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Proceedings of a Workshop—in BriefTargeting Structures, Communications, andBeliefs to Advance Practical Strategies forObesity SolutionsProceedings of a Workshop—in BriefThe Roundtable on Obesity Solutions of the Health planning process the roundtable initiated in 2020. It tookand Medicine Division of the National Academies of a systems-oriented approach to identify priority areas forSciences, Engineering, and Medicine held the virtual obesity solutions, she said, which culminated in a causalpublic workshop Shifting the Paradigm: Targeting systems map that depicts not only the drivers of obesityStructures, Communications, and Beliefs to Advance but also the evidence-based solutions to obesity. ThePractical Strategies for Obesity Solutions on April 19, map was used to determine three crosscutting priority2022. The workshop was the first in a series of three areas that the roundtable has since pursued, includingworkshops to explore how to bridge evidence gaps within through a three-part workshop series in 2021—structuralfoundational drivers of obesity and translate knowledge racism, biased mental models and social norms, andtoward actionable solutions. It examined the connections effective health communication—which Economos saidbetween obesity and structural racism, health were considered to be deep leverage points in the systemcommunication, and biased mental models and social that could bring about lasting, systems-wide change.norms, as well as the interactions of these drivers withthe evidence base and workforce, to uncover potentially This Proceedings of a Workshop—in Brief highlightspractical strategies for intervention. Topics covered in the presentations and discussions that occurred at thethe April workshop sessions included targeting academic workshop and is not intended to provide a comprehensiveand workforce structures that dismantle systemic summary of information shared during the workshop.1 Theracism while building an evidence base, the effect of information summarized here reflects the knowledge andcommunications on perceptions and the understanding of opinions of individual workshop participants and shouldobesity, and strategies to change the conversation around not be seen as a consensus of the workshop participants,representation in media and body image. the Roundtable on Obesity Solutions, or the National Academies of Sciences, Engineering, and Medicine.Christina Economos, New Balance chair in childhood 1 The workshop agenda, presentations, and other materials are availablenutrition and dean for research strategy at the Friedman at of Nutrition Science and Policy at Tufts University, the-paradigm-targeting-structures-communications-and-beliefs- to-advance-practical-strategies-for-obesity-solutions-a-workshopexplained that the workshop series builds on a strategic (accessed June 27, 2022). August 2022 | 1

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SHIFTING THE PARADIGM TO ADVANCE OBESITY SOLUTIONS The loop shows how structural racism—defined by theThe workshop began with an introductory session that Aspen Institute as “a system in which public policies,expounded on concepts presented in the introduction and institutional practices, cultural representations, andfurther described the roundtable’s approach to organizing other norms work in various, often reinforcing, waysthe workshop. Bruce Lee, professor of health policy and to perpetuate racial group inequity”2—can result inmanagement at the City University of New York School unbalanced workforces, which Lee cautioned couldof Public Health, listed several risks of not applying a produce biased studies or data collection and ultimatelysystems approach to obesity and other systems problems. a biased evidence base. This can lead to overly simplisticThe development of “Band-Aids” that only address messages, he continued, which in turn affect healthsurface problems tends to occur, he explained, rather communication that go on to shape people’s mentalthan sustainable solutions that address root causes. This models. Mental models affect how information isleads to the manifestation of unintended consequences; understood and interpreted and give way to socialmissing secondary and tertiary effects; worsening of norms that reinforce the problem, such as structuralexisting disparities and sometimes introducing new racism, which perpetuates the cycle.3 Lee concludedproblems; expending time, effort, and resources through by emphasizing the importance of changing thetrial and error rather than targeting real solutions; and picture of obesity—how society views the problem, theintroducing multiple sources of bias. makeup of its mental models, and how the problem is communicated—in order to achieve systems change.Lee reiterated Economos’ introductory remarks about theimportance of intervening on major leverage points in TARGETING ACADEMIC AND WORKFORCE STRUCTURES THATthe system, which he said is a strategy to disrupt what DISMANTLE SYSTEMIC RACISM WHILE BUILDING AN EVIDENCEhe called a reinforcing loop. He illustrated this loop with BASEa depiction of how major contributors to obesity tend to The workshop’s second session featured four panelistsreinforce each other (Figure 1), noting that intervening who answered two questions. First, how did we geton one or more of these factors can set off positive here: What are the structural processes of racism that(or negative) effects that grow exponentially as they produced the current workforce, and how does that affectreverberate through the system. evidence generation, funding offerings, and research prioritization? Second, what do we do about it: What practical solutions have been successful? Daniel Aaron, Heyman Fellow at Harvard Law School and attorney at the U.S. Food and Drug Administration (FDA), offered five points in response to each question. For the first, he maintained that law has played a role in workforce racism. Law school has been described as a largely white space, he remarked, and one where discussing race and racial issues in the law is often viewed as unintellectual and sometimes even discouraged. This extraction of race and racism from 2 Glossary for Understanding the Dismantling Structural Racism/ Promoting Racial Equity Analysis. The Aspen Institute, Community Roundtable for Change. uploads/files/content/docs/rcc/RCC-Structural-Racism-Glossary.pdf (accessed June 21, 2022). 3 Quote cited by Bruce Lee, “Not only do mental models impact what weFIGURE 1 The reinforcing loop of major contributors to obesity. think and understand, they also shape the connections and opportunitiesSOURCE: Presented by Bruce Lee, April 19, 2022. that we see.” —Melissa Simon, University of Chicago (June 2021, Roundtable on Obesity Solutions Workshop). August 2022 | 2

legal education are manifested in Supreme Court is experiencing a time of heightened racial awareness,outcomes, he said as an example, such as what he accompanied by a commensurately heightenedcalled the court’s taking a hard line on considering race expectation of a new, authentic kind of justice that sheby framing policies that remediate racial inequity as indicated was possible if awareness becomes a launchingunconstitutional. point for systems change and the unearthing of new solutions.Aaron’s second point in response to the first questionwas that nondiscrimination law is inadequate in Dejean recounted her efforts that began in 2017 topreventing racism in the workforce and has led to the address racial disparities in research laboratory personnelattrition of BIPOC—Black, indigenous, and people of at her institution by designing the VERSE program—color—from many institutions. He acknowledged that Visiting and Early Research Scholars Experience—tolaw is not the only solution to stopping discrimination, provide underrepresented, undergraduate prescholarsbut asserted that it has provided an illusion of protection. with substantive research experiences that enable themHis third point emphasized the power of corporations, to become independent junior researchers who designwhich he said employ the majority of U.S. workers and and investigate their own research questions.also influence the foods that are produced and thereforeconsumed. Aaron’s fourth point was that a biology and She recalled her application of John Kotter’s eight stepsgenetics bias exists in many studies that mention race for change, as documented in his book Leading Change, toand that opining on biology has been perceived to be work toward dismantling barriers in institutions (Kotter,less political than opining on corporate power. Fifth, 1996). The first step is to create a sense of urgency,Aaron pointed out that people often study discrete issues which she did (back in 2017) by starting conversationswithout looking at the perspective of race or racism framed around the America Competes Act mandate,within that issue, and suggested that coming together whereby she urged Tufts University to rise to a similarintersectionally on obesity and racism studies would level as that of other nations that had already begunbuild a more durable, effective movement toward solving dismantling racial barriers in their institutions. Thethese problems. second step is building a guiding coalition, which she implemented by recruiting a small team, sharing herFor the second question about solutions, Aaron first vision, and encouraging the team to help evolve it. Thissuggested forming more alliances across identity groups was step three, forming a strategic vision and initiatives.and across disciplines in order to create more durablemovements toward a nonracist workforce. His second As the small team earned buy-in and enlisted otherspoint was to elevate lived experiences and voices at within the institution, Dejean continued, the fourththe ground level, and his third point was to promote step—enlisting a volunteer army—was achieved. Thisdemosprudence, which he described as a legal term for helped spread the vision and gather more people topracticing law in a way that is responsive to social enable action by removing barriers (in her institution’smovements. Aaron’s fourth point was to support what case, it was insufficient funding opportunities to increasehe called race-conscious remedies, such as programs the number of students involved in research labs), whichto remediate the legacy of racism and other historical she listed as step five. Step six is to generate short-terminjustices. Fifth, he echoed his earlier point about the wins, which Dejean said she implemented by celebratingimportance of intersectionality. her success in surpassing her goals for the number of faculty and students she recruited to participate in theJacqueline Dejean, associate dean of research at the program’s first year. These small wins contributed toSchool of Arts and Sciences and associate dean of step seven, sustaining acceleration, which she said shediversity and inclusion at the Graduate School of Arts achieved by using those wins to accelerate the changeand Sciences at Tufts University, expressed that society process. Dejean explained that the eighth and final step August 2022 | 3

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is to embed the change in the culture. Now 5 years out authority, such as faculty hiring or financial spending,from starting the program, she reflected on the gradual and Ko noted that individuals in these positions typicallyemergence of students who had never had a vision for had limited knowledge of existing scholarship and theoryresearch or even recognized it as a career option but have about effecting organizational embraced new realms of education and experiencethat research has facilitated. Ko’s last point was that structural racism in public health, health systems, and policy has ensuredMichelle Ko, associate professor in the Department of disproportionate COVID-19 effects on groups historicallyPublic Health Sciences at the University of California, excluded from the health and research workforce, suchDavis, discussed connections between institutional that the challenges to their pursuits of careers in theseand structural racism in contemporary systems and fields have been compounded by increased financialinequities in the current workforce. She maintained insecurity and family caregiver responsibilities. Inthat White supremacy is embedded in contemporary closing, she emphasized the importance of changing thehigher-education policies and processes; she supported people in the system concurrently with changing theher statement with findings from interviews conducted system 2019 and 2020 with 39 medical school admissionsleaders. She reported that interviewees referenced a lack Eliseo Pérez-Stable, director of the National Institute onof leadership commitment to dismantling structural Minority Health and Health Disparities at the Nationalracism despite verbal affirmation of the topic’s Institutes of Health (NIH), stated that diversity inpriority. Another institutional barrier identified was an science and medicine is a demographic mandate as welloveremphasis on academic metrics, which she thought as an inherent advantage to advance their missions.may be related to pressure on institutions to pursue high He asserted the importance of developing diverseaverage test scores and grade-point averages because clinical and biomedical scientific workforces, engagingthese metrics factor into rankings from influential underrepresented populations to participate in clinicalentities such as U.S. News and World Report. A third barrier research, and ensuring fairness and using intellectualexpressed was the influence of faculty, alumni, and capital with changing demographics. He warned thatlocal politicians and community leaders on admission because racial and ethnic minorities now make up adecisions. significant portion of the U.S. population, the health and medical profession will be alienated from a large part ofKo next shared her belief that diversity, equity, and the population if it does not diversify.inclusion cannot be accomplished unless there isa change in the foundation of schools as racialized Pérez-Stable discussed the “cultural taxation” thatorganizations. She elaborated on this statement by he said affects historically underrepresented minoritysharing four themes emerging from interviews with people who are on university faculty (Pololi et al., 2013).approximately 30 people in positions created to promote They are often asked to serve on multiple committeesdiversity, equity, and inclusion in U.S. medical schools to “represent” and satisfy university requirements forand academic medical centers. One theme is that wide diversity and inclusion, he pointed out, and they arevariability exists in the roles (i.e., day-to-day duties also asked to take responsibility for all diversity efforts.and overall expectations) and the degree of support They receive excess mentorship requests from students,for achieving the role’s objectives. Another theme is residents, and other faculty, yet also experience isolationa mismatch in investment and expectations (e.g., an and lack of community, discrimination, discomfort withindividual might be expected to achieve certain outcomes the culture, and lower perception of relationships owingbut not given staff or volunteer support). Interviewees to being less able to relate to certain components of thealso said that they were asked to promote change in culture.areas of the institution in which they did not have direct August 2022 | 4

Pérez-Stable suggested a series of steps that institutions powerful forms of collaboration through empathy andcould take to address diversity. One is leadership engagement. Empathy calls for engaging directly withcommitment to long-term, sustainable change with individuals and institutions that are entrenched in theresources. Another is promoting and measuring systems involved in the problem, she explained, in orderorganizational change by creating metrics to evaluate to understand and appreciate the vantage point fromthe institutional climate, a third is implementing which others experience and approach communication,unconscious bias training, and a fourth is tracking and rather than assuming that one’s own lived experience ispromoting diversity by holistically reviewing admissions universal. Empathy is not synonymous with sympathy,and hiring. He suggested that tracking applicants’ racial she clarified, and requires dignity and respect for othersand ethnic identities, socioeconomic backgrounds, and but not necessarily agreement. Lindenfeld also called fornational origins is a way to measure baselines. Lastly, he the integration of community engagement into researchhighlighted the value of connecting early-career faculty design and processes in order to understand perspectives,with mentors who have networks to create pathways values, attitudes, and needs, and build trustingof knowledge and further connections. On this note, he partnerships before conducting research.mentioned NIH’s Faculty Institutional Recruitment forSustainable Transformation (FIRST) program, in which Lindenfeld discussed three areas of communicationawardee institutions receive grant funding to hire annual interventions to strengthen linkages between thecohorts of 6 to 10 faculty who commit to promoting production of knowledge and action, which she saiddiversity and sustaining cultures of inclusive excellence could spur meaningful change in addressing the institution. The first area is science communication: it should include training programs that help scientists andHOW COMMUNICATIONS CAN AFFECT PERCEPTIONS AND THE health care professionals develop the critical ability toUNDERSTANDING OF OBESITY accurately and effectively communicate science in orderThe third session of the April 2022 workshop featured to support decision making. Lindenfeld described hertwo presentations about the effect of communications on own organization’s training program, which she said isperceptions and understanding of obesity. unique because of its principles from improvisational theatre. She explained that this approach invites traineesLaura Lindenfeld, executive director of the Alan Alda to embrace the challenges of working across cultures andCenter for Communicating Science and dean in the contexts with a creative lens and to practice genuine,School of Communication and Journalism at Stony responsive listening through empathy.Brook University, framed her presentation around herviews that (1) it is critical to adopt a systems-based The second area is interdisciplinary collaboration.understanding of, and approach to, communication Challenges such as obesity call for strongabout complex situations such as obesity, and interdisciplinary collaboration, yet she contended that(2) communication must be based in empathy. interventions and training programs rarely focus on targeting changes in communication to better prepareLindenfeld shared her perspective that communication teams to work together. A growing body of literatureis both an act of conveying meaning and a system that on team science, she said, offers powerful insightsshapes the interrelationships of different communities, into strategies for creating more productive teaminstitutions, and stakeholders such as scientists and care professionals. This system can be viewed asoperating on top of the system of drivers that contribute The third area is approaching partnerships andto obesity challenges, she suggested, and added that part engagement from the perspective of understandingof the communication infrastructure that is critical to community needs and authentically integratingproblem solving at the systems level is the ability to craft community members into all stages of the research August 2022 | 5

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process to ensure that it centers their needs and names and the values they connect to being a personvalues. In her view, humility and empathy are who bears the name. Attributes related to pride, hardcritical foundations for partnerships, collaboration, work, and faith are shared, and eventually the people inand engagement in the pursuit of obesity solutions. the ad visit a food truck distributing soda cans that haveLindenfeld encouraged attendees to consider building tattoos of Latino surnames on their sides. The peoplemore interdisciplinary project teams that include then press the cans to their arms, wrists, and necks tocommunication researchers who can help establish tattoo their bodies with their family surname, and therelationships and mutual trust between each field’s ad ends by encouraging viewers to share the productresearchers and communities so knowledge is with others. Baer applied the causal loop diagram thatcoproduced, which she said promotes more useful Lee shared in the first session (see Figure 1) to analyzeand meaningful research outcomes for the intended how characteristics of the advertisement map back torecipients. the drivers of obesity. The power of the story is that the ad does not explicitly talk about the soda, but the actorsNeal Baer, a showrunner, television writer and producer, are drinking it throughout the commercial, and it is thusphysician, author, and lecturer at Harvard Medical School associated with the cultural values expressed throughoutand the Yale School of Public Health, discussed the power the ad. It is tough for obesity solutions to compete,of storytelling to change the way people think about he admitted, with this kind of compelling, poignantproblems and solutions. He focused on advertisements, storytelling.which he said are a form of storytelling that deserveattention based on their ubiquity in society and their CHANGING THE CONVERSATIONability to affect people’s decisions about what to eat and AROUND REPRESENTATION IN MEDIA AND BODY IMAGEdrink. The fourth and final session of the April 2022 workshop discussed the marketing landscape and barriers andTo preface his sharing of a soda advertisement video opportunities to address bias, stigma, and the inequitiesto explain its use of storytelling, Baer described soda associated with the hub of a corporate wheel, with its spokesconnected to health effects (e.g., a causal link between Rebecca Pearl, assistant professor in the Department ofconsumption and development of chronic diseases such Clinical and Health Psychology and Social and Behavioralas obesity), environmental impacts (e.g., related to the Sciences at the University of Florida College of Publicvolume of plastic waste it produces), jobs, advertising, Health and Health Professions, stated that society blamesphilanthropy, taxes, government subsidies, and legal obesity mostly on individual choices, primarily poor dietissues. A product’s effect on health and obesity is and failure to exercise, attributed to the person withonly one aspect of the system, he pointed out, and the obesity’s presumed lack of self-control and laziness;exploration of the other aspects is needed to understand meanwhile, thinness is valued and associated with goodthe product’s comprehensive impact and why addressing moral character.only the health effects may not gain much traction. Pearl referenced data indicating that despite increasedBaer played a soda advertisement video that he said attention over the past decade to topics such as bodyseems simple and lighthearted on the surface, but it is shaming, weight bias, and stigma, negative implicitembedded with deep layers of meaning that influence attitudes related to body weight have increased overthe intended audience’s decisions to consume the time (Charlesworth and Banaji, 2019). Negative weight-product. The advertisement tells a story that connects the related attitudes are problematic from ethical, socialproduct to positive attributes related to Latino culture, justice, and public health lenses, Pearl said, because theyhe explained, as it features a variety of people from contribute to negative body image and weight stigma andLatino backgrounds who are asked to share their family discrimination (Neumark-Sztainer, 2006; Pearl et al., August 2022 | 6

2015, 2020; Pearl and Puhl, 2018; Tomiyama et al., 2016). including people with diverse lived experiences whenWeight bias and stigma have been linked to negative creating content to avoid inadvertent stigmatization,effects on access to health care and quality of care and she emphasized the importance of appreciating thatreceived, she explained, as well as to both psychological weight intersects with other identities and represents aand physiological stress on the affected individuals. variety of intersecting experiences.These sources of stress combine and promote copingmechanisms such as engaging in unhealthy behaviors Ginny Levine, managing director of marketing for thethat further contribute to poorer health-related quality U.S. Tennis Association (USTA), offered reflections onof life and increased risk for chronic disease beyond the marketing landscape. She discussed her perspectiveweight-related risks (Pearl et al., 2020). that Generation Z will be a force of change for increasing representation in media, shared examples of USTA’sPearl turned to the topic of body image in the media efforts in this vein, and highlighted a sample of brandsand emphasized the potential of news stories to help that she would position at the forefront of changing theshift the narrative by highlighting the complexity of the conversation about representation.contributors to obesity and the effects of weight stigmaand discrimination. In addition to shifting the content of Media ideals of thinness have persisted for generations,news stories, she also called for them to carry images that Levine observed, and she suggested that this theme indepict people with obesity engaging in health-promoting media and marketing has led to “image conditioning,”behaviors instead of stereotypical unhealthy behaviors. inflating a false sense of reality and fueling biases thatWhen the public sees the former types of images, Pearl have become entrenched in society. Nonetheless, herexplained, they report less negative attitudes toward outlook is that positive shifts in marketing and media arethe people depicted. She shared guidelines for media forthcoming and hold potential to improve perceptionsportrayals of individuals affected by obesity, which and conversations about obesity.include publicly available image galleries. 4,5 Levine explained that a relatively recent shift inPearl highlighted social media for its giving voice marketing approaches has been driven by the comingto diverse individuals to participate in and lead of age of Generation Z—the first generation who hasconversations from which they may have previously been never experienced a world without the Internet, socialmarginalized or excluded (Cha et al., 2022; Cohen et al., media, and other technologies—and current world2019; Fioravanti et al., 2021; Pearl, 2020; Puhl, 2022; dynamics around climate concerns, the effects ofWebb et al., 2019; Zavattaro, 2021). Positive body image the COVID-19 pandemic, and racial equity and socialcontent is present in social media spaces and appears justice. Levine suggested that this environment givesto have positive short-term effects on mood and body way to generational characteristics such as being moreimages, she reported, and she suggested that social politically aware, collaborative, multicultural, andmedia can also be used to elevate activism and correct likely to test current labels and demand representationmisinformation. (CM Group, 2022; Dentsu, 2022). She suggested that the combination of these global dynamics and thesePearl concluded her remarks by observing that increasing characteristics are forcing marketers to change theirdiversity in body sizes shown in the media does not mindsets and accept an upcoming generation thatnecessarily achieve full representation of all bodies in is setting new standards for inclusion, reevaluatingthe United States. She highlighted the importance of inequities, internalizing their self-worth, and pursuing mental health and well-being. If marketers embrace this,4 Levine maintained, “we can catapult the conversation” toimage-gallery/ (accessed June 21, 2022).5 (accessed June 21, 2022). change perceptions and norms about obesity. August 2022 | 7

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Levine discussed USTA’s initiative “The New and Next social norms and views on obesity held by researchers,for Tennis” as an example of how marketers are reacting public health providers, policymakers, and Generation Z’s prompting of the marketing paradigmshift. Qualitative research indicated that people believed The present society’s energy and enthusiasm aroundUSTA (and by default, tennis) to be internal oriented, foundational drivers of obesity carries an excitingtraditional, process heavy, complex, and slow to adapt, potential to drive changes in the current systems. Thiswhich she contrasted to a service-driven culture that state also comes with a high level of expectation foris others oriented, empathetic, helpful, seamless, carrying through some of these changes. Advancingresponsive, and communal. These findings led USTA obesity solutions calls for a focus on intersectionalityto embrace a new service role definition and an aim to and multisectoral collaboration, consideration of existingmake tennis and USTA “open to all.” This is not merely paradigms in institutions as well as social norms, anda marketing campaign, she assured, but a gradual, recognition that each person has one’s own identity andsignificant shift in the way of operating. By elevating the experience and deserves to be heard empathically anddiversity that exists through showing that people of all represented.ages, shapes, sizes, and backgrounds already play andenjoy tennis, Levine explained that the stage is set for REFERENCESchanging perceptions. Cha, H. S., J. A. Mayers, and L. A. Stutts. 2022. The impact of curvy fitspiration and fitspiration on bodyLevine turned to highlight several brands that she thinks dissatisfaction, negative mood, and weight bias inare leaders in body diversity and representation: Dove’s women. Stigma and Health 7(2):226-233.Real Beauty campaign, which she said initiated the Charlesworth, T. E., and M. R. Banaji. 2019. Patterns ofconversation and discussion about representing body implicit and explicit attitudes: I. Long-term changediversity and also launched the era of brand purpose; and stability from 2007 to 2016. Psychological ScienceFenty Beauty, which carries a full range of makeup 30(2):174-192.shades to suit people of every skin color; Blink Fitness, CM Group. 2022. Marketing to Gen Z: A fresh approach towhich showcases body diversity in its campaigns and reach a new generation of consumers. https://cmgroup.leads with how exercise can make one feel, instead of com/wp-content/uploads/2022/02/CM-Group-focusing on how it can change physical appearance; and Marketing-to-Gen-Z-Report.pdf (accessed June 21,Old Navy, which has consistently promoted diversity 2022).in its styles, campaigns, and messages and has also Cohen, R., J. Fardouly, T. Newton-John, and A. Slater.eliminated plus size sections in its stores to address the 2019. #BoPo on Instagram: An experimentalsubconscious bias that is perpetuated by isolating people investigation of the effects of viewing body positivewith obesity to a certain physical area of the store. content on young women’s mood and body image. New Media & Society 21(7):1546-1564.CLOSING REFLECTIONS Dentsu. 2022. Dentsu creative trends report 2022: New worldsStella Yi, associate professor in the Department of order. Health, Section for Health Equity, at NYU trends-report-2022 (accessed June 21, 2022).Grossman School of Medicine, delivered a closing Fioravanti, G., A. Svicher, G. Ceragioli, V. Bruni, andpresentation. In addition to summarizing key points from S. Casale. 2021. Examining the impact of dailyeach of the workshop’s four sessions, Yi also offered exposure to body-positive and fitspiration Instagramher observation of a few overarching themes that were content on young women’s mood and body image:conveyed. It is time to change how society views obesity, An intensive longitudinal study. New Media & Societyshe said. Dismantling structural racism, communicating effectively, and changing mental models, if (accessed July 28, 2022).addressed simultaneously, would ultimately change August 2022 | 8

Kotter, J. P. 1996. Leading change. Boston, Massachusetts: Pololi, L. H., J. T. Civian, R. T. Brennan, A. L. Dottolo, Harvard Business School Press. and E. Krupat. 2013. Experiencing the culture ofNeumark-Sztainer, D., S. J. Paxton, P. J. Hannan, J. academic medicine: Gender matters, a national study. Haines, and M. Story. 2006. Does body satisfaction Journal of General Internal Medicine 28(2):201-207. matter? Five-year longitudinal associations between Puhl, R. M. 2022. Weight stigma, policy initiatives, and body satisfaction and health behaviors in adolescent harnessing social media to elevate activism. Body females and males. Journal of Adolescent Health Image 40:131-137. 39(2):244-251. Tomiyama, A. J., D. Carr, E. M. Granberg, B. Major, E.Pearl, R. L. 2020. Weight stigma and the Robinson, A. R. Sutin, and A. Brewis. 2018. How and “Quarantine-15”. Obesity 28(7):1180. why weight stigma drives the obesity ‘epidemic’ andPearl, R. L., and R. M. Puhl. 2018. Weight bias harms health. BMC Medicine 16(1):1-6. internalization and health: A systematic review. Webb, J. B., E. V. Thomas, C. B. Rogers, V. N. Clark, E. N. Obesity Reviews 19(8):1141-1163. Hartsell, and D. Y. Putz. 2019. Fitspo at every size?Pearl, R. L., R. M. Puhl, and J. F. Dovidio. 2015. A comparative content analysis of# curvyfit versus# Differential effects of weight bias experiences and curvyyoga Instagram images. Fat Studies 8(2):154- internalization on exercise among women with 172. overweight and obesity. Journal of Health Psychology Zavattaro, S. M. 2021. Taking the social justice fight to 20(12):1626-1632. the cloud: Social media and body positivity. PublicPearl, R. L., R. M. Puhl, M. S. Himmelstein, A. M. Pinto, Integrity 23(3):281-295. and G. D. Foster. 2020. Weight stigma and weight- related health: Associations of self-report measures among adults in weight management. Annals of Behavioral Medicine 54(11):904-914. August 2022 | 9

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DISCLAIMER: This Proceedings of a Workshop—in Brief has been MedTech Coalition for Metabolic Health; National Recreationprepared by EMILY A. CALLAHAN as a factual summary of what and Parks Association; Nemours Children’s Health System; Novooccurred at the meeting. The statements made are those of Nordisk; Obesity Action Coalition; Partnership for a Healthierthe rapporteur or individual workshop participants and do not America; Reinvestment Fund; Rudd Center for Food Policy andnecessarily represent the views of all workshop participants; Health; Robert Wood Johnson Foundation; SHAPE America;the planning committee; or the National Academies of Sciences, Society of Behavioral Medicine; Stop & Shop SupermarketEngineering, and Medicine. Company; The Obesity Society; Wake Forest Baptist Medical Center; and Walmart.*The National Academies of Sciences, Engineering, andMedicine’s planning committees are solely responsible for STAFF: HEATHER COOK, AMANDA NGUYEN, CYPRESS LYNX,organizing the workshop, identifying topics, and choosing and MARIAH BRUNS, Food and Nutrition Board, Health andspeakers. The responsibility for the published Proceedings of a Medicine Division, National Academies of Sciences, Engineering,Workshop—in Brief rests with the institution. and Medicine.REVIEWERS: To ensure that it meets institutional standards for For additional information regarding the workshop, visitquality and objectivity, this Proceedings of a Workshop—in was reviewed by SARA J. CZAJA, Weill Cornell Medicine, shifting-the-paradigm-targeting-structures-communications-and JOHN M. JAKICIC, University of Kansas Medical Center. and-beliefs-to-advance-practical-strategies-for-obesity-LESLIE J. SIM, National Academies of Sciences, Engineering, solutions-a-workshop.and Medicine, served as the review coordinator. Suggested citation: National Academies of Sciences,SPONSORS: This workshop was partially supported by the Engineering, and Medicine. 2022. Targeting structures,Academy of Nutrition and Dietetics; Alliance for a Healthier communications, and beliefs to advance practical strategies for obesityGeneration; American Academy of Pediatrics; American Cancer solutions: Proceedings of a workshop—in brief. Washington, DC: TheSociety; American College of Sports Medicine; American Council National Academies Press. Exercise; Blue Shield of California Foundation; GeneralMills, Inc.; The JPB Foundation; Kresge Foundation; Mars, Inc.;Health and Medicine DivisionCopyright 2022 by the National Academy of Sciences. All rights reserved.


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