Unpacking vertical and horizontal integration: childhood overweight/obesity programs and planning, a Canadian perspective

Abstract Background Increasingly, multiple intervention programming is being understood and implemented as a key approach to developing public health initiatives and strategies. Using socio-ecological and population health perspectives, multiple intervention programming approaches are aimed at providing coordinated and strategic comprehensive programs operating over system levels and across sectors, allowing practitioners and decision makers to take advantage of synergistic effects. These approaches also require vertical and horizontal (v/h) integration of policy and practice in order to be maximally effective. Discussion This paper examines v/h integration of interventions for childhood overweight/obesity prevention and reduction from a Canadian perspective. It describes the implications of v/h integration for childhood overweight and obesity prevention, with examples of interventions where v/h integration has been implemented. An application of a conceptual framework for structuring v/h integration of an overweight/obesity prevention initiative is presented. The paper concludes with a discussion of the implications of vertical/horizontal integration for policy, research, and practice related to childhood overweight and obesity prevention multiple intervention programs. Summary Both v/h integration across sectors and over system levels are needed to fully support multiple intervention programs of the complexity and scope required by obesity issues. V/h integration requires attention to system structures and processes. A conceptual framework is needed to support policy alignment, multi-level evaluation, and ongoing coordination of people at the front lines of practice. Using such tools to achieve integration may enhance sustainability, increase effectiveness of prevention and reduction efforts, decrease stigmatization, and lead to new ways to relate the environment to people and people to the environment for better health for children

Obesity, the Endocannabinoid System, and Bias Arising from Pharmaceutical Sponsorship

Previous research has shown that academic physicians conflicted by funding from the pharmaceutical industry have corrupted evidence based medicine and helped enlarge the market for drugs. Physicians made pharmaceutical-friendly statements, engaged in disease mongering, and signed biased review articles ghost-authored by corporate employees. This paper tested the hypothesis that bias affects review articles regarding rimonabant, an anti-obesity drug that blocks the central cannabinoid receptor.A MEDLINE search was performed for rimonabant review articles, limited to articles authored by USA physicians who served as consultants for the company that manufactures rimonabant. Extracted articles were examined for industry-friendly bias, identified by three methods: analysis with a validated instrument for monitoring bias in continuing medical education (CME); analysis for bias defined as statements that ran contrary to external evidence; and a tally of misrepresentations about the endocannabinoid system. Eight review articles were identified, but only three disclosed authors' financial conflicts of interest, despite easily accessible information to the contrary. The Takhar CME bias instrument demonstrated statistically significant bias in all the review articles. Biased statements that were nearly identical reappeared in the articles, including disease mongering, exaggerating rimonabant's efficacy and safety, lack of criticisms regarding rimonabant clinical trials, and speculations about surrogate markers stated as facts. Distinctive and identical misrepresentations regarding the endocannabinoid system also reappeared in articles by different authors.The findings are characteristic of bias that arises from financial conflicts of interest, and suggestive of ghostwriting by a common author. Resolutions for this scenario are proposed

A dual continuum model of the reasons for use of complementary health approaches among overweight and obese adults: Findings from the 2012 NHIS

Background: Obese and overweight individuals have greater illness and disease burden, but previous findings from the 2002 National Health Interview Survey (NHIS) suggest that they are no more likely to use complementary health approaches (CHA) than those of normal weight. The current study investigates the relationship between weight status and CHA use, and among CHA users, examines differences in reasons for use by weight status. We propose and test a Dual Continuum Model of Motivations for Use of CHA to examine differences in reasons for use by weight status. Method: Participants were drawn from the 2012 NHIS, a nationally representative sample of civilian, non-institutionalized US adults (N = 34,525). Weight status was operationalized by body mass index. CHA use was measured in the past year and was categorized into alternative providers, products, and practices. Among CHA users (N = 9,307) factors associated with use were categorized as health enhancing or health reactive. Results: Logistic regression showed overweight and obese individuals were less likely to use alternative providers, products, and practices than normal weight. Multinomial logit regression showed some support that overweight and obese adults were less likely than normal weight persons to use CHA for health-enhancing reasons, and more likely to use for health reactive reasons. Conclusions: Despite greater health burden, overweight and obese adults are underutilizing CHA, including modalities that can be helpful for health management. The Dual Continuum Model of CHA Motivations shows promise for explicating the diversity of reasons for CHA use among adults at risk for health problems

Morality and health: News media constructions of overweight and eating disorders

This article examines how widely shared cultural values shape social problem construction and, in turn, can reproduce social inequality. To do so, we draw on a comparative case study of American news reporting on eating disorders and overweight/obesity between 1995 and 2005. In the contemporary United States, thinness is associated with high social status and taken as evidence of moral virtue. In contrast, fatness is linked to low status and seen as a sign of sloth and gluttony. Drawing on an original data set of news reports, we examine how such social and moral meanings of body size inform news reporting on eating disorders and overweight. We fnd that the news media in our sample typically discuss how a host of complex factors beyond individual control contribute to anorexia and bulimia. In that anorexics and bulimics are typically portrayed as young white women or girls, this reinforces cultural images of young white female victims. In contrast, the media predominantly attribute overweight to bad individual choices and tend to treat binge eating disorder as ordinary and blameworthy overeating. In that the poor and minorities are more likely to be heavy, such reporting reinforces social stereotypes of fat people, ethnic minorities, and the poor as out of control and lazy. While appreciation for bigger female bodies among African Americans is hailed as protecting against thinness-oriented eating disorders, this same cultural preference is partially blamed for overweight and obesity among African American women and girls. © 2010 by Society for the Study of Social Problems, Inc

Gendered Homophobia and the Contradictions of Workplace Discrimination for Women in the Building Trades

Drawing on 63 interviews with a diverse sample of tradeswomen, this article examines how the cultural meanings of sexual orientation-as well as gender presentation, race, and body size-shapes the constraints that women face in the construction industry and the specific resistance strategies they develop. We argue that women's presence in these male-dominated jobs threatens (1) notions of the work as inherently masculine and (2) a gender order that presumes the sexual subordination of women. Tradesmen neutralize the first threat by labeling tradeswomen as lesbians-and therefore not "real" women-and respond to the second by sexualizing straight and lesbian tradeswomen alike. In turn, tradeswomen develop individual resistance strategies, which are shaped by the intersections of their sexual identity, gender presentation, race, and body size. Finally, we show how tradesmen deploy homophobia to stymie collective action and solidarity by tradeswomen, gay or straight. © 2013 by The Author(s)

Morality and health: News media constructions of overweight and eating disorders

This article examines how widely shared cultural values shape social problem construction and, in turn, can reproduce social inequality. To do so, we draw on a comparative case study of American news reporting on eating disorders and overweight/obesity between 1995 and 2005. In the contemporary United States, thinness is associated with high social status and taken as evidence of moral virtue. In contrast, fatness is linked to low status and seen as a sign of sloth and gluttony. Drawing on an original data set of news reports, we examine how such social and moral meanings of body size inform news reporting on eating disorders and overweight. We fnd that the news media in our sample typically discuss how a host of complex factors beyond individual control contribute to anorexia and bulimia. In that anorexics and bulimics are typically portrayed as young white women or girls, this reinforces cultural images of young white female victims. In contrast, the media predominantly attribute overweight to bad individual choices and tend to treat binge eating disorder as ordinary and blameworthy overeating. In that the poor and minorities are more likely to be heavy, such reporting reinforces social stereotypes of fat people, ethnic minorities, and the poor as out of control and lazy. While appreciation for bigger female bodies among African Americans is hailed as protecting against thinness-oriented eating disorders, this same cultural preference is partially blamed for overweight and obesity among African American women and girls. © 2010 by Society for the Study of Social Problems, Inc

Coming out as fat: Rethinking stigma

This paper examines the surprising case of women who "come out as fat" to test and refine theories about social change, social mobilization, stigma, and stigma resistance. First, supporting theories about "social movement spillover," we find that overlapping memberships in queer and fat activist groups, as well as networks between these groups, have facilitated the migration of this cultural narrative. Second, we find that the different, embodied context of body size and sexual orientation leads to changes in meaning as this narrative travels. Specifically, the hyper-visibility of fat changes what it means to come out as a fat person, compared to what it means to come out as gay or lesbian. Third, this case leads us to question the importance of the distinction made in the literatures on stigma and on social movements between assimilationist strategies that stress sameness, on the one hand, and radical political strategies that emphasize difference, on the other. Finally, this case suggests that the extent to which a stigmatized trait is associated with membership in a social group-with its own practices, values, and norms- shapes what it means to "come out" as one who possesses that trait. © 2011 American Sociological Association