Laboratory research has found that individuals will consume more calories and make unhealthy food choices when in the presence of an overweight individual, sometimes even regardless of what that individual is eating. This study expanded these laboratory paradigms to the field to examine how weight salience influences eating in the real world. More specifically, we tested the threshold of the effect of weight salience of food choice to see if a more subtle weight cue (e.g., images) would be sufficient to affect food choice. Attendees (N = 262) at Obesity Week 2013, a weight-salient environment, viewed slideshows containing an image of an overweight individual, an image of a thin individual, or no image (text only), and then selected from complimentary snacks. Results of ordinal logistic regression analysis showed that participants who viewed the image of the overweight individual had higher odds of selecting the higher calorie snack compared to those who viewed the image of the thin individual (OR = 1.77, 95% CI = [1.04, 3.04]), or no image (OR = 2.42, 95% CI = [1.29, 4.54]). Perceiver BMI category did not moderate the influence of image on food choice, as these results occurred regardless of participant BMI. These findings suggest that in the context of societal weight salience, weight-related cues alone may promote unhealthy eating in the general public.

Objective

Weight stigma adversely affects the health of the general population, but almost no studies have examined possible negative consequences of weight stigma in the context of pregnancy. The present study tested whether experiencing weight stigma in pregnancy is inversely related to mental and physical health in mothers during the first postpartum year.

Method

This study examined associations between weight-related experiences of discrimination in everyday life, measured at 1 month after the birth of a child, and physical and mental health outcomes measured concurrently and at 6 months and 1 year postpartum in a sample of 214 women in the Community Child Health Network study. Outcomes of interest were postpartum depressive symptoms, pregnancy weight gain, postpartum weight retention, and two biomarkers of maternal stress (blood pressure and salivary cortisol).

Results

After adjusting for covariates including race/ethnicity and prepregnancy body mass index, weight-related everyday discrimination was associated with greater postpartum depressive symptoms at 1 month postpartum. Weight-related everyday discrimination was also associated with greater pregnancy weight gain and greater weight gain in excess of the recommendations set by the Institute of Medicine. Additionally, weight-related discrimination prospectively predicted greater postpartum depressive symptoms and weight retention at 1 year postpartum. Weight-related everyday discrimination was not associated with blood pressure or cortisol.

Conclusions

These findings offer novel evidence that experiencing weight stigma during pregnancy and in the early postpartum period is prospectively associated with adverse mental and physical health outcomes for women after birth, implicating weight stigma as a potential maternal health threat. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background

Although there is substantial evidence of differential hypothalamic-pituitary-adrenal (HPA) axis activity in both generalized and abdominal obesity, consistent trends in obesity-related HPA axis perturbations have yet to be identified.

Objectives

To systematically review the existing literature on HPA activity in obesity, identify possible explanations for inconsistencies in the literature, and suggest methodological improvements for future study.

Data sources

Included papers used Pubmed, Google Scholar, and the University of California Library search engines with search terms body mass index (BMI), waist-to-hip ratio (WHR), waist circumference, sagittal diameter, abdominal versus peripheral body fat distribution, body fat percentage, DEXA, abdominal obesity, and cortisol with terms awakening response, slope, total daily output, reactivity, feedback sensitivity, long-term output, and 11β-HSD expression.

Study eligibility criteria

Empirical research papers were eligible provided that they included at least one type of obesity (general or abdominal), measured at least one relevant cortisol parameter, and a priori tested for a relationship between obesity and cortisol.

Results

A general pattern of findings emerged where greater abdominal fat is associated with greater responsivity of the HPA axis, reflected in morning awakening and acute stress reactivity, but some studies did show underresponsiveness. When examined in adipocytes, there is a clear upregulation of cortisol output (due to greater expression of 11β-HSD1), but in hepatic tissue this cortisol is downregulated. Overall obesity (BMI) appears to also be related to a hyperresponsive HPA axis in many but not all studies, such as when acute reactivity is examined.

Limitations

The reviewed literature contains numerous inconsistencies and contradictions in research methodologies, sample characteristics, and results, which partially precluded the development of clear and reliable patterns of dysregulation in each investigated cortisol parameter.

Conclusions and implications

The literature to date is inconclusive, which may well arise from differential effects of generalized obesity vs. abdominal obesity or from modulators such as sex, sex hormones, and chronic stress. While the relationship between obesity and adipocyte cortisol seems to be clear, further research is warranted to understand how adipocyte cortisol metabolism influences circulating cortisol levels and to establish consistent patterns of perturbations in adrenal cortisol activity in both generalized and abdominal obesity.