden TA, Didie E. What's in a name? Patients’ preferred terms for describing obesity. Obes Res. 2003;11(9):1140–6.CrossRefPubMed
43.
Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract. 2013;63(606):e76–84.CrossRefPubMed
Metadata
Title
Predictors of weight stigma experienced by middle-older aged, general-practice patients with obesity in disadvantaged areas of Australia: a cross-sectional study
Authors
Catherine Spooner
Upali W. Jayasinghe
Nighat Faruqi
Nigel Stocks
Mark F. Harris
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5556-9

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