Reframing How Providers Advocate for Adolescent Well-Being in Body Image, Eating, and Weight.
Reframing How Providers Advocate for Adolescent Well-Being in Body Image, Eating, and Weight.
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重新定义医疗服务提供者如何倡导青少年在身体形象、饮食和体重方面的健康。
DOI：
10.1016/j.jaac.2023.03.008
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发表时间：
2023
影响因子：
13.3
通讯作者：
Lydecker,JanetA
中科院分区：
文献类型：
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作者：
Ozbardakci,EliseV;Lydecker,JanetA
青春期是一个关键的发展时期，青少年很容易受到那些宣扬不切实际的体型和基于体重的耻辱文化的信息的影响。青少年的脆弱性体现在所有性别的青少年中普遍对身体不满意，1-3，这可能导致负面的心理健康后果，包括饮食失调和抑郁。 4, 5 重要的是，与体重较低的青少年相比，体重较高的青少年对身体的担忧更加复杂，他们更有可能经历基于体重的受害者并内化基于体重的耻辱。 6, 7 医疗保健提供者有机会通过提供有关身体形象、饮食和体重的非污名化信息来倡导青少年患者的健康。虽然身体形象预防计划强调需要促进积极的身体形象和对基于体重的受害者的认识，但临床指南却侧重于预防或治疗疾病（即肥胖或饮食失调）。然而，青少年的健康将受益于包容体重、积极的身体形象信息。提供者可以通过花时间从积极而非关注问题的角度来讨论身体形象，从而树立优先考虑积极身体形象信息的重要性。我们为医疗保健提供者提出了一个倡导框架，以支持青少年的身体形象并减少体重偏见在四种环境中的影响：(1) 诊所、(2) 社交媒体、(3) 青少年家庭和 (4) 学校。提供者可以通过 (1) 实施体重包容性评估策略和 (2) 向家庭提供指导和建议来支持青少年在身体形象、饮食和体重方面的健康发展。我们鼓励提供者评估所有青少年的身体形象、健康和福祉，而不是使用患者特征（例如体重状况、性别）作为健康目标的代理。包容性评估实践既是倡导的一种形式，也是倡导的先决条件。当实践具有包容性时，评估就是倡导，因为它促进非评判性和以患者为中心的沟通，并且可以减少识别时偏见的影响
Adolescence is a critical developmental period when youth are vulnerable to messages that promote unrealistic body shapes and a culture of weight-based stigma. Adolescents’ vulnerability is reflected in high prevalence of body dissatisfaction among adolescents of all genders, 1–3 which can lead to negative mental health consequences including disordered eating and depression. 4, 5 Importantly, body concerns are compounded among adolescents with higher weights who are more likely to experience weight-based victimization and internalize weight-based stigma compared to adolescents with lower weights. 6, 7 Healthcare providers have an opportunity to advocate for adolescent patients’ wellbeing by providing non-stigmatizing messages around body image, eating, and weight. While body image prevention programs emphasize the need to promote positive body image and awareness of weight-based victimization, clinical guidelines instead focus on preventing or treating conditions (ie, obesity or eating disorders). Yet, adolescents’ wellbeing would benefit from weight-inclusive, positive body image messages. Providers can model the importance of prioritizing positive body image messages by spending time discussing body image through a positive rather than problem-focused lens. We propose an advocacy framework for healthcare providers to support adolescents’ body image and to reduce the impact of weight bias across four settings:(1) the clinic,(2) social media,(3) adolescents’ homes, and (4) school.Providers can advocate for adolescents by (1) implementing weight-inclusive assessment strategies and (2) providing guidance and recommendations to families to support adolescents’ development of wellbeing in body image, eating, and weight. We encourage providers to evaluate the body image, health, and wellbeing of all adolescents, rather than using patient characteristics (eg, weight status, gender) as a proxy for health goals. Inclusive assessment practices are both a form of advocacy and a prerequisite for advocacy. Assessment is advocacy when practices are inclusive because it promotes non-judgmental and patient-centered communication and may reduce the impact of bias when identifying