„To Tip the Scale“-Weight-related Discrimination and Consequences on the Treatment of Obesity.

The constantly rising prevalence of overweight and obesity requires intensive research not only in terms of physiological and medicinal aspects but also with regard to psychological factors that increase the burden associated with obesity and can hinder health maintenance or health improvements as suggested by previous studies. Work on weight discrimination among dietitians and nutritionists towards individuals with obesity and overweight was reviewed showing that, despite having knowledge about causation and consequences of obesity, health care professionals are not free of having negative attitudes towards individuals with obesity. Findings of empirical analyses revealed the impact of weight discrimination by general practitioners or internists while recommending bariatric surgery or referring patients with obesity to a surgeon, lowering the possibility for patients with obesity and associated comorbidities of gaining adequate health care services and sufficient obesity treatment. In a second study, the impact of weight discrimination on the desire to lose weight was investigated, demonstrating the pervasive effects of weight stigma on possible treatment outcomes or decision making with regard to obesity treatment. In conclusion, weight discrimination and stigmatization can be seen as having detrimental effects on individuals and therefore bias should be addressed especially within the health care setting to reduce stigma as being a barrier towards health and well-being. This work aims to reveal the consequences of weight-based stigmatization on the treatment of obesity from two different angles: the patient and the health care professional.:List of Figures IV Glossary of Terms V Bibliographic Description VI 1. Introduction - 1 - 1.1 The Psychosocial Side of Obesity - 1 - 1.2 Weight-based Stigmatization and Discrimination - 2 - 1.3 Obesity and Stigma within Health Care Settings - 8 - 2. Stigmatization in Health Care - A Literature-Based Analysis - 11 - 2.1 Dietitians and Nutritionists: Stigma in the Context of Obesity – A Systematic Review - 12 - 3. Quantitative Analyses based on the Current State of Research - 29 - 3.1 Weight-related Stigmatization as Determinant of Recommendation and Referral Behavior of Physicians - 31 - 3.2 Weight-related discrimination and desired body weight. - 42 - 4. Discussion - 57 - 4.1 Connecting Existing Literature to the Empirical Results - 58 - 4.2 Future Research on Weight Stigma and possible Implications - 62 - 4.3 Conclusion - 64 - Summary - 65 - References - 72 - Appendix - 80 - Appendix A - Declaration - 80