Ramos Salas Ximena, Forhan Mary, Caulfield Timothy, Sharma Arya M, Raine Kim D
Obesity Canada, University of Alberta, Edmonton, AB, Canada.
Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
Front Psychol. 2019 Jun 26;10:1409. doi: 10.3389/fpsyg.2019.01409. eCollection 2019.
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.
由于普遍存在的个人、职业、机构和文化层面的体重偏见，肥胖是一种受污名化的疾病。肥胖个体在其一生和各种环境中都会经历体重偏见，这会影响他们的生活机遇，并对健康和社会结果产生重大影响。本研究的目的是：（a）探索肥胖者的体重偏见和污名经历；（b）编写能够减少体重偏见和污名的反叙事故事；（c）反思当前关于肥胖的主流叙事，并确定个人、职业和社会变革的机会。我们采用目的抽样法，与10名肥胖者一起生活，并参与了一项关于体重偏见和肥胖污名的叙事探究。我们在应用三维叙事探究空间（a）时间性；（b）社会性；（c）地点时，共同编写了中期叙事记录，以在参与者的经历中寻找意义。我们还应用叙事修复模型共同创作反叙事故事，以抵制针对参与者以及一般肥胖者的压迫性主流叙事。我们呈现了10个反叙事故事，这些故事为体重偏见和肥胖污名发生的个人、家庭、职业和社会背景提供了一个窗口。参与者经历体重偏见的一个根本驱动因素是对肥胖缺乏了解，这可能导致内化的体重偏见和污名。体重偏见内化影响了参与者的情绪反应，并引发了羞耻、自责、脆弱、压力、抑郁甚至自杀念头和行为等情绪。参与者的故事揭示了一些行为反应，如回避促进健康的行为和社会孤立。体重偏见内化也阻碍了参与者的肥胖管理过程以及他们的康复和恢复策略。参与者通过培养自我同情和自我接纳，并积极努力抵制受损的社会身份，要求得到尊重、尊严和公平对待，从而从内化的体重偏见中走出来。叙事探究与叙事修复模型相结合，可能是解决肥胖者内化的体重偏见以及抵制受损社会身份的一种变革性方式。通过审视促成肥胖主流叙事的经历、信念、价值观、实践和关系，我们可以开始解决一些由社会和机构产生的对肥胖者的负面看法。
