Atomic Weight, Molecular Weight, Formula Weight and Molar Mass
Why Weight? Science, Sgma, Health, Social Jusce &...
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Why Weight? Science, S.gma, Health, Social Jus.ce & Ethics September 14, 2018 NASW-MO Jefferson City MO
Transcript of Why Weight? Science, Sgma, Health, Social Jusce &...
WhyWeight?Science,S.gma,Health,SocialJus.ce&Ethics
September14,2018NASW-MO
JeffersonCityMO
Confirma?onBias
• Thetendencytoembraceinforma?onweagreewithandrejectinforma?onthatchallengesourbeliefs• Reflec?onoftheinfluenceofdesireonourbeliefs• Whatdowewanttobetrue?
OSFEDincludes:Atypicalanorexianervosa:Allofthecriteriaforanorexianervosaaremet,exceptthatdespitesignificantweightloss,theindividual'sweightiswithinorabovethenormalrange.
They are all “Disorders of the Pursuit of Weight
Loss”
DebBurgard
Myths
• Weightisdeterminedby“caloriesin,caloriesout”
• Weightiscontrollable
• Weightisameasureofhealth
• Healthcanbeimprovedwithweightloss
Evalua?ngResearch
• Lengthofstudy• Sizeandreten?onofpar?cipantgroup
• Defini?onof“success”and“significance”
• Unexaminedbias
Evalua?ngResearchcont.
• Informedconsent
• Conflictsofinterest• Correla?onvs.Causa?on• “Showmethedata!”
Determinantsofweight:Gene?cs
• Adop?onstudy,Stunkard,etal.,1986
• “Setpoint”Bennet&Gurin,1984
Determinantsofweight:Behaviors
• Biologicaladapta?onstomaintainsetpointwhenintakeisrestricted(Garner&Wooley,1991;Leibel,etal.,1995;Macpherson-Sánchez,2015;Ochner,etal.,2015;Sumithran,etal.,2011)
• Psychologicaladapta?onsincludeincreasedhunger,hypervigilanceconcerningfood(Keyes,1950)
Ajemptstochangetheenergybalance
• Restrictedintake• Increasedexercise• “Lifestylechanges”• Die?ngcanbedefinedasavoluntary,self-imposedfamine(Macpherson-Sánchez,2015)
WeightandHealth• Always-thinpeoplearenotcomparabletopreviously-fatpeople
• Noclearrela?onshipbetweenhealthandweightloss(Tomiyama,etal.,2013)
• MortalityrateslowestforBMI25-30“overweight”(Flegal,etal.,2013)
• “Normalweight”acutecoronarysyndromepa?entshadhighestmortalityrate(Angerasetal.,2013)
• S?gmaanddiscrimina?onplayarole(Ernsberger,2009;Lillis,etal.,2011;Schafer&Ferraro,2011;Su?n,etal.,2014;Su?n,etal.,2015)
WeightandHealthcon?nued• Psychologicaldistressandbodydissa?sfac?onareassociatedwithhighermetabolicabnormali?es(Becofsky,etal.,2015;Raikkonen,etal.,2002;Wirth,etal.,2014;Wirth,etal.,2015)• Cardiorespirtoryfitnessisabejerindicatorofhealth(Barry,etal.,2013;Blair&LaMonte,2006)
Tomiyama,J.,Hunger,J.,Nguyen-Cuu,J.,&Wells,C.(2016).Misclassifica?onofcardiometabolichealthwhenusingbodymassindexcategoriesinNHANES2005–2012.Interna(onalJournalof
Obesity.,1-4.• 30%of“normalweight”hadmetabolicabnormali?es
• 47%of“overweight”werecardiometabolicallyhealthy
• 29%of“obesetype1”werecardiometabolicallyhealthy
• 16%of“obesetype2and3”werecardiometabolicallyhealthy
UnintendedConsequences• Restric?veea?ngforweightcontrolisarobustpredictorofweightgain(Bacon&Aphramor,2011;Bacon,etal.,2005;Dulloo,etal.,2015;Kater,2010;Mann,etal.,2007;Siahpushetal.,2015;Tsai&Wadden,2005).
• Alsolinkedtodepression,disorderedea?ng(includingbingeea?ng),increasedbloodpressure,impairedinsulinresponse,increasedmortality,reducedself-esteem,andpoorhealthbehaviors(O'Hara&Gregg,2006;Pie?läinen,etal.,2012;Spear,2006;Tribole,2012).
UnintendedConsequencescont.
• Bodydissa?sfac?on,regardlessofsize,isassociatedwithpoorerhealthandhealthbehaviors(Bacon&Aphramor,2011;Muennig,2008;Saguy,2013)
• Unexaminedassump?onsaffectmedicalcare(Amy,etal.,2006;Aphramor,2012;deShazo,etal.,2015;Puhl&Brownell,2006
Weights.gmaandpsychosocialdistress
• ‘WhenboththeprevalenceofBD(bodydissa?sfac?on)andthedegreeofassociatedimpairmentareconsidered,itisapparentthatthereisaverysubstan?alpublichealthburdenofBDatthepopula?onlevel.Hence,thepresentfindingssuggestthatgreaterajen?onmayneedtobegiventoBDasapublichealthprobleminitsownright…Anaddi?onalimplica?onofthepresentfindingsisthatthefactthatdissa?sfac?onwithweightorshapeis“norma?ve”inindustrializedna?onsshouldnotbetakentoinferthatitisbenign.’(Mond,etal.,2013p.6)
WeightNeutralInterven?ons• Bejeroutcomesregardinghealthbehaviors,physiologicalmeasures,psychologicaloutcomes,self-esteem,ea?ngbehaviorsandpar?cipantreten?on(Bacon,etal.,2005;Bacon&Aphramor,2011;Blake,etal.,2013;Eisenberg,etal.,2013;Kater,etal.,2002;Kelly,etal.,2002;Neumark-Sztainer,2009;Neumark-Sztainer,Paxton,Hannan,Haines&Story,2006;Neumark-Sztainer,Wall,Guo,Story,Haines&Eisenberg,2006;Sonneville,etal.,2012;Tylka,etal.,2014)
Hazardra?oforall-causemortalitybybodymassindex(kg/m2)andnumberofhealthyhabits(i.e.,fruitsandvegetableintake,tobacco,exercise,alcohol).(Matheson,et.al.,2012.)
FollowtheMoney
• WeightCyclingIndustry
• Pharmaceu?cals
• Adver?sing• Editorialcontrol• Researchfundingandpublica?on
StealingOurSelfEsteemToSellItBackToUs
• Shame• Disorderedea?ng• Bodydissa?sfac?on• Poorerhealthbehaviors• Increasedanxietyinpeopleofallsizes
Medvedyuk,S.,Ali,A.,Raphael,D.(2017).Ideology,obesityandthesocialdeterminantsofhealth:acri?calanalysisoftheobesityandhealthrela?onship.Cri(calPublicHealth,1-13.
• “Thehealtheffectsofobesityareoverstated”• “Theemphasisonbehaviouralremediessetthestageforcon?nueds?gma?za?onandvic?mblamingwhenweightreduc?onregimensfail.”
• TheeffectofweightonhealthoutcomesisminimalwhencontrollingforSDHsuchassocialclass,genderorrace.
Medvedyukcont.
• An?-obesityperspec?vedistractsfromSDHandpublicpolicy
• An?-obesityperspec?ves?gma?zesindividuals,promo?ngautudesthatthreaten,ratherthanpromotehealth
• “Thebalancesheetisclear.Sincethean?-obesityperspec?vedoesmoreharmthangood,itshouldbeended.”
Mann,T.,Tomiyama,A.,Westling,E.,Lew,A.,Samuels,B.,&Chatman,J.(2007).Medicare'ssearchforeffec?veobesity
treatments:dietsarenottheanswer.TheAmericanPsychologist,62(3),220-233.
• Criteriaforevidencedbasedtreatment
• Sevenstudieswithcontrolgroupandatleastatwoyearfollowup;14observa?onalstudieswithatleastfouryearfollowup;Tenprospec?vestudieswithfouryearfollowup
• Foundmul?plemethodologicalproblems
Mannetal.,cont.• Weightlosswasnotmaintainedlongterm;claimsofhealthimprovementwereinconsistent
• Poten?alharmsofweightcyclingareconsiderable
• “Thebenefitsofdie?ngaresimplytoosmallandthepoten?alharmsofdie?ngaretoolargeforittoberecommendedasasafeandeffec?vetreatmentforobesity.”
Tylka,T.,Annunziato,R.,Burgard,D.,Danielsdour,S.,Shuman,E.,&Calogero,R.(2014).Theweight-inclusiveversusweight-norma?veapproachtohealth:
Evalua?ngtheevidenceforpriori?zingwell-beingoverweightloss.JournalofObesity,1-18.
• Focusonweightisassociatedwithadversephysicalandpsychologicaloutcomes
• Die?ngislinkedtopreventablebarrierstohealth• Theweightnorma?veapproachislinkedtoincreasedshame,blame,s?gma,anddecreasedwell-being
• “Theweightnorma?veapproachbecomesaself-perpetuateddogma”
Tylka,etal.,cont.• Bodyloathingandshameresultsindecreasedselfcare;peoplearemorelikelytoengageingoodselfcarewhentheyfeelposi?velytowardtheirbodies
• Weightneutralapproachesresultinimprovementinhealthbehaviorsaswellasphysicalandpsychologicalmeasures
• Weights?gmaisassociatedwithincreasedcaloricintake
• InternalizedweightbiasisnotrelatedtoBMI
• Publichealthmessagesto“maintainahealthyweight”areunfairanduninformed
Dollar,E.,Berman,M.,&Adachi-Mejia,A.M.(2017).DoNoHarm:MovingBeyondWeightLosstoEmphasizePhysicalAc?vityatEvery
Size.Preven(ngChronicDisease,14.
• CDCwebsite• Focusingonhealthybehaviorsinsteadofweightlosscandecreases?gma,improvehealthoutcomesandstrengthenpa?ent-providerrela?onships
• AcknowledgeSDH• “…thatawareness-raisingconversa?onsaboutbodyweightcandomoreharmthangood.”
Muennig,P.,Jia,H.,Lee,R.,&Lubetkin,E.(2008).IThinkThereforeIAm:PerceivedIdealWeightasaDeterminantofHealth.AmericanJournalofPublicHealth,98(3),501-506.
• Theassump?onthatbodyfatcauseshealthproblemsisnotwellsupportedbythedata
• Internalandexternals?gmacausechronicstress,whichisassociatedwithheartdisease,hypertension,hypercholesterolemiaanddiabetes
• Theamountofdiscrepancybetweenactualandidealbodyweightwasmorepredic?veofhealthproblemsindependentofBMI
Oliver,J.E.(2006).ThePoli?csofPathology:HowObesityBecameanEpidemicDisease.Perspec(vesinBiologyand
Medicine,49(4),611-627.
• Largelydrivenbyfinancialinterests• Ifobesityisa“disease”thenanytreatmentissubjecttoinsurancereimbursement–fromWLStoWeightWatcherstopharmaceu?cals
• Weight-lossproductsareforpeoplewhowanttolookthin,notforhealthconcerns
• Theideathatobesityisdeadlyjus?fiespromo?ngdrugswithdangeroussideeffects
• “Bodyweightisaninappropriatefocusofconcernfrombothahealthandpolicystandpoint.”(p.626)
EthicalConcerns• 1.01Commitmenttoclients• 1.02SelfDetermina?on• 1.03Informedconsent• 1.04Competence• 1.12Derogatorylanguage• 4.02Discrimina?on• 5.02Evalua?onandresearch• 6.01Socialwelfare• 6.04Socialandpoli?calac?on
TheHealthAtEverySize®Principlesare:
WeightInclusivity:Acceptandrespecttheinherentdiversityofbodyshapesandsizesandrejecttheidealizingorpathologizingofspecificweights.
HealthEnhancement:Supporthealthpoliciesthatimproveandequalizeaccesstoinforma.onandservices,andpersonalprac.cesthatimprovehumanwell-being,includingaNen.ontoindividualphysical,economic,social,spiritual,emo.onal,andotherneeds.
RespecPulCare:Acknowledgeourbiases,andworktoendweightdiscrimina.on,weights.gma,andweightbias.Provideinforma.onandservicesfromanunderstandingthatsocio-economicstatus,race,gender,sexualorienta.on,age,andotheriden..esimpactweights.gma,andsupportenvironmentsthataddresstheseinequi.es.
Ea.ngforWell-being:Promoteflexible,individualizedea.ngbasedonhunger,sa.ety,nutri.onalneeds,andpleasure,ratherthananyexternallyregulatedea.ngplanfocusedonweightcontrol.
Life-EnhancingMovement:Supportphysicalac.vi.esthatallowpeopleofallsizes,abili.es,andintereststoengageinenjoyablemovement,tothedegreethattheychoose.
FromhNps://www.sizediversityandhealth.org
WhatToDo?
• Assessment• Interven?on• Policy• Consciousnessraising
SelfEsteemandSelfDetermina?on
• Educa?on• Internalandexternallocusofcontrol• Messageaboutourownworth
• Adequatenutri?onisessen?al
Evalua?ngResources• Isthefocusonbehaviorchangeorweightloss?• Doesitpromiseweightloss?
• Doesitequateweightlosswithimprovedhealth?
• DoesitencouragedecisionmakingbasedonaninternalLOC?
• Whatisitselling?
• Doesitacknowledgesocialdeterminants?
OnlineResources• neomsw.com
• Dr.NEOonFacebook• Associa?onforSizeDiversityandHealth
• haescommunity.com
• jonrobison.net• fitwoman.com
JeanneCourtneycapturedthedifferencesbetweentheHAESparadigmandtheWCHPinthisreinterpreta?onofthelightbulbjoke(Courtney,2010):Howmanyweightlossexpertsdoesittaketoscrewinalightbulb?Three.Onetostandontheladderandkeeptryingtoscrewaburnedoutbulbintosocketthatdoesn’tfit,onetostandundertheladderandtellhimhe’sdoingagreatjob,andonetowriteapressreleasedeclaringthatthethreeofthemhavediscoveredarevolu?onary,completelysafeandeffec?venewwaytoscrewinlightbulbs.HowmanyHealthatEverySizeexpertsdoesittaketoscrewinalightbulb?Thelightbulbisfine,thesocketisfine,theswitchison,andtheroomisbrightlylit,butits?lltakesseveraldozenHealthatEverySizeexperts,withimpeccableacademiccreden?als,topublishindependentstudiesprovingthatthereisnoneedtochangethebulb.Andthosethreeguyswiththeladders?llwon’tgoaway.
O’Hara,L.,&Taylor,J.(2018).What’sWrongWiththe‘WaronObesity?’ANarra?veReviewoftheWeight-CenteredHealthParadigmandDevelopmentofthe3C
FrameworktoBuildCri?calCompetencyforaParadigmShiv.SAGEOpen,8(2),1-28.
PreambleTheprimarymissionofthesocialworkprofessionistoenhancehumanwell-beingandhelpmeetthebasichumanneedsofallpeople,withpar?cularajen?ontotheneedsandempowermentofpeoplewhoarevulnerable,oppressed,andlivinginpoverty.Ahistoricanddefiningfeatureofsocialworkistheprofession'sdualfocusonindividualwell-beinginasocialcontextandthewell-beingofsociety.Fundamentaltosocialworkisajen?ontotheenvironmentalforcesthatcreate,contributeto,andaddressproblemsinliving.
Socialworkerspromotesocialjus?ceandsocialchangewithandonbehalfofclients."Clients"isusedinclusivelytorefertoindividuals,families,groups,organiza?ons,andcommuni?es.Socialworkersaresensi?vetoculturalandethnicdiversityandstrivetoenddiscrimina?on,oppression,poverty,andotherformsofsocialinjus?ce.Theseac?vi?esmaybeintheformofdirectprac?ce,communityorganizing,supervision,consulta?on,administra?on,advocacy,socialandpoli?calac?on,policydevelopmentandimplementa?on,educa?on,andresearchandevalua?on.Socialworkersseektoenhancethecapacityofpeopletoaddresstheirownneeds.Socialworkersalsoseektopromotetheresponsivenessoforganiza?ons,communi?es,andothersocialins?tu?onstoindividuals'needsandsocialproblems.
PrinciplesThemissionofthesocialworkprofessionisrootedinasetofcorevalues.Thesecorevalues,embracedbysocialworkersthroughouttheprofession'shistory,arethefounda?onofsocialwork'suniquepurposeandperspec?ve:-service-socialjus?ce-dignityandworthoftheperson-importanceofhumanrela?onships-integrity-competence.
1.01CommitmenttoClientsSocialworkers'primaryresponsibilityistopromotethewell-beingofclients.Ingeneral,clients'interestsareprimary.However,socialworkers'responsibilitytothelargersocietyorspecificlegalobliga?onsmayonlimitedoccasionssupersedetheloyaltyowedclients,andclientsshouldbesoadvised.(Examplesincludewhenasocialworkerisrequiredbylawtoreportthataclienthasabusedachildorhasthreatenedtoharmselforothers.)
1.02Self-Determina?onSocialworkersrespectandpromotetherightofclientstoself-determina?onandassistclientsintheireffortstoiden?fyandclarifytheirgoals.Socialworkersmaylimitclients’righttoself-determina?onwhen,inthesocialworkers'professionaljudgment,clients’ac?onsorpoten?alac?onsposeaserious,foreseeable,andimminentrisktothemselvesorothers.
1.03InformedConsent(a)Socialworkersshouldprovideservicestoclientsonlyinthecontextofaprofessionalrela?onshipbased,whenappropriate,onvalidinformedconsent.Socialworkersshoulduseclearandunderstandablelanguagetoinformclientsofthepurposeoftheservices,risksrelatedtotheservices,limitstoservicesbecauseoftherequirementsofathird-partypayer,relevantcosts,reasonablealterna?ves,clients'righttorefuseorwithdrawconsent,andthe?meframecoveredbytheconsent.Socialworkersshouldprovideclientswithanopportunitytoaskques?ons.
1.04Competence(a)Socialworkersshouldprovideservicesandrepresentthemselvesascompetentonlywithintheboundariesoftheireduca?on,training,license,cer?fica?on,consulta?onreceived,supervisedexperience,orotherrelevantprofessionalexperience.(b)Socialworkersshouldprovideservicesinsubstan?veareasoruseinterven?ontechniquesorapproachesthatarenewtothemonlyaverengaginginappropriatestudy,training,consulta?on,andsupervisionfrompeoplewhoarecompetentinthoseinterven?onsortechniques.(c)Whengenerallyrecognizedstandardsdonotexistwithrespecttoanemergingareaofprac?ce,socialworkersshouldexercisecarefuljudgmentandtakeresponsiblesteps(includingappropriateeduca?on,research,training,consulta?on,andsupervision)toensurethecompetenceoftheirworkandtoprotectclientsfromharm.
1.05CulturalCompetenceandSocialDiversity(a)Socialworkersshouldunderstandcultureanditsfunc?oninhumanbehaviorandsociety,recognizingthestrengthsthatexistinallcultures.(b)Socialworkersshouldhaveaknowledgebaseoftheirclients'culturesandbeabletodemonstratecompetenceintheprovisionofservicesthataresensi?vetoclients'culturesandtodifferencesamongpeopleandculturalgroups.(c)Socialworkersshouldobtaineduca?onaboutandseektounderstandthenatureofsocialdiversityandoppressionwithrespecttorace,ethnicity,na?onalorigin,color,sex,sexualorienta?on,age,maritalstatus,poli?calbelief,religion,immigra?onstatus,andmentalorphysicaldisability.
1.12DerogatoryLanguageSocialworkersshouldnotusederogatorylanguageintheirwrijen,verbal,orelectroniccommunica?onstooraboutclients.Socialworkersshoulduseaccurateandrespecxullanguageinallcommunica?onstoandaboutclients.
2.03InterdisciplinaryCollabora?on(a)Socialworkerswhoaremembersofaninterdisciplinaryteamshouldpar?cipateinandcontributetodecisionsthataffectthewell-beingofclientsbydrawingontheperspec?ves,values,andexperiencesofthesocialworkprofession.Professionalandethicalobliga?onsoftheinterdisciplinaryteamasawholeandofitsindividualmembersshouldbeclearlyestablished.(b)Socialworkersforwhomateamdecisionraisesethicalconcernsshouldajempttoresolvethedisagreementthroughappropriatechannels.Ifthedisagreementcannotberesolved,socialworkersshouldpursueotheravenuestoaddresstheirconcernsconsistentwithclientwell-being.
4.01Competence(a)Socialworkersshouldacceptresponsibilityoremploymentonlyonthebasisofexis?ngcompetenceortheinten?ontoacquirethenecessarycompetence.(b)Socialworkersshouldstrivetobecomeandremainproficientinprofessionalprac?ceandtheperformanceofprofessionalfunc?ons.Socialworkersshouldcri?callyexamineandkeepcurrentwithemergingknowledgerelevanttosocialwork.Socialworkersshouldrou?nelyreviewtheprofessionalliteratureandpar?cipateincon?nuingeduca?onrelevanttosocialworkprac?ceandsocialworkethics.(c)Socialworkersshouldbaseprac?ceonrecognizedknowledge,includingempiricallybasedknowledge,relevanttosocialworkandsocialworkethics.
4.02Discrimina?onSocialworkersshouldnotprac?ce,condone,facilitate,orcollaboratewithanyformofdiscrimina?ononthebasisofrace,ethnicity,na?onalorigin,color,sex,sexualorienta?on,genderiden?tyorexpression,age,maritalstatus,poli?calbelief,religion,immigra?onstatus,ormentalorphysicalability.
5.01IntegrityoftheProfession(a)Socialworkersshouldworktowardthemaintenanceandpromo?onofhighstandardsofprac?ce.(b)Socialworkersshouldupholdandadvancethevalues,ethics,knowledge,andmissionoftheprofession.Socialworkersshouldprotect,enhance,andimprovetheintegrityoftheprofessionthroughappropriatestudyandresearch,ac?vediscussion,andresponsiblecri?cismoftheprofession.(c)Socialworkersshouldcontribute?meandprofessionalexper?setoac?vi?esthatpromoterespectforthevalue,integrity,andcompetenceofthesocialworkprofession.Theseac?vi?esmayincludeteaching,research,consulta?on,service,legisla?vetes?mony,presenta?onsinthecommunity,andpar?cipa?onintheirprofessionalorganiza?ons.(d)Socialworkersshouldcontributetotheknowledgebaseofsocialworkandsharewithcolleaguestheirknowledgerelatedtoprac?ce,research,andethics.Socialworkersshouldseektocontributetotheprofession'sliteratureandtosharetheirknowledgeatprofessionalmee?ngsandconferences.
5.02Evalua?onandResearch(a)Socialworkersshouldmonitorandevaluatepolicies,theimplementa?onofprograms,andprac?ceinterven?ons.(b)Socialworkersshouldpromoteandfacilitateevalua?onandresearchtocontributetothedevelopmentofknowledge.(c)Socialworkersshouldcri?callyexamineandkeepcurrentwithemergingknowledgerelevanttosocialworkandfullyuseevalua?onandresearchevidenceintheirprofessionalprac?ce.
6.01SocialWelfareSocialworkersshouldpromotethegeneralwelfareofsociety,fromlocaltogloballevels,andthedevelopmentofpeople,theircommuni?es,andtheirenvironments.Socialworkersshouldadvocateforlivingcondi?onsconducivetothefulfillmentofbasichumanneedsandshouldpromotesocial,economic,poli?cal,andculturalvaluesandins?tu?onsthatarecompa?blewiththerealiza?onofsocialjus?ce.
6.02PublicPar?cipa?onSocialworkersshouldfacilitateinformedpar?cipa?onbythepublicinshapingsocialpoliciesandins?tu?ons.
6.04SocialandPoli?calAc?on(a)Socialworkersshouldengageinsocialandpoli?calac?onthatseekstoensurethatallpeoplehaveequalaccesstotheresources,employment,services,andopportuni?estheyrequiretomeettheirbasichumanneedsandtodevelopfully.Socialworkersshouldbeawareoftheimpactofthepoli?calarenaonprac?ceandshouldadvocateforchangesinpolicyandlegisla?ontoimprovesocialcondi?onstomeetbasichumanneedsandpromotesocialjus?ce.(b)Socialworkersshouldacttoexpandchoiceandopportunityforallpeople,withspecialregardforvulnerable,disadvantaged,oppressed,andexploitedpeopleandgroups.
(c)Socialworkersshouldpromotecondi?onsthatencouragerespectforculturalandsocialdiversitywithintheUnitedStatesandglobally.Socialworkersshouldpromotepoliciesandprac?cesthatdemonstraterespectfordifference,supporttheexpansionofculturalknowledgeandresources,advocateforprogramsandins?tu?onsthatdemonstrateculturalcompetence,andpromotepoliciesthatsafeguardtherightsofandconfirmequityandsocialjus?ceforallpeople.(d)Socialworkersshouldacttopreventandeliminatedomina?onof,exploita?onof,anddiscrimina?onagainstanyperson,group,orclassonthebasisofrace,ethnicity,na?onalorigin,color,sex,sexualorienta?on,genderiden?tyorexpression,age,maritalstatus,poli?calbelief,religion,immigra?onstatus,ormentalorphysicalability.
SocialJus?ce
• Jus?ceintermsofthedistribu?onofwealth,opportuni?es,andprivilegeswithinasociety
• Thewayinwhichhumanrightsaremanifestedintheeverydaylivesofpeopleateverylevelofsociety
• Promo?ngtolerance,freedom,andequalityforallpeopleregardlessofrace,sex,orienta?on,na?onalorigin,handicap,etc...
NASWdefini?onofSocialJus?ce
• “Socialjus?ceistheviewthateveryonedeservesequaleconomic,poli?calandsocialrightsandopportuni?es.Socialworkersaimtoopenthedoorsofaccessandopportunityforeveryone,par?cularlythoseingreatestneed.”
• “Indeed,fromthebeginningoftheirprofession,socialworkershavebeeninvolvedin“connec?ngthedots”betweenpeaceandsocialjus?ce”
TheSocialWorkDic?onary
• “Anidealcondi?oninwhichallmembersofasocietyhavethesamebasicrights,protec?on,opportuni?es,obliga?ons,andsocialbenefits.Implicitinthisconceptistheno?onthathistoricalinequali?esshouldbeacknowledgedandremediedthroughspecificmeasures.Akeysocialworkvalue,socialjus?ceentailsadvocacytoconfrontdiscrimina?on,oppressionandinstruc?onalinequi?es.”p.405
S?gma
• amarkofdisgraceassociatedwithapar?cularcircumstance,quality,orperson
• asetofnega?veandovenunfairbeliefs• astrongfeelingofdisapprovalsharedbyothersinsociety
• Anassocia?onofdisgraceorpublicdisapprovalwithsomething,suchasanac?onorcondi?on
Bias
• atendencytobelievethatsomepeople,ideas,etc.,arebejerthanothers
• prejudiceinfavoroforagainstonething,person,orgroupcomparedwithanother,usuallyinawayconsideredtobeunfair
• astronginclina?onofthemindorapreconceivedopinionaboutsomethingorsomeone
Stereotype
• Anexaggeratedbeliefaboutpeoplebasedontheirmembershipinagroup
• Servesasjus?fica?onforhowtheyaretreated• Supportedbythecultureandthemedia
Prejudice
• preconceivedopinionthatisnotbasedonreasonoractualexperience
• anirra?onalautudeofhos?litydirectedagainstanindividual,agroup,arace,ortheirsupposedcharacteris?cs
• theLa?npraejudiciummeans"judgmentinadvance.”
• Unreasonabledislikeordistrustofsomeonedifferentfromyou
Discrimina?on
• Anyformofgroup-basednega?vetreatment• Preconceivednega?vejudgmentbasedonaperson’smembershipinacertaingroup
• Otherdefini?onsspecifythattheharmfulac?onisunjus?fiedorrepresentssomeformofinjus?ce
Oppression
• prolongedcruelorunjusttreatmentorcontrol.• thestateofbeingsubjecttounjusttreatmentorcontrol.
• mentalpressureordistress.• unjustorcruelexerciseofauthorityorpower• Socialoppressionisthesociallysupportedmistreatmentandexploita?onofagroupofindividuals.Socialoppressionisbasedonpowerdynamics,andanindividual'ssocialloca?oninsociety
Microaggression
• asubtlebutoffensivecommentorac?ondirectedataminorityorothernondominantgroupthatisovenuninten?onalorunconsciouslyreinforcesastereotype
• behaviorsorstatementsthatdonotnecessarilyreflectmaliciousintentbutwhichneverthelesscaninflictinsultorinjury
• Insults,assaults,invalida?ons
WeightS?gma
• Internalorexternal• Implicitorexplicit
• Thedevalua?onoflargebodies• Fatphobia• Bodydissa?sfac?on• Anythingshamingoroppressingcontributestotheproblem
Tomiyama,et.al.,2018
“Wedefineweights.gmaasthesocialrejec.onanddevalua.onthataccruestothosewhodonotcomplywithprevailingsocialnormsofadequatebodyweightandshape.”
WeightCenteredHealthParadigm(WCHP)
• Weightnorma?ve
• Weightcentered
• Weightcentric
• Weightconversion
• Weightcorrec?on
HealthJus?ce
• Weightneutral• Weightinclusive
• Health-centric• Afocusonwell-being• Acknowledgessocialdeterminantsofhealth
"Healthisnotastateweowetheworld.Wearenotlessvaluable,worthy,orloveablebecausewearenothealthy."p.21
Taylor,S.R.(2018).Thebodyisnotanapology:Thepowerofradicalself-love.
Oakland,CA:Berrej-Koehler.
Calogero,R.M.,Tylka,T.L.,&Mensinger,J.L.(2016).Scien?ficWeigh?sm:AViewofMainstreamWeightS?gmaResearchThroughaFeministLens.FeministPerspec(veson
BuildingaBeQerPsychologicalScienceofGender,9-28.• Mainstreamweights?gmaresearchissaturatedwithan?-fatbiasands?gma?zingdiscoursesignoringthelivedperspec?veoffatpeople
• Discrimina?ontowardsfatpeopleislikelytobepubliclysanc?oned,evenwhenopenlyhos?le
• Thescien?ficliteratureonweights?gmaisastructuralformofs?gma
• Someresearchersbelievethatencouragingposi?vebodyimage,whichencouragesselfcare,isproblemforwomenwho“should”bedie?nginstead
Calogero,et.al.,cont
• ‘Relatedly,publichealthmessagesto“maintainahealthyweight”arebothuninformedandunfairastheyimplythatbodyweightismalleablethroughsheerwillorvoluntaryac?on.’(p.7)
• Thebeliefthatweightiscontrollablecontributestos?gma
• Whentheliteraturefocusesonthes?gma?zedtarget,thes?gma?zingagentisinvisibleandunaccountable
Saleebey,D.(1992).Biology'sChallengetoSocialWork:EmbodyingthePerson-in-EnvironmentPerspec?ve.SocialWork,37(2),112-118.• Goodnessoffit–whatadapts?• Ourknowledgebasemustberootedintherealitythatbiologyandsocietyexistincon?nuinginterac?onineveryone
• Socialworkersstriveforamorefunc?onalintegra?onofmindandbodynestledmorefirmlyinsocialcontexts
• Weshouldnotbecome,ashelpers,partofthemechanicsandmetaphorsofoppression
“Aculturefixatedonfemalethinnessisnotanobsessionaboutfemalebeauty,butanobsessionaboutfemaleobedience.Die?ngisthemostpotentpoli?calseda?veinwomen’shistory;aquietlymadpopula?onisatractableone.”NaomiWolf,1990
(media)"hasbecomeaneconomicjuggernautforthestructureofglobalcapitalismtogeneratewealthoffourbodyshame....theglobalBody-ShameProfitComplex(BSPC)."p.39
"Bodyshameflourishesinourworldbecauseprofitand
powerdependonit."p.50
Taylor,S.R.(2018).Thebodyisnotanapology:Thepowerofradicalself-love.Oakland,CA:Berrej-Koehler.
WeightandIncome
• Fatnessandincomearehighlycorrelated• Povertymaybefajeningbutastrongercasecanbemadethatfatnessisimpoverishing
• Fatpeoplearelesslikelytobehired,arepaidless,moreharshlydisciplinedandmaybefiredfornotlosingweight
Hartline-Gravon,H.(2011).FoodInsecurityandObesity:UnderstandingtheConnec?ons.Retrievedfromhjps://www.nbcdi.org/food-insecurity-and-
obesity-understanding-connec?ons• Limitedaccesstofoodvariety• Processed,energydensefoodscanstretchthebudget• Physicalac?vityislesssafeinpoorneighborhoods• Fooddepriva?onleadstooverea?ngandmetabolicchangesthatpromotefatstorage
• Foodinsecurityincreasesstress,whichisassociatedwithweightgain
• Lowincomepeoplehavelessaccesstohealthcare
"Ourbeliefsaboutbodiesdispropor?onatelyimpactthosewhoserace,gender,sexualorienta?on,ability,andagedeviatefromourdefaultno?ons.Thefurtherfromthedefault,thegreatertheimpact.Weareallaffected-butnotequally."p.51
Taylor,S.R.(2018).Thebodyisnotanapology:Thepowerofradicalself-love.
Oakland,CA:Berrej-Koehler.
Mensinger,J.L.,Tylka,T.L.,&Calamari,M.E.(2018).Mechanismsunderlyingweightstatusandhealthcareavoidanceinwomen:Astudyofweights?gma,body-relatedshameandguilt,andhealthcarestress.BodyImage,25,139-147.
• WomenwithhighBMIarelessliketoseekhealthcarethanthinnerwomen
• Experiencedandinternalizedweights?gmaarerelatedtobody-relatedshameandguilt
• Healthcarestressassociatedwithbody-relatedshamecontributestohealthcareavoidance
• Educa?nghealthcareprofessionsaboutweightbiasmayimprovepreventa?vehealthcareinhigherweightwomen
Lee,J.A.,&Pausé,C.J.(2016).S?gmainPrac?ce:BarrierstoHealthforFatWomen.Fron(ersinPsychology,7.
• Fatwomenarelesslikelytoreceivescreeningsforbreastandcervicalcancerandmorelikelytodiefromthem
• Fatpeoplearelesslikelytoreceiveevidencebased,bias-freemedicalcarewhentheydoaccessit
• Weights?gmacontributestoea?ngdisordersaswellastothehealthproblemsassociatedwithobesity
Tomiyama, A. J., Carr, D., Granberg, E. M., Major, B., Robinson, E., Sutin, A. R., & Brewis, A. (2018). How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC
Medicine, 16(1).• S?gmaislinkedtopoormetabolicandmentalhealth,weightgain,highercor?sol,exerciseavoidance,andincreasedmortality
• Weights?gmaispervasiveinhealthcareseungs,leadingtoavoidanceofhealthcare
• An?-obesityeffortscontributetoweights?gma• “Fat-shamingmessagesencouragediscrimina?onbycondoningit.”
• Eradica?ngweights?gmawillimprovehealthforeveryone,aspeopleacrosstheBMIspectrumareharmedbyit
O'Hara,L.,&Taylor,J.(2014).HealthatEverySize:AWeight-neutralApproachforEmpowerment,ResilienceandPeace.Interna(onalJournalofSocialWork
andHumanServicesPrac(ce,2(6),272-282.
• Theweight-centeredhealthparadigm(WCHP)createsanadipophobicogenicenvironmentaswellasdiminishedhealthandwell-beingforpeopleofsize
• Thefocusonindividualresponsibilityforhealthleadstoprejudice,bias,s?gmaandgreatersocialsurveillanceofbodies
• GiventhatWCHPisineffec?veandharmful,recommendingitisunethical
• TheHealthatEverySize®(HAES)®approachisastrengthbased,evidencebasedethicalalterna?ve
TownsendCentreforInterna(onalPovertyResearch
BreneBrown,Women&Shame,2004
• "Shameistheintenselypainfulfeelingorexperienceofbelievingweareflawedandthereforeunworthyofacceptanceandbelonging."p.15
• theresultoflayered,conflic?ngandcompe?ngexpecta?onsbasedonrigidsocialandcommunityexpecta?ons
• Fundamentalismis"anygroupespousingabeliefsystemthatholdsitselfsorightandtruethatitdiscouragesorevenpunishesques?oning."p114
TheNatureofPrejudiceGordonAllport
published195425thAnniversaryEdi?on1979
“Referencegroup”vs.“Ingroup”
“In”groupiswhereonebelongs,the"we”
“Reference”groupisonethatiswarmlyaccepted,inwhichonewishestobeincluded,
aspiresto,hasobviousadvantages
"...youcan'tadvocateforyourselfifyouwon'tadmitwhat
youare."p72
"That'swhyreclaimingfatness-livingvisibly,declaring"I'm
fatandIamnotashamed"-isasocialtoolsorevolu?onary,
solibera?ng,itsaveslives."p.113
West,L.(2017).Shrill.NewYork:HachejeBooks.
PossibleDownsidesofPublicHealthPromo?ons
• Whomakesthepolicyandwhy?• Socialdeterminantsofhealth
• Selfdetermina?on
• Scaretac?csandVFHT(vaguefuturehealththreats)
• Deliberateuseofshame
• Anorexiaisframedasanormalconsequence
Bombak,A.(2014).Obesity,healthateverysize,andpublichealthpolicy.AmericanJournalofPublicHealth,104(2),
60-67.
• Reviewof:evidenceofmetabolicadapta?onstoresistweightloss;fitnessvs.fatness;benefitsofweightneutralapproaches;and“obesityparadox”
• Publichealthfocusonindividualresponsibilityforweightlosspromotess?gmaandassociatedadverseoutcomes
• “ObesogenicEnvironment”isnotsupportedbyempiricalevidence
• Ethicalconcerns,includingmaskingdiscrimina?onandlimi?ngfreedomofchoice
Asocialjus?ceorientedviewofwellbeing:someideas
• Acceptanceofbodydiversityratherthanelimina?ngdifferences
• Acknowledgingsocialdeterminantswhendiscussinghealth
• "Wellbeingsolu?on"ratherthanaweightsolu?on
Someideas,con?nued
• Interven?onstoreduces?gmaanddiscrimina?onwithbothindividualsandsociety
• Reframes?gmaasdiscrimina?onratherthanblame
• Focusonchangingcultureratherthanchangingbodies
Idon'tspeaktothebullytochangethebully,Ispeaksothosebeing
bulliedcanhear
JohnPavlovitz,March17,2018
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