Anticipating unintended consequences of public health nutrition policy: Implications for disordered eating and weight stigma.

The potential of dietary interventions in primary and population-based prevention has so far not been fully exploited. One explanation for the relatively sparse public health nutrition (PHN) activities might be related to a lack of rigorous methods for developing and/or selecting effective interventions. Evidence-based PHN sets out to apply existing concepts of an evidence-based approach by incorporating specific aspects from evidence-based public health and evidence-based nutrition. The aim of this review is therefore to propose an answer to the question for constituents of good evidence in PHN. To this end, existing suggestions for an evidence-based approach in PHN and the prevention paradigm of Rose are used as starting points. Complemented by a comprehensive literature search, current and new challenges in evaluating public health and nutrition interventions are summarized. This is followed by theoretical and conceptual considerations for an evidence-based approach in PHN. Structured along three core questions of why and what should be done and how should it be done, essential steps and aspects which have to be considered by decision-makers are presented. As a basic prerequisite, the need for empirical evidence from practise experiences is pointed out. In addition, it is shown that considerations of logic models and intervention theories, of economic simulations and of ethical aspects are required. Finally, a status description regarding ongoing evidence-based activities in PHN is given.

The taxation of sugar-sweetened beverages (SSB) is a widely recommended and implemented public health policy to address “obesity”. However, SSB taxation may also have unintended consequences, including the legitimization or exacerbation of weight stigma. With respect to global calls to end weight stigma in health policy, we sought to qualitatively examine academic literature focused on SSB taxation for elements of weight stigma. We collected 13 scoping reviews that focused on SSB taxation, and then retrieved the articles reviewed, eliminating duplicates, for a total of 176 articles. All articles were uploaded to NVivo 12 software. Two researchers (AW, NR) developed a code list, which was updated iteratively. Regular meetings occurred to ensure consistency in coding. We have currently coded 56 articles, and our preliminary findings support the intersecting themes of the urgency of addressing the “obesity epidemic”, reinforcing negative stereotypes, personal responsibility framing, and reliance on the calorie imbalance model. Within the studies reviewed, we identified weight stigma and/or stigmatizing language from the introduction to the conclusions, such that weight stigma informed the methods and research questions in some cases. Therefore, the potential consequences of implementation of SSB taxation for weight stigma need to be seriously considered.

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.

Abstract: This chapter delves into the advanced mathematical approaches used in precision modeling to analyze and understand complex systems in both science and economics. It explores the foundational principles of nonlinear dynamics, chaos theory, stochastic processes, and agent-based modeling, which are essential for capturing the intricate behaviors of these systems. The chapter further examines the application of these models in various scientific fields, including biology, ecology, physics, and climate science, as well as in economic contexts such as macroeconomic modeling, financial markets, and behavioral economics. It also addresses the challenges associated with precision modeling, including model uncertainty, data quality, and ethical considerations, while highlighting the emerging trends and innovations, such as artificial intelligence integration and hybrid models. The chapter concludes by emphasizing the importance of interdisciplinary collaboration and the transformative potential of precision modeling in driving scientific discovery, informing policy decisions, and addressing global challenges. Keywords: Keywords: Precision Modeling, Complex Systems, Nonlinear Dynamics, Chaos Theory, Stochastic Processes, Agent-Based Modeling, Macroeconomic Modeling, Financial Markets, Behavioral Economics, Interdisciplinary Collaboration, Artificial Intelligence, Hybrid Models, Scientific Discovery, Policy Decision-Making, Global Challenges.

Weight stigma is a key aspect of the lived experience of individuals with obesity, and adversely affects health. This article provides an overview of recent evidence examining links between experiences of weight stigma and weight-related behaviors and health (e.g., maladaptive eating, physical activity, stress, obesity, weight loss), including health consequences for individuals with heightened vulnerability to weight stigma (e.g., youth and people seeking bariatric surgery) and implications for clinicians working with individuals who have obesity. This literature points to weight stigma as a psychosocial contributor to obesogenic behaviors, yet the role of weight stigma in weight loss among treatment-seeking individuals has received little attention. Research priorities are identified, including the need for future studies to (a) determine the potentially predictive value of specific characteristics of weight-stigmatizing experiences for weight loss (such as the time period, interpersonal sources, and coping responses for stigma experiences), (b) identify mechanisms through which weight stigma may undermine or facilitate weight-related treatment outcomes, and (c) test strategies that can be implemented in weight management programs to reduce the negative impact of weight stigma on health behaviors. Broadly, more attention should be directed to weight stigma in the obesity field as a relevant psychosocial factor in obesity-focused prevention and treatment. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Mapping weight stigma in food-based dietary guidelines across thirteen countries in Latin America and the Caribbean: a qualitative analysis

Public health nutrition actions across 14 EU countries: a qualitative study to elicit the views of policy makers and thought leaders

Weight bias refers to prejudice and discrimination towards overweight and obese individuals, and is argued to be one of the last socially acceptable forms of discrimination. Multi-country studies document its widespread prevalence. Children, adults, health professionals, employers, and the media are sources of weight bias. Fifty years of research consistently documents the significant detrimental consequences of weight bias for targets’ psychological and physical health, employment opportunities and income, education, and academic performance. Psychological and sociocultural theories have been posited to explain weight bias, including the role of beliefs about the individual controllability of body weight, and the intersection of social justice issues relating to gender, race, and class. Multi-level strategies have been proposed to address weight bias, spanning psychosocial interventions, re-orienting media and public health campaigns, social policy, and legislation. This chapter provides an overview of the existing evidence for the prevalence, sources, consequences, theories, and intervention approaches for weight bias. It concludes with a set of recommendations to rapidly drive forward research and advocacy efforts that seek to address this pernicious social and public health issue in a strategic and coordinated way.

Investigating the relationship between parental weight stigma and feeding practices

Public health nutrition is a field of practice that is concerned with the prevention of nutrition related disease and the maintenance of nutritional health of populations. Public health nutrition efforts are dependent on the capacity of the workforce to respond to priority issues. Developing the public health nutrition workforce is therefore a key strategy to build society’s capacity to address public health nutrition challenges and improve health. The evidence available suggests that the public health nutrition workforce in Australia does not have the capacity to respond to current health and nutrition issues. On-the-job learning and mentoring have been proposed as strategies for practice improvement in public health nutrition. However there is limited evidence of their effectiveness. This study aimed to evaluate mentoring as a public health nutrition workforce development strategy. Action research methodology embedded within an evaluation framework provided the approach from which to guide this research, which had three phases. Formative evaluation (phase 1) involved an iterative literature review to define the role and models of mentoring as well as in-depth interviews with 18 advanced-level public health nutritionists in Australia to explore the role of mentoring in competence development. The results of phase one were used to inform the intervention (phase 2). This involved a mentoring circle, defined by the literature, where one mentor worked with a group of mentees. Thirty two recently graduated dietitians participated in the intervention and self-selected to one of two face-to-face mentoring circles or the electronic (video-link) mentoring circle for those in rural areas. Participants were required to complete a learning plan and attend the mentoring circle, every six weeks, for two hours, over a six month period. Each session was structured similarly including written reflective practice and facilitated group discussion. After the six month intervention a subset of 12 of the initial participants requested to continue with the mentoring circle for an extended nine months (phase 3). The one mentor, the PhD candidate, facilitated all mentoring circles. Process, impact and outcome evaluation data were obtained through mixed methodologies. A pre-intervention baseline questionnaire, estimation of time dedicated to public health nutrition practice within the participants’ work role and competence importance ranking were used. In-depth interviews with participants following the six month intervention, mentor reflections/observation diary and focus groups at the end of the extension phase added qualitative data. A competency self-assessment was designed and administered at baseline, post the six month mentoring intervention and 12 months post the completion of the intervention. The process evaluation identified that the intervention met participants’ expectations. The participants explained the intervention facilitated the sharing of ideas and strategies and promoted reflective practice. The important attributes of the mentor as having experience in and a passion for public health, facilitating a trusting relationship and providing effective feedback were described. The impact evaluation revealed that participants reported an increase of 15% (p

BackgroundWeight stigma is a public health concern linked to psychological distress, social exclusion, and poorer health outcomes. Although stigma in daily life has been studied internationally, little is known about its effects on lived experience in Finland, especially across different socioeconomic groups. This study examined how weight stigma is encountered in everyday life among Finnish adults, exploring potential differences in the sources and impacts of socioeconomic position and body mass index (BMI).MethodsThis qualitative interview study is a part of the Helsinki Health Study. Participants (n = 40) were selected from the City of Helsinki employee cohort, equally divided by educational level (low/high) and BMI (BMI ≥30 kg/m² and BMI <30 kg/m²), with an equal representation of women and men. Interviews were conducted in 2023-2024, and the data were analyzed using inductive content analysis.ResultsParticipants described experiencing weight stigma as a recurring part of everyday life, especially in close relationships such as parents, partners, and relatives, as well as in healthcare, media, and workplaces. Stigma took many forms, from subtle suggestions or ‘concerns’ to direct criticism and bullying. These experiences led to shame, guilt, frustration, and sometimes defiance. Many reflected on the lasting effects on body image, self-worth, and health behavior. Some also described how their children were bullied because of their weight. The findings revealed how stigma was embedded in social relationships and often internalized over time.ConclusionsThe experience of weight stigma was not limited to public discourse or institutions but was deeply woven into everyday interactions. Even well-meaning comments could reinforce harmful ideals or cause emotional harm. Public health responses must address relational and intergenerational aspects of stigma and promote compassionate, inclusive environments in homes, workplaces, and healthcare.Key messages• Weight stigma experiences affect mental health, body image, and relationships, and cause emotional and social harm, as revealed through people’s lived experiences.• This study highlights the social nature of weight stigma in Finland, emphasizing the need for stigma-free environments in healthcare, workplaces, media, and families.

Bear subculture exists within a larger gay community, which has been recognized by public health experts as disproportionately burdened with stigma and related health adversities. Bears are distinguished by a particular body look—body hirsuteness and heavy-set physique. Previous research documented the various health risks, and the exposure to both sexual minority and weight stigma, of this population. In this study we focused on the determinants of self-esteem in Bears. We explored the significance of such predictors as: perceived sexual minority and weight stigma, age, resilience, and physique as reflected by the BMI. Our sample consisted of 60 men from the Polish Bear community (i.e., Bears, Cubs, Otters, Wolves). Linear regression models were performed for the entire sample (N = 60) and for Bear-identified men (N = 31). Perceived sexual minority stigma negatively, and resilience positively, predicted self-esteem. In the case of Bear-identified men, age, perceived exposure to weight discrimination, and BMI were also significant predictors of self-esteem. Higher BMI in the case of Bear-identified men predicted higher self-esteem. Our results suggest that although Bear-identified men are characterized by their similarities to other gay men, subcultural identities create unique social contexts that are important for health and health interventions in this population.

IntroductionPromoting healthy weight is a top priority in Canada. Recent federal guidelines call for sustained, multisectoral partnerships that address childhood obesity on multiple levels. Current healthy weight messaging does not fully acknowledge the influence of social determinants of health on weight.MethodsAn interactive workshop was developed and implemented by a team of academic researchers and health promoters from the psychology and public health disciplines to raise awareness about 1) weight bias and its negative effect on health, 2) ways to balance healthy weight messaging to prevent the triggering of weight and shape preoccupation, and 3) the incorporation of mental health promotion into healthy weight messaging. We conducted a full-day workshop with 342 Ontario public health promoters and administered a survey at preintervention, postintervention, and follow-up.ResultsParticipation in the full-day workshop led to significant decreases in antifat attitudes and the internalization of media stereotypes and to significant increases in self-efficacy to address weight bias. Participants reported that the training heightened their awareness of their own personal weight biases and the need to broaden their scope of healthy weight promotion to include mental health promotion. There was consensus that additional sessions are warranted to help translate knowledge into action. Buy-in and resource support at the organizational level was also seen as pivotal.ConclusionProfessional development training in the area of weight bias awareness is associated with decreases in antifat attitudes and the internalization of media stereotypes around thinness. Health promoters’ healthy weight messaging was improved by learning to avoid messages that trigger weight and shape preoccupation or unhealthful eating practices among children and youth. Participants also learned ways to integrate mental health promotion and resiliency-building into daily practice.

Much has been written about the conceptual crisis that necessitated the development of quantum mechanics. The backdrop for this workshop is a similar crisis, which may be called the “crisis of complexity”. The conventional scientific wisdom of previous centuries expected First Principles to be “intuitively obvious”, and thus as sure a foundation for natural law as Euclid’s postulates were for geometry. It was also expected that such First Principles would ultimately lead to a “theory of everything” because quantitative discussions of all natural phenomena could be deduced from them simply. The first blow against this simplistic view was the counter-intuitiveness of quantum phenomena, but the postulates of quantum mechanics, if counter-intuitive, were still simple to state (in the appropriate mathematical language). It was “chaos theory” that showed an essential difficulty with the above assertions: a simple system can exhibit such complex dynamics as to be essentially unpredictable over a reasonable time scale. Chaotic dynamics thus emphasizes the need for a “science of complex systems”, the study of systems in which “the whole is more than the sum of its parts,” in contrast to earlier science, which emphasized the study of isolated systems, or “things in themselves”. (It is interesting to note that the Poincare-Bendixson Theorem [1] rules out the existence of chaotic attractors in systems with fewer than three degrees of freedom.

A Call to Action: Addressing Medical School as a Source of Weight Stigma Requires Transformative Change.