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Research article

Mapping changes in the obesity stigma discourse through Obesity Canada: a content analysis

  • Background 

    Stigmatization of persons living with obesity is an important public health issue. In 2015, Obesity Canada adopted person-first language in all internal documentation produced by the organization, and, from 2017, required all authors to use person-first language in abstract submissions to Obesity Canada hosted conferences. The impact of this intentional shift in strategic focus is not known. Therefore, the aim of this study was to conduct a content analysis of proceedings at conferences hosted by Obesity Canada to identify whether or how constructs related to weight bias and obesity stigma have changed over time.

    Methods 

    Of 1790 abstracts accepted to conferences between 2008–2019, we excluded 353 abstracts that featured animal or cellular models, leaving 1437 abstracts that were reviewed for the presence of five constructs of interest and if they changed over time: 1) use of person-first versus use of disease-first terminology, 2) incorporation of lived experience of obesity, 3) weight bias and stigma, 4) aggressive or alarmist framing and 5) obesity framed as a modifiable risk factor versus as a disease. We calculated and analyzed through linear regression: 1) the overall frequency of use of each construct over time as a proportion of the total number of abstracts reviewed, and 2) the ratio of abstracts where the construct appeared at least once based on the total number of abstracts.

    Results 

    We found a significant positive correlation between use of person-first language in abstracts and time (R2 = 0.51, p < 0.01 for frequency, R2 = 0.65, p < 0.05 for ratio) and a corresponding negative correlation for the use of disease-first terminology (R2 = 0.48, p = 0.01 for frequency, R2 = 0.75, p < 0.001 for ratio). There was a significant positive correlation between mentions of weight bias and time (R2 = 0.53 and 0.57, p < 0.01 for frequency and ratio respectively).

    Conclusion 

    Use of person-first language and attention to weight bias increased, while disease-first terminology decreased in accepted abstracts over the past 11 years since Obesity Canada began hosting conferences and particularly since more explicit actions for expectations to use person-first language were put in place in 2015 and 2017.

    Citation: Sara FL Kirk, Mary Forhan, Joshua Yusuf, Ashly Chance, Kathleen Burke, Nicole Blinn, Stephanie Quirke, Ximena Ramos Salas, Angela Alberga, Shelly Russell-Mayhew. Mapping changes in the obesity stigma discourse through Obesity Canada: a content analysis[J]. AIMS Public Health, 2022, 9(1): 41-52. doi: 10.3934/publichealth.2022004

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  • Background 

    Stigmatization of persons living with obesity is an important public health issue. In 2015, Obesity Canada adopted person-first language in all internal documentation produced by the organization, and, from 2017, required all authors to use person-first language in abstract submissions to Obesity Canada hosted conferences. The impact of this intentional shift in strategic focus is not known. Therefore, the aim of this study was to conduct a content analysis of proceedings at conferences hosted by Obesity Canada to identify whether or how constructs related to weight bias and obesity stigma have changed over time.

    Methods 

    Of 1790 abstracts accepted to conferences between 2008–2019, we excluded 353 abstracts that featured animal or cellular models, leaving 1437 abstracts that were reviewed for the presence of five constructs of interest and if they changed over time: 1) use of person-first versus use of disease-first terminology, 2) incorporation of lived experience of obesity, 3) weight bias and stigma, 4) aggressive or alarmist framing and 5) obesity framed as a modifiable risk factor versus as a disease. We calculated and analyzed through linear regression: 1) the overall frequency of use of each construct over time as a proportion of the total number of abstracts reviewed, and 2) the ratio of abstracts where the construct appeared at least once based on the total number of abstracts.

    Results 

    We found a significant positive correlation between use of person-first language in abstracts and time (R2 = 0.51, p < 0.01 for frequency, R2 = 0.65, p < 0.05 for ratio) and a corresponding negative correlation for the use of disease-first terminology (R2 = 0.48, p = 0.01 for frequency, R2 = 0.75, p < 0.001 for ratio). There was a significant positive correlation between mentions of weight bias and time (R2 = 0.53 and 0.57, p < 0.01 for frequency and ratio respectively).

    Conclusion 

    Use of person-first language and attention to weight bias increased, while disease-first terminology decreased in accepted abstracts over the past 11 years since Obesity Canada began hosting conferences and particularly since more explicit actions for expectations to use person-first language were put in place in 2015 and 2017.



    1. Introduction

    The involvement of the cerebellum in affective brain activity has been demonstrated by various approaches including clinical and behavioral studies and brain imaging, but it is still difficult to identify precisely the role that the cerebellum plays in emotional processing and behavior. In two papers [1,2] in this special issue, many examples showing the likely involvement of the cerebellum in emotion regulation are reviewed, but in most cases, the exact role of the cerebellum is difficult to explain. To proceed further toward answering the question posed in the title, I suggest the following two directions that should be explored.

    2. Two directions toward answering the question

    2.1. To clarify which area of the cerebellum specifically represents emotion

    The functional structure of the cerebellum devoted to motor function is hierarchically organized according to longitudinal zonal structures of the cerebellum [3]. Zones A (vermis) and B (paravermis) are devoted to the adaptive control of somatic reflexes, and zones C1-C3 (the intermediate parts of the cerebellar hemisphere) to the internal-model-assisted control of voluntary movements. Between zones D1 and D2 (the lateral parts of the cerebellar hemisphere), D1 is considered to be devoted to the control of motor actions (e.g., dancing, tool uses), whereas zone D2 (the most lateral part of the cerebellar hemisphere) is allocated to cognitive functions [4]. The thought process is a typical cognitive function, in which the prefrontal cortex manipulates ideas expressed in the cerebral parietal cortex. Zone D2 may support the thought process by providing an internal model of ideas, but how ideas are represented in the neural circuit is still unknown. With this longitudinal zonal organization map, one can comprehend that cerebellar lesions lead to not only motor control dysfunction but also cognitive syndromes; however, where is emotion represented likewise?

    Functional localization related to emotion has been shown for autonomic reflexes. In the vermis and flocculonodular lobe (parts of zones C1-C3), there are areas controlling cardiovascular homeostasis via the sympathetic nervous system [5]. In the first paper of this special issue [6], it is described that a discrete area of the cerebellar flocculus controls arterial blood flow associated with defense reactions. Lesions of the cerebellum at the flocculus, nodulus, and uvula impair these autonomic reflexes and their integrated functions, which will lead to impairment of physiological expressions of affective processes. The role of the cerebellum can be defined as the adaptive control of autonomic functions that support emotion regulation by a mechanism common to the adaptive control of motor functions.

    2.2. Neuropeptide-containing cerebellar afferents mediate mood control

    Mood impairment is a major clinical symptom associated with cerebellar diseases [7]. One may recall that some neuropeptides play a modulatory role in mood. For example, neuropeptide Y is involved in mood and anxiety disorders [8] and a decrease in its level is associated with an increased risk of suicide [9]. Corticotropin-releasing factor and galanin may also be involved in mood control as their antagonists exert antidepressant-like effects [10]. Recently, a number of neuropeptides have been shown to be substantially expressed in the cerebellum [11]. These neuropeptides are contained in beaded fibers, which project to the cerebellum diffusely and dispersedly [12]. This form of innervation is typical in neuromodulation [13], in which dispersed fibers do not convey information specific to individual fibers, but they govern the general activity of their target neurons as a whole. Thus, beaded fibers would switch the operational mode of their target neuronal circuit as a whole by neuromodulation.

    As explained in the first paper of this special issue [6], the orexinergic system functions in the organization of neural circuits for anger and defense behavior; this case may provide a prototype mechanism for selecting an emotional behavioral repertoire via neuromodulation. Each neuropeptide may activate a certain unique set of neuronal circuits selected through the spinal cord, brainstem, and cerebellum, which jointly represent a specific emotion and behavior. The selected cerebellar portion is expected to control selected autonomic reflexes and their integrated functions in the spinal cord and brainstem. This mechanism could be an answer to the question posed in the title of this special issue.

    Conflict of Interest

    The author declares to have no conflict of interest.


    Acknowledgments



    The authors thank Dawn Hatanaka and Nicole Pearce from Obesity Canada who collated the abstracts for review. The authors received no external funding for this work.

    Conflict of interests



    Dr. Mary Forhan is the current Scientific Director of Obesity Canada (May 2021). Her work on this paper was completed prior to taking up this role. Ximena Ramos Salas is an independent consultant and has received consulting fees from Obesity Canada, the European Association for the Study of Obesity and the World Health Organization Regional Office for Europe. The remaining authors declare no conflict of interest.

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