A weight stigma-informed model to improve energy intake assessment

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1 PROJECT SUMMARY 2 Underreporting of energy intake among people with overweight and obesity is widely acknowledged 3 as a problem in nutrition research. As a majority (74%) of U.S. adults experience overweight/obesity, 4 and as most of adults with overweight/obesity report experiencing weight stigma in the form of teasing, 5 bullying, discrimination, rejection, or other unfair treatment that indicates social devaluation due to 6 body weight, it is imperative that dietary assessment methods are improved to address factors specific 7 to weight status, such as stigma, that may influence reporting accuracy. Weight stigma is associated 8 with many negative psychosocial and health consequences, including impeding weight management 9 efforts and contributing to disordered eating behaviors. For participants with a history of weight stigma, 10 underreporting of energy intake may be a coping mechanism for mitigating the anticipated negative 11 effects of weight stigma. To date, the impact of weight stigma on energy intake underreporting among 12 people with overweight/obesity is unknown. The overall objective of this R21 proposal is to establish 13 proof-of-concept for the relationship between weight stigma and energy intake underreporting for 14 adults with overweight/obesity. Adults (n=68; ≥18 yrs) with overweight/obesity (BMI ≥25 kg/m2) will 15 complete a crossover investigation to determine associations between weight stigma (anticipated, 16 perceived, and internalized weight stigma) and energy intake underreporting, determined by 17 comparing reported energy intake from interviewer-administered 24-hr dietary recalls to objectively 18 measured total energy expenditure from a 10-day doubly-labeled water period (DLW). Participants will 19 be randomized into 1 of 2 dietary recall sequence periods, both with 10-days of DLW, separated by a 20 20-day washout: Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) first, 21 followed by interviewer-administered dietary recalls during the second period, or vice versa. 22 Participants will complete validated assessments of weight stigma, dieting history, social desirability, 23 body size dissatisfaction, and binge eating prior to randomization. This research may help to inform 24 obesity treatment protocols by increasing recognition of negative impacts of weight stigma on health 25 and addressing self-reported dietary intake limitations in adults experiencing overweight/obesity. This 26 research could have public health impact by informing U.S. dietary surveillance methods and 27 guidelines by providing a model that is responsive to the impact of weight stigma on dietary 28 assessment accuracy. This approach may provide an improved self-reported energy intake approach 29 that will allow for future correction of underreporting in adults with overweight/obesity.