UConn Rudd Center for Food Policy and Health

This scoping review summarized findings and key measures from U.S.-based studies that 1) examined associations between geographic indicators of structural racism (e.g., redlining, racial segregation) and access to food retailers (e.g., supermarkets, convenience stores) or 2) documented disparities in access by neighborhood racial/ethnic composition. All studies featuring indicators of structural racism reported significant findings; however, indicators varied across studies making it difficult to make direct comparisons. Key indicators of structural racism in the food access literature included redlining (n = 3), gentrification (n = 3), and racial segregation (n = 4). Moving forward, studies should model indicators of structural racism and determine their influence on geographic access to large and small food retailers.

Full citation: Singleton, C. R., Wright, L. A., McDonald, M., Archer, I. G., Bell, C. N., McLoughlin, G. M., Houghtaling, B., Cooksey Stowers, K., & Steeves, E. A. (2023). Structural racism and geographic access to food retailers in the United States: A scoping review. Health & Place, 83, 103089. https://doi.org/10.1016/j.healthplace.2023.103089

This study assessed attitudes towards individuals with type 2 diabetes (T2D) and obesity among physicians who treat T2D. Physicians specializing in internal medicine or endocrinology (n = 205) completed a series of online questionnaires assessing their attitudes towards patients with T2D and obesity, and their attributions of controllability and blame of individuals with T2D and obesity. While 85% of physicians felt professionally prepared and confident to treat patients with T2D, 1/3 reported being repulsed by patients with T2D and view them as lazy (39%), lacking motivation (44%), and non-compliant with treatment (44%). Many witnessed professionals in their field making negative comments about patients with T2D (44%). Physicians endorsed worse levels of bias towards patients with obesity than T2D, but differences were small.

Full citation: Bennett, B. L., & Puhl, R. M. (2023). Diabetes stigma and weight stigma among physicians treating type 2 diabetes: Overlapping patterns of bias. Diabetes Research and Clinical Practice, 110827. https://doi.org/10.1016/j.diabres.2023.110827

To inform development of a scalable, health-care-system-based intervention targeting family beverage choice, a formative qualitative study was conducted using semi-structured phone interviews with 39 parents/caregivers of children ages 1–8 who were identified as over-consuming sugar-sweetened beverages (SSB) and/or fruit juice (FJ). Parents expressed that sugary drinks were unhealthy and water was a better alternative. Most were familiar with the health consequences of excess sugar consumption. They identified many reasons why sugary drinks are chosen over water despite this knowledge. One common reason was concern about tap water safety. Few differences were noted across racial and ethnic groups in our sample. Parents were enthusiastic about a technology-based intervention to be delivered through their child’s doctor’s office.

Full citation: Newman CM, Zoellner J, Schwartz MB, Peña J, Wiseman KD, Skelton JA, Shin TM, Lewis KH. Knowing Is Not Doing: A Qualitative Study of Parental Views on Family Beverage Choice. Nutrients. 2023; 15(12):2665. https://doi.org/10.3390/nu15122665

The present study examined the extent to which positive and negative weight-related comments from mothers and fathers are related to adolescent health and wellbeing, and whether these associations differ according to adolescent sociodemographic characteristics. Online questionnaires  were collected from a diverse sample of 2032 U.S.-based adolescents aged 10–17 years (59% female; 40% White, 25% Black or African American, 23% Latinx). Results showed more frequent negative weight-related comments from parents were associated with poorer adolescent health and wellbeing, while positive comments contributed to lower levels of WBI and body appreciation; these associations were documented regardless of whether mothers or fathers were the source of such comments, and considerable consistency was demonstrated across adolescent sociodemographic characteristics.

Full citation: Lessard, L.M., Puhl, R.M., Foster, G.D., Cardel, M. (2023). Parental communication about body weight and adolescent health: The role of positive and negative comments. Journal of Pediatric Psychology. https://doi.org/10.1093/jpepsy/jsad040

Social media is a free and easy tool for sponsors of summer meal programs to reach eligible participants. However, Rudd Center research shows that many programs are not using social media effectively.

This toolkit contains step-by-step instructions for sponsors to create graphics, brand content, and post information on social media.

Health-care providers express weight-based stigma toward patients with obesity, who in turn perceive negative judgements, disrespectful communication, and lack of compassion from health-care providers. Weight stigma in health-care encounters is associated with lower patient motivation and adherence, poorer provider-patient communication, reduced quality of care, and health-care avoidance. Multifaceted approaches are needed to reduce stigma-related barriers in patient care.

Full citation: Puhl, R.M. (2023). Weight stigma and barriers to effective obesity care. Gastorenterology Clinics of North America, 52, 417-428. https://doi.org/10.1016/j.gtc.2023.02.002

The purpose of this mixed methods study was to assess the relationship between body image and refusal to be weighed by a healthcare provider among women in the United States, including examination of their reasons for refusal. Of the 384 respondents, 32.3 % reported refusing to be weighed by a healthcare provider.  The most common reasons for refusing to be weighed were having a negative impact on emotions, self-esteem, or mental health (52.4 %). Reasons for refusing to be weighed ranged from shame and embarrassment to lack of provider trust, personal autonomy, and concerns about discrimination. Identifying interventions and alternatives such as telehealth to provide healthcare services that are weight-inclusive may mediate these negative experiences.

Full citation: Ramseyer Winter, V., Trout, K., Harrop, E., O’Neill, E., Puhl, R., Bartlett-Equilant, G. (2023). Women’s refusal to be weighed during healthcare visits: Links to body image. Body Image, 46, 41-47. https://doi.org/10.1016/j.bodyim.2023.04.006

US Department of Agriculture (USDA) Foods programs for households – The Emergency Food Assistance Program (TEFAP), The Food Distribution Program on Indian Reservations (FDPIR), and the Commodity Supplemental Food Program (CSFP) – provide nutritious foods at no cost to income-eligible individuals. The Healthy Eating Research (HER) Nutrition Guidelines for the Charitable Food System were used to evaluate the quality of foods in each program. Foods are categorized into a three-tiered system based on levels of saturated fat, sodium, and added sugar per serving, and presence of whole grains: Green (choose often,) Yellow (choose sometimes,) and Red (choose rarely.)

This document provides an outline that charitable food organizations can use to prepare data for HER analyses using FANO categories.

Rules of thumb to help rank food utilizing the HER Guidelines for the Charitable Food System.