Publications by authors named "Ximena Ramos Salas"

22 Publications

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Parental Perceptions of Children's Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017.

Obes Facts 2021 Nov 5:1-17. Epub 2021 Nov 5.

Observatory of Nutrition and Study of Obesity, Spanish Agency for Food Safety & Nutrition, Ministry of Health, Madrid, Spain.

Introduction: Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child's weight status. The purpose of this study was to measure parental perceptions of their child's weight status and to identify predictors of potential parental misperceptions.

Methods: We used data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative and 22 countries. Parents were asked to identify their perceptions of their children's weight status as "underweight," "normal weight," "a little overweight," or "extremely overweight." We categorized children's (6-9 years; n = 124,296) body mass index (BMI) as BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the distribution of children according to the WHO weight status classification, distribution by parental perception of child's weight status, percentages of accurate, overestimating, or underestimating perceptions, misclassification levels, and predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with overweight (including obesity). Statistical analyses were performed using Stata version 15 1.

Results: Overall, 64.1% of parents categorized their child's weight status accurately relative to the WHO growth charts. However, parents were more likely to underestimate their child's weight if the child had overweight (82.3%) or obesity (93.8%). Parents were more likely to underestimate their child's weight if the child was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28-1.55); the parent had a lower educational level (adjOR: 1.41; 95% CI: 1.26-1.57); the father was asked rather than the mother (adjOR: 1.14; 95% CI: 0.98-1.33); and the family lived in a rural area (adjOR: 1.10; 95% CI: 0.99-1.24). Overall, parents' BMI was not strongly associated with the underestimation of children's weight status, but there was a stronger association in some countries.

Discussion/conclusion: Our study supplements the current literature on factors that influence parental perceptions of their child's weight status. Public health interventions aimed at promoting healthy childhood growth and development should consider parents' knowledge and perceptions, as well as the sociocultural contexts in which children and families live.
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http://dx.doi.org/10.1159/000517586DOI Listing
November 2021

Closing obesity care gaps and achieving health equity for people living with obesity.

Eur J Intern Med 2021 09 2;91:1-2. Epub 2021 Jul 2.

Director of Research & Policy, Obesity Canada, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.ejim.2021.06.016DOI Listing
September 2021

Complexity and Stigma of Pediatric Obesity.

Child Obes 2021 06 29;17(4):229-240. Epub 2021 Mar 29.

Obesity Canada, University of Alberta, Edmonton, Alberta, Canada.

Weight stigma is rooted in a fundamental misunderstanding of the origins of obesity, wherein the interplay of behavioral, environmental, genetic, and metabolic factors is deemphasized. Instead, the widespread societal and cultural presence of weight stigma fosters misconceptions of obesity being solely a result of unhealthy personal choices. Weight stigma is pervasive in childhood and adolescence and can affect individuals throughout their life. Although the prevalence of pediatric obesity remains high throughout the world, it becomes increasingly important to understand how weight stigma affects weight and health outcomes in children and adolescents with overweight or obesity, including in those with rare genetic diseases of obesity. We identified and reviewed recent literature (primarily published since 2000) on weight stigma in the pediatric setting. Articles were identified with search terms including pediatric obesity, weight bias, weight stigma, weight-based teasing and bullying, and weight bias in health care. In this narrative review, we discuss the stigma of pediatric obesity as it relates to the complex etiology of obesity as well as describe best practices for avoiding bias and perpetuating stigma in the health care setting.
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http://dx.doi.org/10.1089/chi.2021.0003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8147499PMC
June 2021

L’obésité chez l’adulte : ligne directrice de pratique clinique.

CMAJ 2020 Dec;192(49):E1757-E1775

Départements de médecine (Wharton), endocrinologie et métabolisme (Poddar, Sherifali), médecine familiale (Naji, Tytus), et Health Research Methods, Evidence and Impact (HEI) Canada (Naji), Université McMaster; Clinique Wharton (Wharton, Poddar), Hamilton, Ont.; Départements: de médecine (Lau, Nerenberg) et médecine familiale (Boyling, Henderson, McInnes, Walji, Wicklum), École de médecine Cumming, Université de Calgary; Centre de recherche sur le diabète Julia McFarlane et Institut de cardiologie Libin de l'Alberta (Lau), Calgary, Alta.; Département de médecine familiale (Vallis, Piccinini-Vallis), Université Dalhousie, Halifax, N.-É; Départements de médecine (Sharma, Toth), médecine familiale (Campbell-Scherer, Kemp), agriculture, alimentation et science de la nutrition (Bell, Pereira), éducation physique et loisirs (Boulé), et ergothérapie (Forhan), Université de l'Alberta; Adult Bariatric Specialty Clinic (Sharma), Hôpital Royal Alexandra; Obésité Canada (Sharma, Patton, Ramos Salas), Edmonton, Alta.; Département de chirurgie (Biertho), Université Laval, Québec, Que.; École des sciences de l'activité physique (Adamo, Prud'homme), Université d'Ottawa, Ottawa, Ont.; Département de santé, kinésiologie et physiologie appliquée (Alberga), Université Concordia, Montréal, Que.; Centre d'Excellence en soins bariatriques(Brown), Hôpital d'Ottawa, Ottawa, Ont.; Départements de médecine familiale (Calam) et endocrinologie (Manjoo), Université de la Colombie-Britannique; Programme de résidence en pratique familiale de la UBC (Calam) et chaire de recherche en prévention des maladies cardiovasculaires Pfizer/Fondation des maladies du cœur et de l'AVC (Lear), Hôpital St. Paul, Vancouver, C.-B.; consultant en nutrition (Clarke), Hamilton, Ont.; Indigenous Health Dialogue (Crowshoe), Health Sciences Centre, Université de Calgary, Calgary, Alta.; Main East Medical Associates (Divalentino), Hamilton, Ont.; Bariatric Medical Institute (Freedhoff), Ottawa, Ont.; Département de médecine familiale (Freedhoff) et Division d'endocrinologie et métabolisme (Shiau), Département de médecine, Université d'Ottawa, Ottawa, Ont.; Herbert Wertheim School of medicine (Gagner), Florida International University, Miami, FL; Hôpital du Sacré-Cœur de Montréal (Gagner), Montréal, Que.; Humber River Hospital (Glazer), Toronto, Ont.; Division d'endocrinologie et métabolisme (Glazer), Université Queen's, Kingston, Ont.; Départements de médecine interne (Glazer), psychiatrie (Hawa, Sockalingam), médecine familiale et communautaire (Macklin), et des sciences de la nutrition (Sievenpiper), Université de Toronto, Toronto, Ont.; Services de santé de l'Alberta (Grand, Hung, Johnson-Stoklossa), Edmonton, Alta.; Départements de médecine familiale, et d'études sur les sciences et les politiques de santé publique (Green), Université Queen's; Centre des sciences de la santé de Kingston (Green); Providence Care Hospital (Green), Kingston, Ont.; Centre for Addiction and Mental Health (Hahn, Sockalingam); Réseau universitaire de santé (Hawa, Sockalingam), Toronto, Ont.; Division de chirurgie générale (Hong), Université McMaster, Hamilton, Ont.; Département de médecine familiale et de santé biocomportementale (Jacklin), Faculté de médecine de l'Université du Minnesota, campus Duluth, Duluth, Minn.; Faculté de kinésiologie et d'études sur la santé (Janssen), Université Queen's, Kingston, Ont.; École de santé et performance humaine (Kirk), Université Dalhousie, Halifax, N.-É; École de kinésiologie et de sciences de la santé (Wharton, Kuk), Université York, Toronto, Ont.; Division d'endocrinologie (Langlois), Université de Sherbrooke; Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (Langlois), Sherbrooke, Qc; École de kinésiologie (Lear), Université Simon Fraser, Vancouver, C.-B.; Medcan Clinic ( Macklin), Toronto, Ont.; Cardiometabolic Collaborative Clinic (Manjoo), Régie régionale de la santé de Vancouver, Victoria, C.-B.; Institut universitaire de cardiologie et de pneumologie de Québec (Morin, Poirier), Université Laval, Québec, Qc; Centre médical Foothills (Nerenberg); C-ENDO Diabetes & Endocrinology Clinic (Pedersen), Calgary, Alta.; LMC Diabetes and Endocrinology (Poddar), Toronto, Ont.; Département de médecine (Rueda-Clausen), Université de la Saskatchewan; Hôpital général de Regina (Rueda-Clausen), Regina, Sask.; Psychologie de l'éducation (Russell-Mayhew), Faculté d'éducation Werklund, Université de Calgary, Calgary, Alta.; LEAF Weight Management Clinic (Shiau), Ottawa, Ont.; Chaire de recherche en santé interprofessionnelle de l'Institut de recherche sur la santé des populations Heather M Arthur/Hamilton Health Sciences, Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Division d'endocrinologie et métabolisme (Sievenpiper), Hôpital St. Michael, Toronto, Ont.; Département de psychiatrie (Taylor), Université de Calgary, Calgary, Alta.; École de pharmacie (Twells), Université Memorial, St. John's, T.-N.-L.; Steelcity Medical Clinic (Tytus), Hamilton, Ont.; Calgary Weight Management Centre (Walji), Calgary, Alta.; École de santé des populations et de santé publique (Walker), Université de la Colombie-Britannique; Centre for Excellence in Indigenous Health (Walker), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de santé publique O'Brien (Wicklum), Université de Calgary, Calgary, Alta.

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http://dx.doi.org/10.1503/cmaj.191707-fDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721377PMC
December 2020

Obesity in adults: a clinical practice guideline.

CMAJ 2020 Aug;192(31):E875-E891

Departments of Medicine (Wharton), Endocrinology and Metabolism (Poddar, Sherifali), Family Medicine (Naji, Tytus) and Health Research Methods, Evidence and Impact Canada (Naji), McMaster University, Hamilton, Ont; The Wharton Medical Clinic (Wharton, Poddar), Hamilton, Ont.; Departments of Medicine (Lau, Nerenberg) and Family Medicine (Boyling, Henderson, McInnes, Walji, Wicklum), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Julia McFarlane Diabetes Research Centre and Libin Cardiovascular Institute of Alberta (Lau), Calgary, Alta.; Department of Family Medicine (Vallis, Piccinini-Vallis), Dalhousie University, Halifax, NS; Departments of Medicine (Sharma, Toth), Family Medicine (Campbell-Scherer, Kemp), Agricultural, Food and Nutritional Science (Bell, Pereira), Physical Education and Recreation (Boulé), and Occupational Therapy (Forhan), University of Alberta, Edmonton, Alta.; Adult Bariatric Specialty Clinic (Sharma), Royal Alexandra Hospital, Edmonton, Alta.; Obesity Canada (Sharma, Patton, Ramos Salas), Edmonton, Alta.; Department of Surgery (Biertho), Laval University, Quebec, Que.; School of Human Kinetics (Adamo, Prud'homme), University of Ottawa, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Alberga), Concordia University, Montréal, Que.; Bariatric Centre of Excellence (Brown), The Ottawa Hospital, Ottawa, Ont.; Departments of Family Practice (Calam) and Endocrinology (Manjoo), University of British Columbia, Vancouver, BC; UBC Family Practice Residency Program (Calam) and Pfizer/Heart and Stroke Foundation Chair in Cardiovascular Prevention Research (Lear), St. Paul's Hospital, Vancouver, BC; nutrition consultant (Clarke), Hamilton, Ont.; Indigenous Health Dialogue (Crowshoe), Health Sciences Centre, University of Calgary, Calgary, Alta.; Main East Medical Associates (Divalentino), Hamilton, Ont.; Bariatric Medical Institute (Freedhoff), Ottawa, Ont.; Department of Family Medicine (Freedhoff) and Division of Endocrinology and Metabolism (Shiau), Department of Medicine, University of Ottawa, Ottawa, Ont.; Herbert Wertheim School of Medicine (Gagner), Florida International University, Miami, Fla.; Hôpital du Sacre Coeur de Montréal (Gagner), Montréal, Que.; Humber River Hospital (Glazer), Toronto, Ont.; Division of Endocrinology and Metabolism (Glazer), Queen's University, Kingston, Ont.; Departments of Internal Medicine (Glazer), Psychiatry (Hawa, Sockalingam), Family and Community Medicine (Macklin) and Nutritional Sciences (Sievenpiper), University of Toronto, Toronto, Ont.; Alberta Health Services (Grand, Hung, Johnson-Stoklossa), Edmonton, Alta.; Departments of Family Medicine and Public Health Sciences and Policy Studies (Green), Queen's University, Kingston, Ont.; Kingston Health Sciences Centre (Green), Kingston, Ont.; Providence Care Hospital (Green), Kingston, Ont.; Centre for Addiction and Mental Health (Hahn, Sockalingam), Toronto, Ont.; University Health Network (Hawa, Sockalingam), Toronto, Ont.; Division of General Surgery (Hong), McMaster University, Hamilton, Ont.; Department of Family Medicine and Biobehavioral Health (Jacklin), University of Minnesota Medical School Duluth Campus, Duluth, Minn.; School of Kinesiology and Health Studies (Janssen), Queen's University, Kingston, Ont.; School of Health and Human Performance (Kirk), Dalhousie University, Halifax, NS; School of Kinesiology and Health Science (Wharton, Kuk), York University, Toronto, Ont.; Division of Endocrinology (Langlois), Université de Sherbrooke, Sherbrooke, Que.; Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (Langlois), Sherbrooke, Que.; School of Kinesiology (Lear), Simon Fraser University, Vancouver, BC; Medcan Clinic (Macklin), Toronto, Ont.; Cardiometabolic Collaborative Clinic (Manjoo), Vancouver Island Health Authority, Victoria, BC; Institut universitaire de cardiologie et de pneumologie de Québec (Morin, Poirier), Laval University, Québec, Que.; Foothills Medical Centre (Nerenberg), Calgary, Alta.; C-ENDO Diabetes & Endocrinology Clinic (Pedersen), Calgary, Alta.; LMC Diabetes and Endocrinology ( Poddar), Toronto, Ont.; Department of Medicine (Rueda-Clausen), University of Saskatchewan, Regina, Sask.; Regina General Hospital (Rueda-Clausen), Regina, Sask.; Education Psychology (Russell-Mayhew), Werklund School of Education, University of Calgary, Calgary, Alta.; LEAF Weight Management Clinic (Shiau), Ottawa, Ont.; Heather M. Arthur Population Health Research Institute/Hamilton Health Sciences Chair in Interprofessional Health Research, School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Division of Endocrinology & Metabolism (Sievenpiper), St. Michael's Hospital, Toronto, Ont.; Department of Psychiatry (Taylor), University of Calgary, Calgary, Alta.; School of Pharmacy (Twells), Memorial University, St. John's, NL; Steelcity Medical Clinic (Tytus), Hamilton, Ont.; Calgary Weight Management Centre (Walji), Calgary, Alta.; School of Population and Public Health (Walker), University of British Columbia, Vancouver, BC; Centre for Excellence in Indigenous Health (Walker), University of British Columbia, Vancouver, BC.; O'Brien Institute of Public Health (Wicklum), University of Calgary, Calgary, Alta.

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http://dx.doi.org/10.1503/cmaj.191707DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828878PMC
August 2020

Obesity and COVID-19: The Two Sides of the Coin.

Obes Facts 2020 13;13(4):430-438. Epub 2020 Jul 13.

European Association for the Study of Obesity (EASO), Teddington, United Kingdom.

The World Health Organization declared COVID-19, the infectious disease caused by the coronavirus SARS-CoV-2, a pandemic on March 12, 2020. COVID-19 is causing massive health problems and economic suffering around the world. The European Association for the Study of Obesity (EASO) promptly recognised the impact that the outbreak could have on people with obesity. On one side, emerging data suggest that obesity represents a risk factor for a more serious and complicated course of COVID-19 in adults. On the other side, the health emergency caused by the outbreak diverts attention from the prevention and care of non-communicable chronic diseases to communicable diseases. This might be particularly true for obesity, a chronic and relapsing disease frequently neglected and linked to significant bias and stigmatization. The Obesity Management Task Force (OMTF) of EASO contributes in this paper to highlighting the key aspects of these two sides of the coin and suggests some specific actions.
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http://dx.doi.org/10.1159/000510005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841065PMC
October 2020

Joint international consensus statement for ending stigma of obesity.

Nat Med 2020 04 4;26(4):485-497. Epub 2020 Mar 4.

Obesity Action Coalition, Tampa, FL, USA.

People with obesity commonly face a pervasive, resilient form of social stigma. They are often subject to discrimination in the workplace as well as in educational and healthcare settings. Research indicates that weight stigma can cause physical and psychological harm, and that affected individuals are less likely to receive adequate care. For these reasons, weight stigma damages health, undermines human and social rights, and is unacceptable in modern societies. To inform healthcare professionals, policymakers, and the public about this issue, a multidisciplinary group of international experts, including representatives of scientific organizations, reviewed available evidence on the causes and harms of weight stigma and, using a modified Delphi process, developed a joint consensus statement with recommendations to eliminate weight bias. Academic institutions, professional organizations, media, public-health authorities, and governments should encourage education about weight stigma to facilitate a new public narrative about obesity, coherent with modern scientific knowledge.
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http://dx.doi.org/10.1038/s41591-020-0803-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154011PMC
April 2020

Perceptions of barriers to effective obesity management in Canada: Results from the ACTION study.

Clin Obes 2019 Oct 11;9(5):e12329. Epub 2019 Jul 11.

Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

Obesity is a chronic disease with a significant and growing impact on Canadians. The "Awareness, Care and Treatment In Obesity MaNagement" (ACTION) Study investigated perceptions, attitudes and perceived barriers to obesity management among Canadian people with obesity (PwO), healthcare providers (HCPs) and employers. In this study adult PwO (body mass index ≥30 kg/m , based on self-reported height/weight), HCPs (physicians and allied HCPs managing PwO) and employers (≥20 employees; offering health insurance), completed online surveys between 3 August and 11 October 2017 in a cross-sectional design. Survey respondents (N = 2545) included 2000 PwO, 395 HCPs and 150 employers. Obesity was viewed as a "chronic medical condition" by most PwO (60%), HCPs (94%) and employers (71%) and deemed to have a large impact on overall health (74%, 78%, 81%, respectively). Many PwO (74%) believed weight management was their own responsibility. While PwO (55%) reportedly knew how to manage their weight, only 10% reported maintaining ≥10% weight reduction for >1 year. Despite low success rates, the most commonly reported effective long-term weight loss methods tried and/or recommended were "improvements in eating habits" (PwO 38%; HCP 63%) and "being more active" (PwO 39%; HCP 54%). PwO and HCPs reported very different perceptions of the quality and content of their interaction during obesity management discussions. These findings highlight the communication gaps and misunderstanding between PwO, HCPs and employers. This underscores the importance of, and need for, evidence-based management of obesity and a collaborative approach and understanding of the complex nature of this chronic disease.
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http://dx.doi.org/10.1111/cob.12329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6771494PMC
October 2019

Addressing Internalized Weight Bias and Changing Damaged Social Identities for People Living With Obesity.

Front Psychol 2019 26;10:1409. Epub 2019 Jun 26.

Obesity Canada, University of Alberta, Edmonton, AB, Canada.

Obesity is a stigmatized disease due to pervasive personal, professional, institutional, and cultural weight bias. Individuals with obesity experience weight bias across their lifespan and settings, which can affect their life chances and significantly impact health and social outcomes. The objectives of this study were to: (a) explore weight bias and stigma experiences of people living with obesity; (b) develop counterstories that can reduce weight bias and stigma; and (c) reflect on current obesity master narratives and identify opportunities for personal, professional, and social change. Using purposive sampling, we lived alongside and engaged persons with obesity ( = 10) in a narrative inquiry on weight bias and obesity stigma. We co-developed interim narrative accounts while applying the three-dimensional narrative inquiry space: (a) temporality; (b) sociality; and (c) place, to find meaning in participants' experiences. We also applied the narrative repair model to co-create counterstories to resist oppressive master narratives for participants and for people living with obesity in general. We present 10 counterstories, which provide a window into the personal, familial, professional, and social contexts in which weight bias and obesity stigma take place. A fundamental driver of participants' experiences with weight bias is a lack of understanding of obesity, which can lead to internalized weight bias and stigma. Weight bias internalization impacted participants' emotional responses and triggered feelings of shame, blame, vulnerability, stress, depression, and even suicidal thoughts and acts. Participants' stories revealed behavioral responses such as avoidance of health promoting behaviors and social isolation. Weight bias internalization also hindered participants' obesity management process as well as their rehabilitation and recovery strategies. Participants embraced recovery from internalized weight bias by developing self-compassion and self-acceptance and by actively engaging in efforts to resist damaged social identities and demanding respect, dignity, and fair treatment. Narrative inquiry combined with the narrative repair model can be a transformative way to address internalized weight bias and to resist damaged social identities for people living with obesity. By examining experiences, beliefs, values, practices, and relationships that contribute to dominant obesity narratives, we can begin to address some of the socially and institutionally generated negative views of individuals with obesity.
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http://dx.doi.org/10.3389/fpsyg.2019.01409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6606721PMC
June 2019

Obesity Prevention and Management Strategies in Canada: Shifting Paradigms and Putting People First.

Curr Obes Rep 2018 Jun;7(2):89-96

Canadian Obesity Network, University of Alberta, Li Ka Shing Building, Rm 2-126, 87th Avenue and 112th Street, Edmonton, AB, T6G 2E1, Canada.

Purpose Of Review: The purpose of this study was to review public and private sector obesity policies in Canada and to make recommendations for future evidence-based obesity prevention and management strategies.

Recent Findings: Synthesis of obesity prevention and management policies and research studies are presented in three primary themes: (1) Increased awareness about the impact of weight bias and obesity stigma in Canada; (2) Inadequate government obesity prevention and management policies and strategies; and (3) Lack of comprehensive private sector obesity prevention and management policies. Findings suggest that in Canada, obesity continues to be treated as a self-inflicted risk factor, which affects the type of interventions and approaches that are implemented by governments or covered by private health plans. The lack of recognition of obesity as a chronic disease by Canadian public and private payers, health systems, employers, and the public, has a trickle-down effect on access to evidence-based prevention and treatment. Although there is increasing recognition and awareness about the impact of weight bias and obesity stigma on the health and social well-being of Canadians, interventions are urgently needed in education, healthcare, and public policy sectors. We conclude by making recommendations for the advancement of evidence-based obesity prevention and management policies that can improve the lives of Canadians affected by obesity.
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http://dx.doi.org/10.1007/s13679-018-0309-8DOI Listing
June 2018

A critical analysis of obesity prevention policies and strategies.

Can J Public Health 2017 Sep 1;108(5-6):e598-e608. Epub 2017 Sep 1.

Centre for Health Promotion Studies, School of Public Health, University of Alberta, Edmonton, AB, Canada.

Objectives: Public health policies have been criticized for promoting a simplistic narrative that may contribute to weight bias. Weight bias can impact population health by increasing morbidity and mortality. The objectives of this study were to: 1 ) critically analyze Canadian obesity prevention policies and strategies to identify underlying dominant narratives; 2) deconstruct dominant narratives and consider the unintended consequences for people with obesity; and 3) make recommendations to change dominant obesity narratives that may be contributing to weight bias.

Methods: We applied Bacchi's "what's-the-problem-represented-to-be?" (WPR) approach to 15 obesity prevention policies and strategies (1 national, 2 territorial and 12 provincial). Bacchi's WPR approach is composed of six analytical questions designed to identify conceptual assumptions as well as possible effects of policies.

Results: We identified five prevailing narratives that may have implications for public health approaches and unintended consequences for people with obesity: 1 ) childhood obesity threatens the health of future generations and must be prevented; 2) obesity can be prevented through healthy eating and physical activity; 3) obesity is an individual behaviour problem; 4) achieving a healthy body weight should be a population health target; and 5) obesity is a risk factor for other chronic diseases, not a disease in itself.

Conclusion: The consistent way in which obesity is constructed in Canadian policies and strategies may be contributing to weight bias in our society. We provide some recommendations for changing these narratives to prevent further weight bias and obesity stigma.
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http://dx.doi.org/10.17269/CJPH.108.6044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6972457PMC
September 2017

Overweight and Obesity in Children under 5 Years: Surveillance Opportunities and Challenges for the WHO European Region.

Front Public Health 2017 13;5:58. Epub 2017 Apr 13.

Department of Nutrition, Physical Activity, and Obesity, European Region of World Health Organization, Copenhagen, Denmark.

Background: Many children who have overweight or obesity before puberty can develop obesity in early adulthood, which is associated with increased morbidity and mortality. The preschool years (ages 0-5) represents a point of opportunity for children to be active, develop healthy eating habits, and maintain healthy growth. Surveillance of childhood overweight and obesity in this age group can help inform future policies and interventions.

Objective: To review and report available prevalence data in WHO European Region Member States and determine how many countries can accurately report on rates of overweight and obesity in children under 5 years.

Methods: We conducted a rapid review of studies reporting on overweight and obesity prevalence in children ages 0-5 in the WHO European region member states from 1998 to 2015.

Results: Currently, 35 of the 53 member states have data providing prevalence rates for overweight and obesity for children under 5 years. There was little consistency in study methods, impacting comparability across countries. The prevalence of overweight and obesity in children under 5 years ranges from 1 to 28.6% across member states.

Conclusion: Although measuring overweight and obesity in this age group may be challenging, there is an opportunity to leverage existing surveillance resources in the WHO European Region.
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http://dx.doi.org/10.3389/fpubh.2017.00058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5389968PMC
April 2017

Future research in weight bias: What next?

Obesity (Silver Spring) 2016 06 30;24(6):1207-9. Epub 2016 Apr 30.

Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

The 2015 Canadian Weight Bias Summit disseminated the newest research advances and brought together 40 experts, stakeholders, and policy makers in various disciplines in health, education, and public policy to identify future research directions in weight bias. In this paper we aim to share the results of the Summit as well as encourage international and interdisciplinary research collaborations in weight bias reduction. Consensus emerged on six research areas that warrant further investigation in weight bias: costs, causes, measurement, qualitative research and lived experience, interventions, and learning from other models of discrimination. These discussions highlighted three key lessons that were informed by the Summit, namely: language matters, the voices of people living with obesity should be incorporated, and interdisciplinary stakeholders should be included.
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http://dx.doi.org/10.1002/oby.21480DOI Listing
June 2016

Potential Policies and Laws to Prohibit Weight Discrimination: Public Views from 4 Countries.

Milbank Q 2015 Dec;93(4):691-731

Canadian Obesity Network.

Context: People viewed as "overweight" or "obese" are vulnerable to weight-based discrimination, creating inequities and adverse health outcomes. Given the high rates of obesity recorded globally, studies documenting weight discrimination in multiple countries, and an absence of legislation to address this form of discrimination, research examining policy remedies across different countries is needed. Our study provides the first multinational examination of public support for policies and legislation to prohibit weight discrimination.

Methods: Identical online surveys were completed by 2,866 adults in the United States, Canada, Australia, and Iceland. We assessed public support for potential laws to prohibit weight-based discrimination, such as adding body weight to existing civil rights statutes, extending disability protections to persons with obesity, and instituting legal measures to prohibit employers from discriminating against employees because of body weight. We examined sociodemographic and weight-related characteristics predicting support for antidiscrimination policies, and the differences in these patterns across countries.

Findings: The majority of participants in the United States, Canada, and Australia agreed that their government should have specific laws in place to prohibit weight discrimination. At least two-thirds of the participants in all 4 countries expressed support for policies that would make it illegal for employers to refuse to hire, assign lower wages, deny promotions, or terminate qualified employees because of body weight. Women and participants with higher body weight expressed more support for antidiscrimination measures. Beliefs about the causes of obesity were also related to support for these laws.

Conclusions: Public support for legal measures to prohibit weight discrimination can be found in the United States, Canada, Australia, and Iceland, especially for laws to remedy this discrimination in employment. Our findings provide important information for policymakers and interest groups both nationally and internationally and can help guide discussions about policy priorities to reduce inequities resulting from weight discrimination.
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http://dx.doi.org/10.1111/1468-0009.12162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4678937PMC
December 2015

Potential Policies and Laws to Prohibit Weight Discrimination: Public Views from 4 Countries.

Milbank Q 2015 Dec;93(4):691-731

Canadian Obesity Network.

Context: People viewed as "overweight" or "obese" are vulnerable to weight-based discrimination, creating inequities and adverse health outcomes. Given the high rates of obesity recorded globally, studies documenting weight discrimination in multiple countries, and an absence of legislation to address this form of discrimination, research examining policy remedies across different countries is needed. Our study provides the first multinational examination of public support for policies and legislation to prohibit weight discrimination.

Methods: Identical online surveys were completed by 2,866 adults in the United States, Canada, Australia, and Iceland. We assessed public support for potential laws to prohibit weight-based discrimination, such as adding body weight to existing civil rights statutes, extending disability protections to persons with obesity, and instituting legal measures to prohibit employers from discriminating against employees because of body weight. We examined sociodemographic and weight-related characteristics predicting support for antidiscrimination policies, and the differences in these patterns across countries.

Findings: The majority of participants in the United States, Canada, and Australia agreed that their government should have specific laws in place to prohibit weight discrimination. At least two-thirds of the participants in all 4 countries expressed support for policies that would make it illegal for employers to refuse to hire, assign lower wages, deny promotions, or terminate qualified employees because of body weight. Women and participants with higher body weight expressed more support for antidiscrimination measures. Beliefs about the causes of obesity were also related to support for these laws.

Conclusions: Public support for legal measures to prohibit weight discrimination can be found in the United States, Canada, Australia, and Iceland, especially for laws to remedy this discrimination in employment. Our findings provide important information for policymakers and interest groups both nationally and internationally and can help guide discussions about policy priorities to reduce inequities resulting from weight discrimination.
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http://dx.doi.org/10.1111/1468-0009.12162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4678937PMC
December 2015

Inequities in healthcare: a review of bias and discrimination in obesity treatment.

Can J Diabetes 2013 Jun 29;37(3):205-9. Epub 2013 May 29.

University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada; Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall, Edmonton, Alberta, Canada. Electronic address:

This review is based on an exploration of the published literature over the past 20 years in the area of weight bias, stigma and discrimination and its association with obesity treatment. National and international obesity organizations have identified obesity stigma as a key barrier to effectively addressing the obesity epidemic and have called for theory driven interventions to reduce it. Both the Canadian Obesity Network (http://www.obesitynetwork.ca) and the Obesity Society (http://www.obesity.org) have strategic directions, mission statements and collaborations that strongly oppose weight bias and recognize the potential of such bias to negatively impact obesity treatment. Comprehensive reviews of the literature in the area of weight bias have been published and have subsequently raised awareness of the potential impact of weight bias and discrimination on the health and well-being of individuals living with obesity. The purpose of this review is to highlight drivers of weight bias and to discuss its impact on obesity treatment.
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http://dx.doi.org/10.1016/j.jcjd.2013.03.362DOI Listing
June 2013

Rehabilitation in bariatrics: opportunities for practice and research.

Disabil Rehabil 2010 ;32(11):952-9

Department of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.

Purpose: Obesity is associated with a wide range of chronic illnesses and disabilities familiar to rehabilitation researchers and practitioners. Obesity discourse in the area of rehabilitation science and practice is limited.

Method: A meeting of rehabilitation researchers, practitioners, industry and decision makers was held for the purpose of identifying research and practice priorities in the area of bariatric rehabilitation.

Results: Areas of common ground in terms of the identification of gaps in research, practice and knowledge about obesity in the context of rehabilitation science were identified. Participants developed a concept for a bariatric rehabilitation treatment and research institute. A commitment to embark on priority action items was made.

Conclusions: This article describes a process that successfully gathered a diverse group of researchers, clinicians, industries and decision makers for the purpose of collectively advancing the area of bariatric rehabilitation in Canada.
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http://dx.doi.org/10.3109/09638280903483885DOI Listing
July 2010
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