"Improving Understanding Of Weight Stigma With Causal Inference Methods And General Population Survey Data".

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Context: Obesity is common, affecting 16% of adults and 6% of children in Europe, but it is also highly stigmatized. People are discriminated against because of their weight in medical, education, and workplace settings, with serious consequences. People who experience weight stigma have worse mental health and quality of life. People with obesity avoid seeking healthcare due to fear of negative, stigmatizing interactions with medical professionals. Ironically, weight stigma may also contribute to obesity, by affecting eating patterns and acting as barrier to physical activity. When weight stigma is 'internalized', people come to believe that negative obesity-related stereotypes apply to themselves - for example, thinking of themselves as lazy, incompetent, or less valuable than others. This 'internalized' weight stigma is linked to disordered eating not only for people with obesity, but also for normal-weight and underweight people. This means that weight stigma is relevant to mental health across the bodyweight range. There is widespread concern that public health initiatives aiming to reduce obesity may contribute to weight stigma, making them less effective, and causing harm. For example, sending 'weight report cards' to parents of UK schoolchildren does not reduce obesity, but does make heavier children skip breakfast and feel tired and unhappy at school. With the onset of the COVID-19 pandemic, the focus on weight control during national lockdowns may have made this situation worse, contributing to a huge increase in referrals to eating disorder services. Weight stigma is becoming recognised as a public health problem in its own right, but we do not know how to reduce weight stigma or protect people from its effects. This is because weight stigma research has been almost entirely based on small samples which are not representative of the whole population. Research has also focused on the United States, so we know very little about weight stigma in the UK or Europe. We do not know how a person's ethnicity or gender might change their experience of stigma around their weight, or what makes some young people more likely than others to 'internalize' weight stigma. Finally, previous research which did use larger, more representative samples may have been biased because of the methods used. Aims: This project aims to transform current understanding of the extent of everyday weight stigma, who is most affected by it, and how it becomes internalized, using large, general population European surveys.Objective 1: Explore how risk of discrimination and harassment varies with combinations of different ethnicities, genders, and body sizes.Objective 2: Investigate the extent of weight stigma in the workplace, and if this is changing with time, using methods to avoid bias which may have affected earlier research.Objective 3. Identify risk factors which make young people more likely to internalize weight stigma (apply negative obesity-related stereotypes to themselves).Potential applications and benefits: Objective 1 will help identify groups of adults at especially high risk of discrimination and harassment for multiple reasons and help us better understand how discrimination plays out in the UK. Objective 2 will clarify the need to tackle weight stigma in the workplace, for instance via employee training programmes - and if this need may increase in the future. Objective 3 will help identify which groups of young people are most at risk of negative psychological effects of weight stigma, and factors which could be used to protect them. It will help us better understand the relationships between weight stigma and mental health, including eating disorders and depression, and how attitudes about weight are passed down through families. Findings can be used by organizations and policymakers aiming to mitigate the effects of weight, ethnic, and gender discrimination, reduce bullying in the workplace, and improve mental health.