peers (93%) and friends (70%). However, 42% of surveyed youth indicated physical education teachers and coaches as sources of bias, while 37% and 27% indicated parents and teachers as perpetrators, respectively.67 Thus, youth may be vulnerable to weight victimization at school and at home. Lauder et al. 2006; Puhl & Brownell 2006; Puhl et al. 2011, 2013,Schumaker et al. 1985; Strauss & Pollack 2003; Zeller et al. 2008; Ali et al. 2012; Cawley et al. 2006; Eisenberg et al. 2011; Sutin et al. 2014 Part 2: Social Impact of Weight Bias 10 Participant Weight/Type of video watched Kilocalories consumed Overweight/Stigmatizing 302.8 Overweight/Neutral 89.0 Normal weight/Stigmatizing 170.4 Normal weight/Neutral 144.7 Part 2: Health Consequences of Weight Bias – Eating Behaviors Research with adults with overweight and obesity have documented the contribution of weight stigmatization to binge eating39,68-72 and immediate food consumption.66,73-75 In one study of 2400 adults with overweight and obesity, nearly 80% reported coping with weight bias by eating more food, while 75% reported refusing to diet.66 Furthermore, individuals who internalize the negative stereotypes report more frequent binge eating.34-39 Experiment Highlight In a 2011 experimental study,73 39 women who were either normal weight or with overweight watched a video with either weight stigmatizing or neutral content, and were then provided with snacks to eat ad libitum. Did you know… Experiences of weight bias and subsequent negative affect may elicit coping strategies involving unhealthy eating behaviors such as, · Increased food consumption · Binge eating · Refusal to diet Similarly, youth of all body weights who experience weight-based teasing are at an increased risk for having or later developing disordered eating behaviors (e.g., binge eating and emotional eating).76-82 Women with overweight who watched the stigmatizing video ate three times more kilocalories, compared to those who watched the video with neutral content 11 Part 2: Health Consequences of Weight Bias – Physical Activity Motivation for physical activity Self-efficacy for physical activity Levels of physical activity Adults who experience weight stigma, compared to those without such experiences, report,83 For youth, experiences of weight teasing negatively influence their attitudes toward and engagement in physical activity.84-89 One research study found that 84% of adolescents report witnessing their peers with overweight being teased during physical activity at school.59 In particular, adults with greater internalization of weight stigma report, 40-42 Less Desire for physical activity Lower Perceived competence for exercising Research Highlight In a study of 394 adolescents who had reported being teased about their weight during the past year,77 o Both boys and girls who felt more negative affect in response to teasing experiences were more likely to cope with teasing through avoidance of school activities, including avoiding participating in physical activities and going to gym class. 12 Part 2: Health Consequences of Weight Bias – Physiological Stress * Among adults reporting high waist-to-hip ratio Research has recently begun to substantiate the physiological effect of experiences of weight stigma. ↑ risk of cardiovascular disease, and metabolic & endocrine disorders Experiments have documented the effect of weight stigmatization on blood pressure90,91 and cortisol reactivity.92,93 In a 2014 experiment, 123 women viewed either a weight stigmatizing or neutral video.92 Findings showed that compared to the neutral video, the stigmatizing content elicited greater cortisol reactivity for women across the weight spectrum. Similar findings evidence the detrimental impact of stigma on C-reactive protein94 and glycemic control (indexed by HbA1C).95 Did you know… Discrimination based on weight may have a unique effect on physiology. In a nationally representative study of 7,394 adults with overweight and obesity,94 weight discrimination was associated with higher levels of circulating C-reactive protein. However, experiences of discrimination based on race and age were unrelated this physiological measure. 13 Part 2: Impact of Weight Bias on Obesity With implications of weight bias on health behaviors, recent studies have begun to examine obesity as outcomes of stigma. Among adults, research suggests a clear link between weight discrimination and obesity96,97 and weight gain96,98 over time. In a 2013 nationally representative study examining longitudinal outcomes of adults who reported experiencing different forms of discrimination,97 those who reported weight discrimination were 2.5 to 3 times more likely to become or remain obese, compared to adults who had not experienced such discrimination. Similarly for youth, weight teasing contributes to later overweight and obese. Especially for girls, those who were previously weight teased experienced an increased risk of 64-66% for overweight and obesity.99-101 Research Highlight In a second longitudinal study of 2,944 adults,96 people reporting perceived weight discrimination experienced o 6.67 times greater odds of becoming obese o Significant increases in weight by on average, 1.66 kg o Significant increases in waist circumference by on average, 1.12 cm 14 Part 2: Impact of Weight Bias on Weight Loss Weight stigma poses challenges in efforts to lose weight. Among patients seeking treatment for weight loss, preliminary evidence suggests that weight stigmatization may