Sánchez Enric, Elghazally Noha M, El-Sallamy Rania M, Ciudin Andreea, Sánchez-Bao Ana, Hashish Mohamed S, Barakat-Barakat Hosam, Gutiérrez-Medina Sonsoles, Valdés Nuria, Flores Lilliam, Marí-Sanchis Amelia, Goñi Fernando, Sánchez Marta, Nicolau Joana, Muñoz Concepción, Díaz-Trastoy Olaia, Cuatrecasas Guillem, Cañizares Silvia, Lecube Albert
Endocrinology and Nutrition Department, Obesity Unit, University Hospital Arnau de Vilanova de Lleida, Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University of Lleida, Lleida, Spain.
Faculty of Medicine, Tanta University, Tanta, Egypt.
Obes Facts. 2024;17(6):582-592. doi: 10.1159/000540635. Epub 2024 Aug 8.
This study explores the under-investigated area of obesity-related discrimination and stigmatization across different countries, specifically comparing Spain (Europe) and Egypt (Middle East).
We conducted a cross-sectional observational study involving 2,090 participants from both countries. Participants completed three well-validated questionnaires to assess their attitudes toward obesity, experiences of weight-related stigma, and internalization of weight bias: Antifat Attitudes Scale (AFA), Stigmatizing Situations Inventory (SSI), and Weight Bias Internalization Scale (WBIS). Participants were categorized into four groups based on body mass index (BMI) and history bariatric surgery.
Egyptian participants (BMI = 30.2 ± 6.7 kg/m2 [range: 18.5-69.0 kg/m2]) showed significantly higher aversion toward obesity, as indicated by higher AFA score, compared to their Spanish counterparts (BMI = 35.4 ± 10.1 kg/m2 [18.5-71.9 kg/m2]). In contrast, Spanish participants reported higher levels of weight bias internalization with increasing BMI, while in Egypt, this association was negative. The association of bariatric surgery on stigma reduction also differed between the countries. Multivariate analysis revealed that residing in Egypt was an independent risk factor for higher scores in AFA and WBIS (odds ratio 8.20 [95% confidence interval: 6.78-9.62], p < 0.001 and odds ratio (OR) 6.28 [95% CI: 4.78-7.78], p < 0.001, respectively). In contrast, Spaniards experienced more stigmatizing situations than Egyptians (OR -2.54 [95% CI: 6.78-9.62], p < 0.001).
Our study underscores the complex and diverse nature of obesity-related attitudes across cultures. Understanding these cultural differences is crucial for developing effective, culturally sensitive strategies to tackle weight stigma. This research opens avenues for further studies and interventions tailored to cultural contexts.
本研究探索了不同国家间肥胖相关歧视与污名化这一研究较少的领域，特别比较了西班牙（欧洲）和埃及（中东）。
我们开展了一项横断面观察性研究，涉及来自两国的2090名参与者。参与者完成了三份经过充分验证的问卷，以评估他们对肥胖的态度、与体重相关的污名经历以及体重偏见内化程度：反肥胖态度量表（AFA）、污名化情境量表（SSI）和体重偏见内化量表（WBIS）。参与者根据体重指数（BMI）和减肥手术史被分为四组。
埃及参与者（BMI = 30.2 ± 6.7 kg/m² [范围：18.5 - 69.0 kg/m²]）与西班牙参与者（BMI = 35.4 ± 10.1 kg/m² [18.5 - 71.9 kg/m²]）相比，AFA得分更高，表明对肥胖的厌恶程度显著更高。相比之下，西班牙参与者体重偏见内化程度随BMI增加而升高，而在埃及，这种关联呈负相关。减肥手术对减少污名的影响在两国之间也有所不同。多变量分析显示，居住在埃及是AFA和WBIS得分较高的独立危险因素（优势比8.20 [95%置信区间：6.78 - 9.62]，p < 0.001；优势比（OR）6.28 [95% CI：4.78 - 7.78]，p < 0.001）。相反，西班牙人比埃及人经历了更多的污名化情境（OR -2.54 [95% CI：6.78 - 9.62]，p < 0.001）。
我们的研究强调了跨文化背景下肥胖相关态度的复杂性和多样性。理解这些文化差异对于制定有效、具有文化敏感性的策略来应对体重污名至关重要。这项研究为进一步针对文化背景开展研究和干预开辟了道路。
