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1 Hunger JM

Tomiyama AJ Weight labeling and disordered eating among adolescent females: Longitudinal evidence from the NHLBI Growth and Health Study. 2 Hunger JM

Tomiyama AJ Weight labeling and obesity: A longitudinal study of girls aged 10 to 19 years. 3 Neumark-Sztainer D.

Falkner N.

Story M.

et al. Weight-teasing among adolescents: Correlations with weight status and disordered eating behaviors. 4 Brochu PM., Pearl RL., and Simontacchi L. Weight stigma and related social factors in psychological care. In S. Cassin, R. Hawa, and S. Sockalingam (Eds.), Psychological care in severe obesity: A practical and integrated approach (pp. 42–60). Cambridge: Cambridge University Press; 2018. https://doi.org/10.1017/9781108241687.004. In this issue, Hunger and Tomiyama show that being labeled as “too fat” at age 14 increases the risk of disordered eating behaviors and cognitions four years later []. This study builds upon existing research with the same sample, showing that being labeled as “too fat” at age 10 predicts weight gain and “obesity” at age 19 []. These findings contribute to the broader research literature demonstrating that weight teasing predicts disordered eating among adolescent girls and boys, and that perceived weight discrimination negatively influences physical and psychological health [].

4 Brochu PM., Pearl RL., and Simontacchi L. Weight stigma and related social factors in psychological care. In S. Cassin, R. Hawa, and S. Sockalingam (Eds.), Psychological care in severe obesity: A practical and integrated approach (pp. 42–60). Cambridge: Cambridge University Press; 2018. https://doi.org/10.1017/9781108241687.004. 5 Tomiyama AJ Weight stigma is stressful. A review of evidence for the cyclic obesity/weight-based stigma model. 6 Hunger JM

Major B

Blodorn A

Miller CT Weighed down by stigma: How weight-based social identity threat contributes to weight gain and poor health. 7 Amy NK

Aalborg A

Lyons P

Keranen L Barriers to routine gynecological cancer screening for White and African-American obese women. 8 Blodorn A

Major B

Hunger J

Miller C Unpacking the psychological weight of weight stigma: A rejection-expectation pathway. 9 Cohen S. Social relationships and health. Further research is needed to understand the mechanisms by which weight stigma influences health. Thus far, the literature has proposed four mechanisms: increased stress, unhealthy behavior changes, health care underutilization, and social disconnection []. Weight stigma is physiologically and psychologically stressful, influences emotional processes (e.g., shame), and impairs health outcomes (e.g., blood pressure) []. Weight stigma may undermine self-regulation and executive functioning, resulting in increased eating and avoidance of physical activity, and may motivate people to engage in unhealthy weight loss behaviors (e.g., fasting, diet pills, purging) in an effort to shed the stigma []. Weight stigma in health care settings can lead to health care underutilization and avoidance, which can then perpetuate weight-based health disparities by delaying diagnosis and treatment. For example, higher body-weight women who perceive discrimination in health care are less likely to receive age-appropriate preventative health care screenings such as pelvic examinations and mammograms []. Weight stigma may lead to experiences of social disconnection, thwarting the fundamental human need to belong and feel accepted by others, and leading to expectations of social rejection in interpersonal interactions []. And we know that quality social relationships (including social integration, social support, and positive interaction) are an essential component of health and well-being [].

10 Lipson SK

Sonneville KR Eating disorder symptoms among undergraduate and graduate students at 12 U.S. colleges and universities. 11 Sim LA

Lebow J

Billings M Eating disorders in adolescents with a history of obesity. 12 Simontacchi LA

Serrano J

Brochu P. What's weight got to do with it? The impact of BMI on case conceptualization. 13 Lebow J

Sim LA

Kransdorf LN Prevalence of a history of overweight and obesity in adolescents with restrictive eating disorders. Each of these weight stigma processes can be observed in patients with eating disorders. Weight stigma is a systemic barrier to eating disorder prevention, diagnosis, and treatment. Contrary to popular thought, higher-weight people are more likely to engage in restrictive eating-disordered behaviors than all other weight groups []. Unfortunately, these symptoms are often unnoticed, overlooked, and untreated in higher-weight bodies []. In a study led by two of my students, mental health trainees read a vignette featuring a patient presenting with symptoms of anorexia nervosa and were randomly assigned to one of three conditions in which the patient was described as “underweight,” “normal weight,” or “overweight” []. Results revealed that participants were less likely to assign a diagnosis of anorexia nervosa or atypical anorexia nervosa, recommended fewer treatment sessions, and reported more weight-stereotypical perceptions of the patient when she was described as “overweight.” This is a serious concern given that early detection of eating disorders leads to better treatment outcomes [].

4 Brochu PM., Pearl RL., and Simontacchi L. Weight stigma and related social factors in psychological care. In S. Cassin, R. Hawa, and S. Sockalingam (Eds.), Psychological care in severe obesity: A practical and integrated approach (pp. 42–60). Cambridge: Cambridge University Press; 2018. https://doi.org/10.1017/9781108241687.004. 1 Hunger JM

Tomiyama AJ Weight labeling and disordered eating among adolescent females: Longitudinal evidence from the NHLBI Growth and Health Study. 3 Neumark-Sztainer D.

Falkner N.

Story M.

et al. Weight-teasing among adolescents: Correlations with weight status and disordered eating behaviors. 14 Puhl RM

Brownell KD Confronting and coping with weight stigma: An investigation of overweight and obese adults. 15 Puhl RM

Luedicke J

Heuer CA Weight-based victimization toward overweight adolescents: Observations and reactions of peers. 16 van Geel M

Vedder P

Tanilon J Are overweight and obese youths more often bullied by their peers? A meta-analysis on the relation between weight status and bullying. 17 Ikeda JP

Crawford PB

Woodward-Lopez G BMI screening in schools: Helpful or harmful. Weight stigma is pervasive and can influence experiences across many important domains of living, including health care, employment, education, interpersonal relationships, and in the media []. As Hunger and Tomiyama show, weight labeling from family members is more strongly associated with disordered eating []. Higher-weight young people frequently experience weight teasing and other weight stigma from family members and close friends, people who might otherwise be expected to be unconditional sources of social support and safety []. Furthermore, weight is one of the most common reasons for bullying among school-aged children []. Beyond teasing and victimization, still other contexts that involve weight labeling are worthy of concern. For instance, body mass index screening in schools may unintentionally exacerbate disordered eating, body dissatisfaction, and weight gain [].

18 Logel C

Stinson DA

Brochu PM Weight loss is not the answer: A well-being solution to the “obesity problem.”. 12 Simontacchi LA

Serrano J

Brochu P. What's weight got to do with it? The impact of BMI on case conceptualization. 19 Brochu PM. Addressing weight bias in a clinical psychology training program. 20 Brochu PM. Teaching clinical psychology trainees about weight bias. Women & Therapy. (in press) 21 Pearl RL.

Hopkins CH

Berkowitz RI.

Wadden TA Group cognitive-behavioral treatment for internalized weight stigma: A pilot study. 22 Hayward LE.

Vartanian LR.

Pinkus RT Coping with weight stigma: Development and validation of a brief coping responses inventory. 1 Hunger JM

Tomiyama AJ Weight labeling and disordered eating among adolescent females: Longitudinal evidence from the NHLBI Growth and Health Study. But there are a number of approaches that can reduce the risk of weight stigma for disordered eating and poor health outcomes more generally. We must shift our focus from weight to health and well-being []. Such a shift should encourage healthful and weight-inclusive approaches to health behaviors, reduce weight stigma and discrimination, and promote strategies for coping with weight stigma. For example, diagnostic criteria for anorexia nervosa could remove weight requirements and instead focus on behavioral symptoms in an effort to reduce systemic weight bias in eating disorder treatment and prevention []. Mental health training programs could address weight stigma in their curricula, which would reduce weight stigma and improve understanding of weight-related conditions []. Acknowledging that weight stigma is a diversity issue may also enable weight stigma interventions and effective coping responses to weight discrimination []. As Hunger and Tomiyama state in their current article, “weight stigma is a potent yet modifiable risk factor for disordered eating” []. It is time that we realize this and do something about it.

Article Info Publication History Identification DOI: https://doi.org/10.1016/j.jadohealth.2018.06.016 Copyright © 2018 Society for Adolescent Health and Medicine. All rights reserved. ScienceDirect Access this article on ScienceDirect