Avoiding exercise mediates the effects of internalized and experienced weight stigma on physical activity in the years following bariatric surgery

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Abstract

Background

People living with severe obesity report high levels of weight-related stigma. Theoretically, this stigma undermines weight loss efforts. The objective of this study is to test one proposed mechanism to explain why weight loss is so difficult once an individual becomes obese: that weight-related stigma inhibits physical activity via demotivation to exercise.

Methods

The study focused on individuals who had bariatric surgery within the past 5 years ( N = 298) and who report a post-surgical body mass index (BMI) ranging from 16 to 70. Exercise avoidance motivation (EAM) and physical activity (PA) were modeled as latent variables using structural equation modeling. Two measures of weight stigma, the Stigmatizing Situations Inventory (SSI) and the Weight Bias Internalization Scale (WBIS) were modified for people with a long history of extreme obesity for use as observed predictors.

Results

Exercise avoidance motivation (EAM) significantly mediated the association between both experienced (SSI) and internalized (WBIS) weight stigma and physical activity (PA) in this population.

Conclusion

Exercise avoidance motivation, influenced by weight stigma, may be a significant factor explaining the positive relationship between higher body weights with lower levels of physical activity.

Electronic supplementary material

The online version of this article (10.1186/s40608-018-0195-3) contains supplementary material, which is available to authorized users.

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Most cited references 48

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Physical Activity and Public Health: Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association

William Haskell, I-Min Lee, Russell R. Pate … (2007)

In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation. To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)]

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Social stigma and self-esteem: The self-protective properties of stigma.

Jennifer Crocker, Brenda Major (1989)

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Is Open Access

Long-term health benefits of physical activity – a systematic review of longitudinal studies

Miriam Reiner, Christina Niermann, Darko Jekauc … (2013)

Background The treatment of noncommunicable diseases (NCD), like coronary heart disease or type 2 diabetes mellitus, causes rising costs for the health system. Physical activity is supposed to reduce the risk for these diseases. Results of cross-sectional studies showed that physical activity is associated with better health, and that physical activity could prevent the development of these diseases. The purpose of this review is to summarize existing evidence for the long-term (>5 years) relationship between physical activity and weight gain, obesity, coronary heart disease, type 2 diabetes mellitus, Alzheimer’s disease and dementia. Methods Fifteen longitudinal studies with at least 5-year follow up times and a total of 288,724 subjects (>500 participants in each study), aged between 18 and 85 years, were identified using digital databases. Only studies published in English, about healthy adults at baseline, intentional physical activity and the listed NCDs were included. Results The results of these studies show that physical activity appears to have a positive long-term influence on all selected diseases. Conclusions This review revealed a paucity of long-term studies on the relationship between physical activity and the incidence of NCD.

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Author and article information

Contributors

SeungYong Han:

ORCID: http://orcid.org/0000-0002-8389-2766

shan32@asu.edu

Gina Agostini: gina.agostini@asu.edu

Alexandra A. Brewis: alex.brewis@asu.edu

Amber Wutich: amber.wutich@asu.edu

Journal

Journal ID (nlm-ta): BMC Obes

Journal ID (iso-abbrev): BMC Obes

Title: BMC obesity

Publisher: BioMed Central (London )

ISSN (Electronic): 2052-9538

Publication date (Electronic): 2 July 2018

Publication date PMC-release: 2 July 2018

Publication date Collection: 2018

Volume: 5

Electronic Location Identifier: 18

Affiliations

[1 ]Mayo Clinic/Arizona State University Obesity Solutions, 1000 Cady Mall Suite 164, Tempe, AZ 85287 USA

[2 ]ISNI 0000 0001 2151 2636, GRID grid.215654.1, School of Human Evolution and Social Change, Arizona State University, ; 900 Cady Mall, Tempe, AZ 85287 USA

Author information

SeungYong Han http://orcid.org/0000-0002-8389-2766

Article

Publisher ID: 195

DOI: 10.1186/s40608-018-0195-3

PMC ID: 6027738

PubMed ID: 29988619

SO-VID: a1b94db7-db98-4c2e-858f-47223858f736

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 26 January 2017

Date accepted : 2 May 2018

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Keywords: obesity,bariatric surgery,stigma,physical activity,exercise

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Keywords: obesity, bariatric surgery, stigma, physical activity, exercise

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Avoiding exercise mediates the effects of internalized and experienced weight stigma on physical activity in the years following bariatric surgery

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Most cited references 48

Physical Activity and Public Health: Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association

Social stigma and self-esteem: The self-protective properties of stigma.

Long-term health benefits of physical activity – a systematic review of longitudinal studies

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Cited by 17

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