Browsing by Author "Alberga, Angela S."
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Item Open Access Canadian Senate Report on Obesity: Focusing on Individual Behaviours versus Social Determinants of Health May Promote Weight Stigma(Hindawi, 2018-07-02) Alberga, Angela S.; McLaren, Lindsay; Russell-Mayhew, Shelly; von Ranson, Kristin M.Very little attention has been given to unintended consequences of government reporting on obesity. This paper argues that the 2016 Senate report, “Obesity in Canada: A Whole-Of-Society Approach,” exemplifies the systemic public health issue of weight stigma. The purpose of this viewpoint is to critique the approach taken in the Report, by illustrating that it (1) takes a weight centric approach to health, (2) does not acknowledge important limitations of the definition and measurement of obesity, (3) reifies obesity as a categorical phenomenon that must be prevented, and (4) uses aggressive framing and disrespectful terminology. The Report perpetuates a focus on the individual, thereby failing to recognize the role that governments can play in reducing weight stigma and addressing social determinants of health. If steps are taken to avoid propagating weight stigma, future reports could more constructively address health promotion, equity, and social determinants of health in their policies.Item Open Access Canadian Senate Report on Obesity: Focusing on Individual Behaviours versus Social Determinants of Health May Promote Weight Stigma(2018-07-02) Alberga, Angela S.; McLaren, Lindsay; Russell-Mayhew, Shelly; von Ranson, Kristin M.Very little attention has been given to unintended consequences of government reporting on obesity. This paper argues that the 2016 Senate report, “Obesity in Canada: A Whole-Of-Society Approach,” exemplifies the systemic public health issue of weight stigma. The purpose of this viewpoint is to critique the approach taken in the Report, by illustrating that it (1) takes a weight-centric approach to health, (2) does not acknowledge important limitations of the definition and measurement of obesity, (3) reifies obesity as a categorical phenomenon that must be prevented, and (4) uses aggressive framing and disrespectful terminology. The Report perpetuates a focus on the individual, thereby failing to recognize the role that governments can play in reducing weight stigma and addressing social determinants of health. If steps are taken to avoid propagating weight stigma, future reports could more constructively address health promotion, equity, and social determinants of health in their policies.Item Open Access Changes in the Brain-Derived Neurotrophic Factor Are Associated with Improvements in Diabetes Risk Factors after Exercise Training in Adolescents with Obesity: The HEARTY Randomized Controlled Trial(2018-09-30) Walsh, Jeremy J.; D’Angiulli, Amedeo; Cameron, Jameason D.; Sigal, Ronald J.; Kenny, Glen P.; Holcik, Martin; Doucette, Steve; Alberga, Angela S.; Prud’homme, Denis; Hadjiyannakis, Stasia; Gunnell, Katie; Goldfield, Gary S.Obesity in youth increases the risk of type 2 diabetes (T2D), and both are risk factors for neurocognitive deficits. Exercise attenuates the risk of obesity and T2D while improving cognitive function. In adults, these benefits are associated with the actions of the brain-derived neurotrophic factor (BDNF), a protein critical in modulating neuroplasticity, glucose regulation, fat oxidation, and appetite regulation in adults. However, little research exists in youth. This study examined the associations between changes in diabetes risk factors and changes in BDNF levels after 6 months of exercise training in adolescents with obesity. The sample consisted of 202 postpubertal adolescents with obesity (70% females) aged 14–18 years who were randomized to 6 months of aerobic and/or resistance training or nonexercise control. All participants received a healthy eating plan designed to induce a 250/kcal deficit per day. Resting serum BDNF levels and diabetes risk factors, such as fasting glucose, insulin, homeostasis model assessment (HOMA-B—beta cell insulin secretory capacity) and (HOMA-IS—insulin sensitivity), and hemoglobin A1c (HbA1c), were measured after an overnight fast at baseline and 6 months. There were no significant intergroup differences on changes in BDNF or diabetes risk factors. In the exercise group, increases in BDNF were associated with reductions in fasting glucose ( = −6.57, = 3.37, ) and increases in HOMA-B ( = 0.093, = 0.03, ) after controlling for confounders. No associations were found between changes in diabetes risk factors and BDNF in controls. In conclusion, exercise-induced reductions in some diabetes risk factors were associated with increases in BDNF in adolescents with obesity, suggesting that exercise training may be an effective strategy to promote metabolic health and increases in BDNF, a protein favoring neuroplasticity. This trial is registered with ClinicalTrials.gov NCT00195858, September 12, 2005 (funded by the Canadian Institutes of Health Research).Item Open Access Effects of the HEARTY exercise randomized controlled trial on eating behaviors in adolescents with obesity(World Obesity and The Obesity Society and John Wiley & Sons Ltd., 2022-06-06) Alberga, Angela S.; Edache, Iyoma Y.; Sigal, Ronald J.; von Ranson, Kristin M.; Russell-Mayhew, Shelly; Kenny, Glen P.; Doucette, Steve; Prud'homme, Denis; Hadjiyannakis, Stasia; Cameron, Jameason D.; Goldfield, Gary S.Background There are well-recognized benefits of behavioral interventions that include exercise for children and adolescents with obesity. However, such behavioral weight management programs may precipitate unintended consequences. It is unclear if different exercise modalities impact eating behaviors differently in youth with obesity. Objectives The purpose of this study was to examine the effects of aerobic, resistance, and combined aerobic and resistance exercise training on eating attitudes and behaviors (uncontrolled eating, restrained eating, emotional eating, external eating and food craving) among adolescents with overweight and obesity. Methods N = 304 (70% female) adolescents with overweight and obesity participated in the 6-month Healthy Eating Aerobic and Resistance Training in Youth (HEARTY) randomized controlled trial. All participants were inactive post-pubertal adolescents (15.6 ± 1.4 years) with a mean BMI = 34.6 ± 4.5 kg/m2. The Food Craving Inventory (food cravings), Dutch Eating Behavior Questionnaire (restrained eating, emotional eating, external eating), and the Three-Factor Eating Questionnaire (uncontrolled eating) were used to assess eating attitudes and behaviors. Results All exercise groups showed within-group decreases in external eating and food cravings. Participants randomized to the Combined training group and were more adherent showed the greatest improvements in eating behaviors and cravings. Conclusions A 6-month exercise intervention produced improvements in disordered eating behaviors and food cravings, but effects may be gender and modality-specific. Findings highlight the need to tailor exercise intervention to participant characteristics for the promotion of healthier eating and weight management outcomes in youth with obesity.Item Open Access Environmental Scan of Weight Bias Exposure in Primary Health Care Training Programs(Society for Teaching and Learning in Higher Education, 2016-12-11) Russell-Mayhew, Shelly; Nutter, Sarah; Alberga, Angela S.; Jelinski, Susan; Ball, Geoff D. C.; Edwards, Alun; Oddie, Scott; Sharma, Arya M.; Pickering, Barbara; Forhan, MaryNegative attitudes and beliefs about individuals with obesity (also known as weight bias) have negative consequences for physical and mental health for individuals with obesity and impact the quality of care provided by health professionals. A preliminary environmental scan of college and university training programs was conducted consisting of 67 degree and diploma granting programs from 22 institutions in Alberta, targeting programs training future health professionals. Publicly available online course descriptions were examined for weight-related keywords. Keyword frequency was used to determine the extent that coursework addressed weight-related issues. The results suggested that courses are structured to include learning about general health promotion as well as lifestyle factors that may contribute to obesity but may not systematically include learning about weight bias or its potential impact. Our findings highlight the need for further in-depth investigations as well as the need to enhance current curricula in higher education by including information related to weight, obesity and weight bias. Les attitudes et les croyances négatives concernant les personnes obèses (également connues comme partialité contre les obèses) ont des conséquences négatives sur la santé physique et mentale des personnes obèses et affectent la qualité des soins qui leur sont prodigués par les professionnels de la santé. Nous avons mené une étude environnementale préliminaire des programmes de formation universitaires et collégiaux qui a porté sur67 programmes menant à un certificat ou à un diplôme dans 22 établissements d’Alberta, et nous avons principalement visé les programmes de formation de futurs professionnels de la santé. Les descriptions de cours en ligne accessibles au grand public ont été examinées et les mots clés faisant référence aux problèmes de poids ont été identifiés. Les résultats suggèrent que les cours sont structurés de manière à inclure l’apprentissage de la promotion de la santé en général ainsi que les facteurs relatifs au style de vie qui peuvent contribuer à l’obésité mais ils n’incluent pas l’apprentissage systématique de la partialité contre les obèses ou ses effets potentiels. Nos résultats illustrent le besoin de mener des enquêtes approfondies ainsi que celui de renforcer les programmes de cours actuels en enseignement supérieur pour y inclure des informations relatives au poids, à l’obésité et à la partialité contre les obèses.Item Open Access Examining Weight Bias among Practicing Canadian Family Physicians(Karger Publishers, 2019-11-08) Alberga, Angela S.; Nutter, Sarah; MacInnis, Cara; Ellard, John H.; Russell-Mayhew, ShellyObjectives: The aim of this study was to examine the attitudes of practicing Canadian family physicians about individuals with obesity, their healthcare treatment, and perceptions of obesity treatment in the public healthcare system. Method: A national sample of Canadian practicing family physicians (n = 400) completed the survey. Participants completed measures of explicit weight bias, attitudes towards treating patients with obesity, and perceptions that people with obesity increase demand on the public healthcare system. Results: Responses consistent with weight bias were not observed overall but were demonstrated in a sizeable minority of respondents. Many physicians also reported feeling frustrated with patients with obesity and agreed that people with obesity increase demand on the public healthcare system. Male physicians had more negative attitudes than females. More negative attitudes towards treating patients with obesity were associated with greater perceptions of them as a public health demand. Conclusion: Results suggest that negative attitudes towards patients with obesity exist among some family physicians in Canada. It remains to be determined if physicians develop weight bias partly because they blame individuals for their obesity and its increased demand on the Canadian public healthcare system. More research is needed to better understand causes and consequences of weight bias among health professionals and make efforts towards its reduction in healthcare.Item Open Access Exploring weight bias internalization in pregnancy(2022-07-29) Nagpal, Taniya S.; Salas, Ximena R.; Vallis, Michael; Piccinini-Vallis, Helena; Alberga, Angela S.; Bell, Rhonda C.; da Silva, Danilo F.; Davenport, Margie H.; Gaudet, Laura; Rodriguez, Angela C. I.; Liu, Rebecca H.; Myre, Maxine; Nerenberg, Kara; Nutter, Sarah; Russell-Mayhew, Shelly; Souza, Sara C. S.; Vilhan, Candace; Adamo, Kristi B.Abstract Background Recent research has shown that pregnant individuals experience weight stigma throughout gestation, including negative comments and judgement associated with gestational weight gain (GWG). Weight bias internalization (WBI) is often a result of exposure to weight stigma and is detrimental to biopsychological health outcomes. The purpose of this study was to explore WBI in pregnancy and compare scores based on maternal weight-related factors including pre-pregnancy body mass index (BMI), obesity diagnosis and excessive GWG. Methods Pregnant individuals in Canada and USA completed a modified version of the Adult Weight Bias Internalization Scale. Self-reported pre-pregnancy height and weight were collected to calculate and classify pre-pregnancy BMI. Current weight was also reported to calculate GWG, which was then classified as excessive or not based on Institute of Medicine (2009) guidelines. Participants indicated if they were diagnosed with obesity by a healthcare provider. Inferential analyses were performed comparing WBI scores according to pre-pregnancy BMI, excessive GWG, and obesity diagnosis. Significance was accepted as p < 0.05 and effect sizes accompanied all analyses. Result 336 pregnant individuals completed the survey, with an average WBI score of 3.9 ± 1.2. WBI was higher among those who had a pre-pregnancy BMI of obese than normal weight (p = 0.04, η2 = 0.03), diagnosed with obesity than not diagnosed (p < 0.001, Cohen’s d = 1.3), and gained excessively versus not (p < 0.001, Cohen’s d = 1.2). Conclusions Pregnant individuals who have a higher BMI, obesity and gain excessively may experience WBI. Given that weight stigma frequently occurs in pregnancy, effective person-oriented strategies are needed to mitigate stigma and prevent and care for WBI.Item Open Access Exploring weight bias internalization in pregnancy(BMC, 2022-07-29) Nagpal, Taniya S.; Ramos Salas, Ximena; Vallis, Michael; Piccinini-Vallis, Helena; Alberga, Angela S.; Bell, Rhonda C.; da Silva, Danilo F.; Davenport, Margie H.; Gaudet, Laura; Incollingo Rodriguez, Angela C.; Liu, Rebecca H.; Myre, Maxine; Nerenberg, Kara; Nutter, Sarah; Russell-Mayhew, Shelly; Souza, Sara C. S.; Vilhan, Candace; Adamo, Kristi B.Background: Recent research has shown that pregnant individuals experience weight stigma throughout gestation, including negative comments and judgement associated with gestational weight gain (GWG). Weight bias internalization (WBI) is often a result of exposure to weight stigma and is detrimental to biopsychological health outcomes. The purpose of this study was to explore WBI in pregnancy and compare scores based on maternal weight-related factors including pre-pregnancy body mass index (BMI), obesity diagnosis and excessive GWG. Methods: Pregnant individuals in Canada and USA completed a modified version of the Adult Weight Bias Internalization Scale. Self-reported pre-pregnancy height and weight were collected to calculate and classify pre-pregnancy BMI. Current weight was also reported to calculate GWG, which was then classified as excessive or not based on Institute of Medicine (2009) guidelines. Participants indicated if they were diagnosed with obesity by a healthcare provider. Inferential analyses were performed comparing WBI scores according to pre-pregnancy BMI, excessive GWG, and obesity diagnosis. Significance was accepted as p < 0.05 and effect sizes accompanied all analyses. Result: 336 pregnant individuals completed the survey, with an average WBI score of 3.9 ± 1.2. WBI was higher among those who had a pre-pregnancy BMI of obese than normal weight (p = 0.04, η2 = 0.03), diagnosed with obesity than not diagnosed (p < 0.001, Cohen’s d = 1.3), and gained excessively versus not (p < 0.001, Cohen’s d = 1.2). Conclusions: Pregnant individuals who have a higher BMI, obesity and gain excessively may experience WBI. Given that weight stigma frequently occurs in pregnancy, effective person-oriented strategies are needed to mitigate stigma and prevent and care for WBI.Item Open Access Positioning of Weight Bias: Moving towards Social Justice(2016-09-22) Nutter, Sarah; Russell-Mayhew, Shelly; Alberga, Angela S.; Arthur, Nancy; Kassan, Anusha; Lund, Darren E.; Sesma-Vazquez, Monica; Williams, EmilyWeight bias is a form of stigma with detrimental effects on the health and wellness of individuals with large bodies. Researchers from various disciplines have recognized weight bias as an important topic for public health and for professional practice. To date, researchers from various areas have approached weight bias from independent perspectives and from differing theoretical orientations. In this paper, we examined the similarities and differences between three perspectives (i.e., weight-centric, non-weight-centric (health-centric), and health at every size) used to understand weight bias and approach weight bias research with regard to (a) language about people with large bodies, (b) theoretical position, (c) identified consequences of weight bias, and (d) identified influences on weight-based social inequity. We suggest that, despite differences, each perspective acknowledges the negative influences that position weight as being within individual control and the negative consequences of weight bias. We call for recognition and discussion of weight bias as a social justice issue in order to change the discourse and professional practices extended towards individuals with large bodies. We advocate for an emphasis on social justice as a uniting framework for interdisciplinary research on weight bias.Item Open Access Positioning of Weight Bias: Moving towards Social Justice(Hindawi Publishing Corporation, 2016-09-22) Nutter, Sarah; Russell-Mayhew, Shelly; Alberga, Angela S.; Arthur, Nancy; Kassan, Anusha; Lund, Darren E.; Sesma-Vazquez, Monica; Williams, EmilyWeight bias is a form of stigma with detrimental effects on the health and wellness of individuals with large bodies. Researchers from various disciplines have recognized weight bias as an important topic for public health and for professional practice. To date, researchers from various areas have approached weight bias from independent perspectives and from differing theoretical orientations. In this paper, we examined the similarities and differences between three perspectives (i.e., weight-centric, nonweight- centric (health-centric), and health at every size) used to understand weight bias and approach weight bias research with regard to (a) language about people with large bodies, (b) theoretical position, (c) identified consequences of weight bias, and (d) identified influences on weight-based social inequity. We suggest that, despite differences, each perspective acknowledges the negative influences that position weight as being within individual control and the negative consequences of weight bias.We call for recognition and discussion ofweight bias as a social justice issue in order to change the discourse and professional practices extended towards individuals with large bodies. We advocate for an emphasis on social justice as a uniting framework for interdisciplinary research on weight bias.Item Open Access Understanding low adherence to an exercise program for adolescents with obesity: The HEARTY trial(John Wiley & Sons Ltd, World Obesity and The Obesity Society, 2019-08) Alberga, Angela S.; Sigal, R. J.; Sweet, Shane Norman; Doucette, Steve; Russell-Mayhew, Shelly; Tulloch, Heather; Kenny, Glen P.; Prud'homme, Denis; Hadjiyannakis, S.; Goldfield, G. S.Introduction: Despite efforts to improve adherence to physical activity interventions in youth with obesity, low adherence and attrition remain areas of great concern. Objective: The study was designed to determine which physiological and/or psychological factors predicted low adherence in adolescents with obesity enrolled in a 6-month exercise intervention study aimed to improve body composition. Methods: Three hundred four adolescents with obesity aged 14-18 years who volunteered for the HEARTY (Healthy Eating Aerobic and Resistance Training in Youth) randomized controlled trial completed physiological (body mass index, waist circumference, per cent body fat, resting metabolic rate and aerobic fitness) and psychological (body image, mood, self-esteem and self-efficacy) measures. Results: One hundred forty-one out of 228 (62%) randomized to exercise groups had low adherence (completed <70% of the prescribed four exercise sessions per week) to the intervention protocol. Logistic regression revealed that there were no baseline demographic or physiological variables that predicted low adherence in the participants. Appearance concern (a subscale of body image) (odds ratio [OR] 1.46, 95% confidence interval [CI]: 1.01, 2.1, P = 0.04), depressive mood (OR 1.12, 95% CI: 1.01, 1.23, P = 0.03) and confused mood (OR 1.16, 95% CI: 1.05, 1.27, P = 0.003) (two subscales of mood) were significant predictors of low adherence. Conclusions: Adolescents with obesity who had higher appearance concerns and depressive and confused moods were less likely to adhere to exercise. Body image and mood should be screened to identify adolescents who may be at high risk of poor adherence and who may need concurrent or treatment support to address these psychological issues to derive maximal health benefits from an exercise programme.Item Open Access Weight bias and health care utilization: A scoping review(Cambridge University Press, 2019-07-22) Alberga, Angela S.; Edache, Iyoma Y.; Forhan, Mary; Russell-Mayhew, ShellyAim: The purpose of this scoping review was to explore the evidence on how perceptions and/or experiences of weight bias in primary health care influence engagement with and utilization of health care services by individuals with obesity. Background: Prior studies have found discrepancies in the use of health care services by individuals living with obesity; a greater body mass index has been associated with decreased health care utilization, and weight bias has been identified as a major barrier to engagement with health services. Methods: PubMed was searched from January 2000 to July 2017. Four reviewers independently selected 21 studies examining perceptions of weight bias and its impact on engagement with primary health care services. Findings: A thematic analysis was conducted on the 21 studies that were included in this scoping review. The following 10 themes were identified: contemptuous, patronizing, and disrespectful treatment, lack of training, ambivalence, attribution of all health issues to excess weight, assumptions about weight gain, barriers to health care utilization, expectation of differential health care treatment, low trust and poor communication, avoidance or delay of health services, and ‘doctor shopping’. Overall, our scoping review reveals how perceptions and/or experiences of weight bias from primary care health professionals negatively influence patient engagement with primary health care services.Item Open Access Weight bias: A call to action(Springer Nature, 2016-11-07) Alberga, Angela S.; Russell-Mayhew, Shelly; von Ranson, Kristin M.; McLaren, LindsayWeight-related issues (including excess weight, disordered eating and body concerns) are often considered as comprising distinct domains of ‘obesity’ and ‘eating disorders’. In this commentary we argue that the concept of weight bias is an important variable when considering wellbeing across the spectrum of weight-related issues. We make the following six points in support of this argument: i) weight bias is common and has adverse health consequences, ii) shaming individuals for their body weight does not motivate positive behaviour change, iii) internalized weight bias is particularly problematic, iv) public health interventions, if not carefully thought out, can perpetuate weight bias, v) weight bias is a manifestation of social inequity, and vi) action on weight bias requires an upstream, population-level approach. To achieve sustainable reductions in weight bias at a population level, substantive modifications and collaborative efforts in multiple settings must be initiated. We provide several examples of population-level interventions to reduce weight bias.Item Open Access Weight Bias: A Systematic Review of Characteristics and Psychometric Properties of Self-Report Questionnaires(Karger Publishers, 2017-06-10) Lacroix, Emilie; Alberga, Angela S.; Russell-Mayhew, Shelly; McLaren, Lindsay; von Ranson, KristinBackground: People living with overweight and obesity often experience weight-based stigmatization. Investigations of the prevalence and correlates of weight bias and evaluation of weight bias reduction interventions depend upon psychometrically-sound measurement. Our paper is the first to comprehensively evaluate the psychometric properties, use of people-first language within items, and suitability for use with various populations of available self-report measures of weight bias. Methods: We searched five electronic databases to identify English-language self-report questionnaires of weight bias. We rated each questionnaire's psychometric properties based on initial validation reports and subsequent use, and examined item language. Results: Our systematic review identified 40 original self-report questionnaires. Most questionnaires were brief, demonstrated adequate internal consistency, and tapped key cognitive and affective dimensions of weight bias such as stereotypes and blaming. Current psychometric evidence is incomplete for many questionnaires, particularly with regard to the properties of test-retest reliability, sensitivity to change as well as discriminant and structural validity. Most questionnaires were developed prior to debate surrounding terminology preferences, and do not employ people-first language in the items administered to participants. Conclusions: We provide information and recommendations for clinicians and researchers in selecting psychometrically sound measures of weight bias for various purposes and populations, and discuss future directions to improve measurement of this construct.