Responding to weight stigma: Helpful and unhelpful coping strategies

在全球范围内，高体重状态的流行程度正在上升，根据BMI标准，大约60%的英国人被认为“超重”或“肥胖”，在许多其他国家也有类似的比例。尽管如此，体重较高的人在日常生活的几乎所有领域都会遭遇偏见和歧视，包括教育、就业、医疗保健和人际关系。我们从其他受压迫的群体中了解到，耻辱与较差的健康和生活结果有关，在过去十年中，这些影响也在体重耻辱的情况下得到了证明。更好地了解这些过程是如何发生的，并确定潜在的干预目标，以减少由此造成的危害，这对公共政策至关重要。人们对体重污名的影响是如何传播的知之甚少，更不知道如何将危害降至最低。我的博士工作主要集中在内在化体重污名(IWS)--体重较高的人因为体重而贬低自己的现象。IWS与一系列身体和心理健康问题以及无益的应对策略有关，如饮食失调、避免运动、社交孤立和药物使用。IWS也是许多与遭受他人耻辱相关的问题的中间人。然而，我们不知道为什么一些人将社会污名内化，另一些人基本上不受影响，一些人积极抵制和挑战这种污名。在我读博士期间，我开发了第一份问卷来衡量体重污名的抵抗力，并证明了抵抗力与心理健康的改善有关。我还参考了心理健康污名文献中的研究，找出了内向者和抵抗者的一些关键特征。一个重要的因素是这个人是否有强烈的群体认同感--也就是说，他们是否感到与其他体重较高的人有一种亲切感和归属感。群体认同感高的人不太可能内化，更有可能抵制。另一个重要因素是，他们是否觉得体重是由个人控制的，只是意志力的问题。那些认为自己可以变得更苗条的人往往不会抗拒耻辱，更有可能将其内化。但也许最有趣的是，认为对体重较高的人的污名是没有道理的，这有助于定义抵抗者，即使他们没有很高的群体认同感，无论他们是否认为自己的体重状况是可控的。这意味着有可能制定采取基于社会正义的方法的健康促进干预措施：无论在什么情况下，这种耻辱都是错误的，人们应该得到平等和尊重，无论他们的体重如何。这样的干预可能会改善体重较高的人的心理健康，而不管他们目前对自己体重的信念和感受如何。我的目标是在学术界内继续这一研究途径。这笔奖学金将在多个方面提高我未来申请研究资金和教师职位的能力。两项小型研究将帮助我测试我的污名抵抗力测量的统计特性，并将增加我的抵抗力研究发表在顶级期刊上的可能性，在那里它将产生更大的影响。我想做的另一项研究将探索在大样本医科学生的培训过程中，既被污名化，又观察到其他人在健康、福祉和使用不健康应对策略方面被污名化之间的关系。我还会利用这个机会建立专业网络，更广泛地传播我的工作，增强特定学科的知识，并获得额外的研究、教学和其他学术技能，这些技能将显著增强我未来的职业前景，并帮助我朝着独立研究职业生涯迈出下一步。

The prevalence of high-weight status is increasing globally, with approximately 60% of people in the UK considered "overweight" or "obese" by BMI standards, and similar rates in many other countries. Despite this, higher-weight individuals experience prejudice and discrimination in practically every domain of daily living, including education, employment, healthcare, and interpersonal relationships. We know from other oppressed groups that stigma is associated with poorer health and life outcomes, and in the last ten years, these effects have been demonstrated also in the case of weight stigma. A better understanding of how these processes occur and identification of potential targets for intervention to reduce resulting harms is of critical importance to public policy.Little is known about how the impact of weight stigma is transmitted, and even less on how the harms can be minimised. My PhD work focused predominantly on internalised weight stigma (IWS) - the phenomenon where higher-weight people devalue themselves because of their weight. IWS has been linked with a range of physical and psychological health problems, and unhelpful coping strategies such as disordered eating, avoidance of exercise, social isolation, and substance use. IWS is also an intermediary in many of the problems associated with experiencing stigma from others. However, we do not know why some people internalise societal stigma, others are largely unaffected, and some actively resist and challenge the stigma.During my PhD, I developed the first questionnaire to measure weight stigma resistance and demonstrated that resistance was associated with improved psychological wellbeing. I also drew on research from the mental health stigma literature and identified a number of key characteristics of internalisers and resisters. One important factor was whether the individual had a strong group identity - that is, whether they feel a sense of kinship and belonging with other higher-weight people. People with high group identity were less likely to internalise and more likely to resist. Another important factor was whether or not they felt that body weight was under individual control and simply a matter of willpower. Those who believed they could become slimmer tended not to resist stigma and were more likely to internalise it. But perhaps most interestingly, believing that stigma of higher-weight people was not justified helped to define resisters even if they didn't have high group identity and whether or not they felt their weight status was controllable. This means that it may be possible to develop health promotion interventions that take a social justice-based approach: that stigma is wrong whatever the circumstances and people deserve to be treated equally and with respect whatever their weight. Such an intervention may improve psychological wellbeing in higher-weight individuals regardless of their current beliefs and feelings about their weight.My goal is to pursue this avenue of research within academia. This fellowship would enhance my future applications for research funding and faculty positions in a number of ways. Two small studies would help me test the statistical properties of my stigma resistance measure, and would increase the likelihood that my resistance research will be published in a top journal where it would have a greater impact. Another study I would like to do would explore the relationship between both being stigmatised and observing other people being stigmatised on health, wellbeing, and use of unhealthy coping strategies in a large sample of medical students over the course of their training. I would also use the opportunity to build professional networks, disseminate my work more widely, enhance subject-specific knowledge, and acquire additional research, teaching, and other acadmic skills that would significantly strengthen my future career prospects and help me take the next steps toward an independent research career.