Comparing Self-Perceptions, Meta-Perceptions, and Peer Judgments of the Academic Experience of Autistic and Non-Autistic University Students.

Weight inclusivity is an emerging approach to healthcare, emphasizing that everyone can achieve health and well-being irrespective of their weight. This approach was developed to shift the focus from weight-normative approaches that prioritize weight management to an emphasis on overall health promotion. It also responds to research demonstrating that restrictive eating and dieting may increase risks for disordered eating behaviors, weight cycling, and heightened instances of medical, societal, and internalized weight stigma. There are several models and frameworks that are grounded in weight inclusivity including Health in Every Respect, Physical Activity in Every Size, and Weight-Inclusive Patient Care Practices. However, one that is used among weight-inclusive (WI) clinicians is the Health at Every Size (HAES) Framework of Care, which was developed by the Association for Size Diversity and Health. This framework was designed to support healthcare providers implementing HAES principles. These principles encourage body acceptance as opposed to weight loss or maintenance, reliance on internal signals of hunger and satiety rather than dietary restriction, and active embodiment, as opposed to structured exercise. Since the evolution of WI, HAES has become a practice among clinicians in the eating disorders and dietetics field. Programs with a WI approach have demonstrated clinical and statistical improvements in a range of behavioral (e.g. disordered eating behaviors), physiological (e.g., blood pressure, cholesterol), and psychological (e.g., improved mental health) outcomes, including weight stabilization and weight loss. For example, in a systematic review, WI interventions were found to improve cardiometabolic markers such as blood glucose, low-density lipoprotein cholesterol, and systolic blood pressure, in addition to improvements in behavioral measures such as physical activity and emotional eating. Furthermore, while Ulian and colleagues found that the most marked cardiovascular and quality of life improvements were in participants who lost weight throughout the course of a WI intervention, these improvements were significant even in participants who had not lost weight. Of the participants who had maintained or increased bodyweight, 34% experienced improvements in cardiometabolic risk, and 73% experienced improvements in quality of life. Moreover, Bégin and colleagues found that women participating in a WI intervention experienced significant improvements in psychological measures such as increased self-esteem and decreased depression in addition to improvements in disordered eating behaviors. Weight -inclusivity has also been shown to reduce internalized weight stigma and weight bias. This approach contributes to less client shame within the healthcare system and can promote program adherence compared to weight-normative approaches that perpetuate dieting. Despite these gains, there are still several limitations to address to ensure the approach meets the needs of diverse populations. One challenge with weight inclusivity is the limited guidance it provides to those experiencing multiple forms of oppression or intersectionality. People experience the world and the repercussions of their weight differently based on their overlapping identity markers, such as race and ethnicity, gender, sexual orientation, ability, and class. Individuals facing greater social disadvantages tend to experience more severe health disparities and encounter less favorable interactions with their healthcare providers compared to their more socially advantaged counterparts. This may increase vulnerability to chronic diseases and may undermine personal preventive health measures and behaviors. For example, in a longitudinal study examining intersectional trends in weight gain, those who were most socially disadvantaged related to race, gender, and socioeconomic status experienced more significant weight gain over time compared to those with the least social disadvantage. Thus, those with multiple marginalized identities may experience more severe consequences related to the experience of living with excess weight, which may shift their motivations and desires related to weight loss or weight management. Current WI approaches do not discuss or provide guidance on this distinction.