Weight Stigma and Social Media: Evidence and Public Health Solutions

Weight stigma is a pressing issue that affects individuals across the weight distribution. The role of social media in both alleviating and exacerbating weight bias has received growing attention. On one hand, biased algorithms on social media platforms may filter out posts from individuals in stigmatized groups and concentrate exposure to content that perpetuates problematic norms about weight. Individuals may also be more likely to engage in attacks due to increased anonymity and lack of substantive consequences online. The critical influence of social media in shaping beliefs may also lead to the internalization of weight stigma. However, social media could also be used as a positive agent of change. Movements such as Body Positivity, the Fatosphere, and Health at Every Size have helped counter negative stereotypes and provide more inclusive spaces. To support these efforts, governments should continue to explore legislative solutions to enact anti-weight discrimination policies, and platforms should invest in diverse content moderation teams with dedicated weight bias training while interrogating bias in existing algorithms. Public health practitioners and clinicians should leverage social media as a tool in weight management interventions and increase awareness of stigmatizing online content among their patients. Finally, researchers must explore how experiences of stigma differ across in-person and virtual settings and critically evaluate existing research methodologies and terminology. Addressing weight stigma on social media will take a concerted effort across an expansive set of stakeholders, but the benefits to population health are consequential and well-worth our collective attention.

Existência e eficácia de intervenções nutricionais ‘sem dieta’ no tratamento de indivíduos com compulsão alimentar

Compulsões alimentares tem sido uma condição cada vez mais frequente, principalmente entre indivíduos com sobrepeso e obesidade. Porém, as intervenções nutricionais comumente trabalhadas com estes indivíduos impõem restrições alimentares, as quais podem piorar o quadro da compulsão alimentar. Assim, objetivou-se investigar na literatura a existência de intervenções nutricionais ‘sem dieta’ e sua eficácia na compulsão alimentar. Em forma de revisão bibliográfica, foram considerados nesta pesquisa os estudos entre 2007 e 2017 que conduziram intervenções nutricionais ‘sem dieta’ e avaliaram sua eficácia na compulsão alimentar. Dezoito estudos preencheram os critérios de inclusão, e trouxeram intervenções baseadas em Intuitive Eating, Health at Every Size, Mindful Eating, Eating Competence e outras intervenções classificadas como ‘sem dieta’. Em todos eles, observou-se a redução significante nos episódios de compulsão alimentar, além de melhora em outros aspectos do comportamento e consumo alimentares. Foi observado que, apesar de terem sido identificadas diferentes intervenções, elas tinham pontos em comum, como respeito aos sinais de fome e saciedade e quebra da mentalidade de restrição alimentar, os quais, em concordância com outros autores, podem estar no cerne da eficiência no trabalho de compulsão alimentar. Sugere-se que intervenções nutricionais ‘sem dieta’ sejam promissoras para tratamento de compulsão alimentar.

Intuitive eating and Health at Every Size in community settings: Dietitian's perceptions of practice barriers

Intuitive Eating (IE) and Health at Every Size (HAES) are health promotion paradigms used by dietitians in private practice more commonly than in community-based practice where more diverse and vulnerable populations are served. The primary objective of this study was to examine the perceived barriers and facilitators that dietitians encounter when using IE and HAES in community nutrition practice settings. This phenomenological, qualitative study applied a grounded theory analysis to identify emergent themes from transcripts of semi-structured interviews with 27 dietitians working in community settings in the United States. Dietitians reported the following perceived barriers to the use of IE/HAES: diet culture which was often expressed as inconsistent messages patients receive from the media and other professionals that conflict with nutrition providers’ messages; legislative restrictions and weight-centric administrative policies; and personal beliefs of clients and colleagues concerning weight and health. Dietitians reported occupational autonomy as a salient factor facilitating the use of IE/HAES in community practice and identified the need for shifts in attitudes about weight and its relation to health achieved through research and dissemination of information on weight-inclusive practices. Collectively, respondents experienced more systemic barriers than individual barriers and identified several macro-level facilitators that remain elusive. The unique experiences of RDNs in community practice provide a roadmap for ongoing research to establish the evidence base for best practices, inform education and training, and achieve cultural shifts that move towards weight-inclusive practice in this setting. More research is needed to explore the generalizability of these experiences.