Fatphobia Among Adolescents: how future health professionals perceive weight-related violence and the influence of social media

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Adolescents undergoing technical education in the health field are simultaneously vulnerable to weight-related stigma especially through social media, and in training for future health professions, where discriminatory practices may be reproduced or challenged. This study aimed to explore how adolescent students enrolled in professional technical health courses perceive fatphobia and its relationship with social media. Methods: This qualitative study was conducted with 24 adolescents aged 15 to 17 years enrolled in Nursing and Aesthetics technical programs at a public technical school in Fortaleza, Brazil. Two focus group sessions were held, one for each program, using a semi-structured guide. Sessions were audio-recorded, transcribed verbatim, and analyzed using Descending Hierarchical Classification with the IRaMuTeQ software. The analysis sought to identify thematic patterns based on the frequency and association of textual segments. The study followed established qualitative reporting criteria to ensure transparency and rigor. Results: Five thematic classes emerged from the analysis: 1. Recognition and reproduction of weight stigma; 2. Personal and witnessed experiences of fatphobia; 3. Social construction of the “ideal body”; 4. Reinterpretation of health and critical perspectives on biomedical weight-centered discourse; and 5. Influence of social media and use of digital filters. Students recognized the existence and harmful effects of weight stigma but also acknowledged reproducing stigmatizing comments and behaviors, often perceived as normalized or humorous. Students demonstrated nuanced views about the relationship between body size and health, challenging weight-centered biomedical interpretations. Social media was described as a powerful driver of unrealistic aesthetic expectations, particularly through the use of digital filters, edited images, and influencer content that intensifies self-comparison and body dissatisfaction. Conclusions: Adolescents in technical health training recognize fatphobia as both an individual and structural issue, shaped by social norms and amplified by social media. Although they express empathy toward people with larger bodies, many simultaneously reproduce weight-stigmatizing practices. Technical-vocational schools represent strategic spaces for integrating educational interventions that promote body diversity, challenge weight-based prejudice, and support the development of more inclusive future health professionals. Clinical trial number: not applicable. weight stigma adolescents social media body dissatisfaction professional training in health Figures Figure 1 INTRODUCTION Fatphobia, understood as prejudice and bias directed at people with bodies categorized as fat, impacts individuals' physical, psychological, and social health [ 1 ]. It is a form of discrimination that affects adults, children, and adolescents alike [ 2 ], and is reproduced through scientific discourse and institutional practices, manifesting in various contexts, such as educational settings [ 3 ], social media [ 4 ], and healthcare services [ 5 ]. In the healthcare field, fatphobia influences interactions between healthcare professionals and patients with fat bodies, resulting in delayed diagnoses, reduced quality of care, and negative health outcomes [ 6 ]. The use of stigmatizing language and the belief that weight is entirely controllable through individual effort compromise the therapeutic bond and hinder treatment adherence, even among children and adolescents [ 7 ]. As a result, overweight individuals often delay or avoid seeking medical care, even when faced with serious and treatable conditions, due to fear of judgment or previous negative experiences [ 8 ]. The literature indicates that professionals recognize limitations in their competencies to address larger bodies, reporting insecurity and a lack of adequate educational training [ 9 ]. Education about fatphobia and obesity is limited in both content and depth in the curricula of health professional training programs. Programs still do not adequately address the multifactorial determinants of body weight, the psychosocial implications of fatphobia, or practical strategies to reduce it [ 3 , 10 ]. Fatphobia among undergraduate health students is present even at the beginning of their studies, with negative weight stereotypes attributed primarily to personal flaws or lack of willpower [ 11 , 12 , 13 ]. A study comparing health students at different stages of their studies found that students with lower educational levels (high school) were more likely to show fatphobia than those pursuing or completing a master's degree [ 10 ]. However, a systematic literature review indicates that the influence of education on fatphobia remains inconclusive, as studies have shown conflicting results [ 14 ]. On social media, adolescents are more exposed to fatphobia, with this exposure influenced by both the time spent using the platform and the type of content consumed by this audience [ 15 ]. Furthermore, the idealization of thin bodies on social media intensifies body dissatisfaction, negatively impacting adolescents' physical and mental health [ 16 ]. Adolescents in professional training in the health field are a target group for further study, as they are most affected by social media exposure and will also be future care agents capable of reproducing or modifying fatphobia practices. Therefore, this study aimed to analyze the perceptions of adolescent students in professional technical courses in the health field regarding fatphobia and its relationship with social media. METHODS This is a qualitative study guided by the theoretical framework of Transdisciplinary Studies of Fat Corporalities in Brazil, an epistemological field that questions the structural prejudice sustained by the biomedical paradigm of obesity and proposes new ways of understanding fat bodies [ 17 , 18 ]. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used as methodological guidance to improve the structure and credibility of this study [ 19 ]. The project was approved by the Research Ethics Committee of the University of Fortaleza, under ruling No. 5,885,073. The research was conducted in the city of Fortaleza, the capital of the state of Ceará, located in the Northeast region of Brazil. Participants included students from a technical-vocational high school enrolled in Nursing and Aesthetics programs. In the state of Ceará, secondary technical training is predominantly offered by State Schools of Vocational Education (EEEPs), institutions that integrate the high school curriculum with full-time technical training, focusing on professional qualifications. Data collection was conducted in October and November 2022. The participating school was selected because it already had a prior partnership with one of the researchers and because it offered professional training courses in the health field, aligning with the study objectives. Two focus groups (FG) were conducted, one with Nursing students and the other with Aesthetics students, each composed of 12 participants, making a total of 24 students. The sessions were led by a physiotherapist, a doctoral student in Public Health, accompanied by a Scientific Initiation scholarship holder from the Physiotherapy program, who acted as observer and reporter. The inclusion criteria were: adolescents between 14 and 18 years old, regularly enrolled in the educational institution, starting in the first year of high school, regardless of gender, with parental permission. Students with any cognitive impairment were excluded. The participants were randomly selected in the classroom from among students who met the inclusion criteria, proportionally considering courses and school years. In the Nursing program, students from the first, second, and third years participated (4 per class), while in the Aesthetics program, students from the second and third years participated (6 per class). Minimum and maximum group sizes were defined as 6 to 12 participants. The focus groups took place in a private room provided by the school administration, led by a moderator and accompanied by an observer/reporter. A semi-structured script guided the discussions, addressing the following questions: "What does fatphobia mean to you, and how does it relate to your course?" "Have you ever experienced any fatphobic situations in your daily life (personal or observed)?"; "How do you perceive the use of filters on social media, and what do people try to change with them?"; "What influence does social media have on the ideal body shape?"; and "Do you consider yourself to have fatphobia?" The sessions were held separately by course, on previously scheduled dates and times, lasting an average of 75 minutes. The meetings were audio-recorded, transcribed verbatim, and stored in a secure digital environment with restricted access to the researchers. The corpus for analysis consisted of transcripts of the 24 participants' responses and was subjected to Descending Hierarchical Classification (DHC) with the aid of the IRaMuTeQ software [ 20 ]. This technique allows for the grouping of textual segments based on their frequency and statistical association (chi-square test), forming content classes that are similar to each other and distinct from others. Words with a frequency greater than four and a statistical significance of χ² > 3.84 (df = 1) were considered for interpretation [ 21 ]. RESULTS Twenty-four students participated in the study, evenly distributed between the Nursing and Aesthetics technical programs. Participants were adolescents aged between 15 and 17, predominantly female (n = 20; 83%), enrolled in the 1st to 3rd year of high school. The analytical corpus, titled "Fatphobia among Adolescents," consisted of 24 texts, totaling 363 text segments (TSs), of which 294 (80.99%) were retained by the IRaMuTeQ software for analysis. Descending Hierarchical Classification (DHC) resulted in the identification of five thematic content classes, which summarize the main discursive axes emerging from the participants' statements. Figure 1 presents the DHC dendrogram, with the class names, the most frequent words and their respective chi-square values, in addition to associated variables, when present. Figure 1 Dendrogram of the DHC corpus "Fatphobia among adolescents" Recognition and Reproduction of Weight Stigma Class 1, composed of 59 text segments (20.07%), showed nursing as an associated variable, revealing that adolescents recognize that the reproduction of discriminatory discourse and behaviors against fat people often occurs without explicit intention to offend, but rather as a reflection of established societal norms and values. This class also highlights the recognition of students' own involvement in fatphobia attitudes and the need to address this type of discrimination. We take action and don't recognize that we're being fatphobic. And with some comments we make we don't realize how wrong and harmful they are, which is why I consider myself fatphobic (P02, Nursing, female). I think because it's so "normal" for people to joke about it (fat people), I end up laughing and agreeing with fatphobic behavior. Most of the people here (professional technical course students, in general), I believe, have experienced some kind of fatphobic behavior at least once in their lives (P13, Nursing, female). If we don't assert ourselves, if we don't say that this bothers us, that this is wrong, that this isn't right, it won't stop. What's also missing is saying no, don't do that. That's why it's important for this person, this victim, to speak up. Mainly, defending yourself, because otherwise this won't stop. If you don't assert yourself, if we don't say that it's bothering you, that it's wrong, that it's not right, it won't stop (P15, Nursing, female). Experience of Fatphobia Class 2 consisted of 67 text segments (22.79%), and showed the male gender as an associated variable, gathering accounts of situations of prejudice experienced or witnessed by the students. The statements demonstrate the students' empathy when experiencing situations of fatphobia in public and family spaces, also revealing how this form of violence is normalized in everyday life and disguised as a form of humor. Yesterday, a young man was on the bus, speaking loudly for everyone on the bus to hear. He said, "Hold on, the whale is getting on." This was a conversation about an obese man who got on the bus (P21, Nursing, male). I was on the bus once, and there was a person next to me in the back seat, a little chubby, but the guy didn't want to sit next to her because he was saying that fat people smell (P23, Nursing, male). When I was a child, in my family, my mother and my aunts would tell me to stop eating because otherwise I would roll around like a ball (P07, Aesthetics, female). Social Construction of the Ideal Body Class 3, consisting of 53 text segments (18.03%), showed the nursing course as an associated variable, addressing the social perception of the "ideal body" and the exclusion of bodies that deviate from the norm. The statements highlight how society associates thinness with beauty and health, while fatness is seen as synonymous with ugliness and illness. The content of the statements highlights the participants' critical thinking regarding the difficulty of body acceptance in a context that values ​​aesthetic standardization over physical diversity and health. It's about being perfect according to their standards (valuing large breasts, a flat stomach, wide hips), which is why we're often sought out, not for health reasons, but rather in search of that standard of a flat stomach and a slim waist (P06, Aesthetics, female). The problem is that the eyes of those looking have this prejudice that fat people are ugly and thin people are beautiful (P13, Nursing, female). You can't be fat, you can't be obese. You think people won't accept you, they won't accept you if you're obese (P15, Nursing, female). The Fat Body and the Reinterpretation of Health Class 4, comprising 47 text segments (15.99%), presents the relationship between the fat body, health, and disease, problematizing biomedical discourses. The students demonstrate an understanding that body weight should not be treated as the sole indicator of health and that overweight people can maintain healthy habits and a good quality of life, reinforcing the importance of an empathetic and unbiased approach to healthcare. Obesity is a serious issue; it can lead to cardiovascular problems. However, if you like your body even if it's a little heavier and you eat a healthy diet, there's no problem. The problem is when it starts to affect your health (P13, Nursing, female). You have to lose weight to improve your health, but the person doesn't have a health problem. This happened in my family, and the person didn't have any health problems. Especially because Nursing is about empathy, and the nursing professional's job is to care for the sick person (P17, Nursing, female). Influence of social media and use of digital filters Class 5, composed of 68 text segments (23.13%), showed the female gender and nursing course as associated variables, highlighting the influence of social media in the construction and maintenance of aesthetic standards considered unattainable. Participants discussed the use of digital image filters as a common practice, related to the attempt to meet beauty expectations disseminated on social media, and the impact of constant comparison with edited images, generating feelings of inadequacy and low self-esteem. Many people use filters to slim their waists to make their bodies, buttocks, and breasts look bigger. I don't know how to take photos without filters (P01, Aesthetics, female). They post completely edited photos to attract attention, so everyone thinks, "Oh my God, I want to be like that." They choose someone, for example, Virgínia [a digital influencer from Brazil], and sell a product that won't work (P03, Aesthetics, female). And today I realize that wasn't it. I wasn't less beautiful than them. Everyone is equal. No one was better than me, and I wasn't better than them because of my body or the things people say about me (P12, Aesthetics, female). But then we have to understand that we have different bodies, different metabolisms; it's a whole different issue (P16, Nursing, female). Nowadays, I feel beautiful just the way I am, and I don't care if someone says so; I just cut them off (P13, Nursing, female). DISCUSSION Adolescents recognize the negative impacts of fatphobia and acknowledge it as a structural phenomenon, reinforced by social media, while also admitting to reproducing fatphobic discourses. This duality of perceptions highlights the internalization of aesthetic standards and a developing critical consciousness, possibly influenced by adolescence itself and the educational context in health programs. Students identified that fatphobic behaviors are often naturalized and interpreted as "jokes" or harmless comments. This situation is similar to Pierre Bourdieu's [ 22 ] concept of symbolic violence, which describes subtle forms of domination based on the unconscious acceptance of values ​​and hierarchies imposed by the dominant culture. In the context of fatphobis, this violence is related to practices such as attributing negative characteristics to people with fat bodies (e.g., lack of self-control or incompetence), which become socially acceptable and even legitimized [ 23 ]. Reports of personal or witnessed experiences of discrimination in public and family spaces reinforce that fatphobia acts as a form of everyday violence. Family members, especially parents, and siblings, can be common sources of fatphobia, often manifested through criticism, judgment, jokes, and weight-related teasing [ 24 ]. In public spaces, the lack of physical adaptations causes embarrassment and limits participation in common activities such as access to health services, leisure, and transportation. Therefore, overweight people often avoid public environments or situations where they may be exposed to judgment or physical inadequacy [ 8 , 25 , 26 ]. The presence of empathy and indignation in situations of fatphobia in the adolescents' statements demonstrates that awareness exists, albeit in its infancy, and can be strengthened by educational initiatives in the educational environment, focused on respect for body diversity [ 17 ]. Although the participants critically acknowledge fatphobia, they also reproduce the same discourses they seek to deconstruct. This situation is consistent with adolescence, when body identity is still being constructed and is influenced by social norms and group belonging [ 27 ]. The ideal of a thin and curvy body is presented in the adolescents' statements. This standard, known as slim-thick, is considered more harmful to mental health than the traditional thin ideal, as it requires the simultaneous pursuit of thinness and curves, a goal difficult to achieve without invasive interventions or unhealthy practices [ 28 ]. The search for this type of body is influenced by advertising, social media and digital influencers, leading teenagers, especially females, to seek not only thinness, but also curves in specific areas of the body [ 29 ]. By pointing out that weight should not be the sole indicator of health, adolescents demonstrate an affinity with approaches such as Health At Every Size (HAES), which proposes a non-pathologizing understanding of fat bodies and emphasizes person-centered care rather than weight [ 30 ]. Body weight alone is not a reliable marker of health. Weight-based measures, such as the Body Mass Index (BMI), are independent of key metabolic markers (such as blood pressure, lipid profile, and glycated hemoglobin), thus, people with the same weight may present different metabolic health profiles [ 31 ]. Strategies that prioritize healthy behaviors and well-being are considered more effective for promoting comprehensive health [ 30 ]. Adolescents report routinely using digital filters on social media to enhance desired physical characteristics, indicating a link between the beauty standards promoted on these platforms and dissatisfaction with self-image. The practice of manipulating photos with filters influences adolescents to negatively compare their bodies to edited versions of themselves or others [ 32 ]. Digital influencers intensify this process by promoting the "ideal body" as a consumer product, supposedly attainable through the use of weight-loss products and restrictive eating habits, and associating it with health, beauty, and happiness [ 33 ]. Constant exposure to this content contributes to the naturalization of unrealistic aesthetic standards, hindering the appreciation of body diversity and perpetuating fatphobia [ 34 ]. It is possible to observe the attempt to resignify one's own image among students, as indicated by the statements that recognize their own beauty and the natural diversity of bodies. Body-positive content (a movement that promotes self-compassion and body acceptance) is growing on social media and is associated with increased positive self-image thinking [ 35 , 36 , 37 ]. A study with adolescents and young adults revealed that these groups recognize the relevance of body-positive posts for self-acceptance, although some still demonstrate resistance to this type of content due to internalized beauty ideals [ 38 ]. This coexistence of discourses highlights the complexity of social media interactions and their contribution to the formation of divergent perceptions regarding the body. Like all qualitative research, this study does not seek to generalize the results, but rather to gain a deeper understanding of the perceptions of adolescents undergoing technical training in the health field regarding fatphobia. The sample restricted to a single educational institution limits the generalizability of the findings to other social and cultural contexts. The use of focus groups and analysis using the IRaMuTeQ software favored greater depth in the interpretation of the statements, revealing symbolic aspects of fatphobia that would be difficult to capture through quantitative approaches. Conclusion Adolescents undergoing technical training in healthcare recognize the existence and impacts of fatphobia, both individually and structurally. While demonstrating critical awareness of the discrimination faced by fat people, participants also recognize their own participation in the reproduction of fatphobic practices. The influence of social media, particularly through the use of filters and the propagation of difficult-to-achieve aesthetic standards, was recognized as an important factor in the construction of self-image and the perception of the ideal body, reinforcing discriminatory behaviors. The adolescents' statements highlight the need for educational approaches that promote respect for body diversity and the deconstruction of fatphobia. Vocational schools, as spaces for professional and critical training, can be a strategic environment for developing more inclusive and anti-discriminatory care practices. It is essential that these institutions incorporate content and pedagogical practices that enable future professionals to recognize and avoid fatphobic practices within healthcare settings. Declarations Ethics approval and consent to participate The project was approved by the Research Ethics Committee of the University of Fortaleza, under ruling No. 5,885,073., and all participants provided written informed consent in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests Funding This research received no funding. Authors' contributions CSVF contributed to data collection, performed formal analysis, and drafted the manuscript. BBB contributed to writing the original draft and to the review and editing process. CMAPM was responsible for data collection and participated in revising the manuscript. GMP, LLS, and LRP contributed to writing the manuscript and provided critical review and editing. GMP also analyzed the qualitative data and contributed to both the manuscript writing and the interpretation of the findings. AAFC contributed to writing the manuscript and critical review and editing, coordinated the research project, and supervised all stages of the study. All authors have read and approved the final version of the manuscript and agree to be accountable for all aspects of the work. Acknowledgements We would like to thank the participants in this study. References Tomiyama AJ, Carr D, Granberg EM, Major B, Robinson E, Sutin AR, et al. 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Cite Share Download PDF Status: Published Journal Publication published 04 Feb, 2026 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 30 Dec, 2025 Reviews received at journal 29 Dec, 2025 Reviews received at journal 22 Dec, 2025 Reviewers agreed at journal 21 Dec, 2025 Reviewers agreed at journal 21 Dec, 2025 Reviewers agreed at journal 19 Dec, 2025 Reviewers invited by journal 19 Dec, 2025 Editor invited by journal 25 Nov, 2025 Editor assigned by journal 24 Nov, 2025 Submission checks completed at journal 24 Nov, 2025 First submitted to journal 14 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":161475,"visible":true,"origin":"","legend":"\u003cp\u003eDendrogram of the DHC corpus \"Fatphobia among adolescents\"\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8116421/v1/3135b031a92d56ca856a055a.jpg"},{"id":102234378,"identity":"4816b8b4-00d2-4a79-9822-4608a6825948","added_by":"auto","created_at":"2026-02-09 16:11:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":739078,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8116421/v1/00a660ec-729e-47ba-8fbc-668481f8519c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Fatphobia Among Adolescents: how future health professionals perceive weight-related violence and the influence of social media","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eFatphobia, understood as prejudice and bias directed at people with bodies categorized as fat, impacts individuals' physical, psychological, and social health [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is a form of discrimination that affects adults, children, and adolescents alike [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], and is reproduced through scientific discourse and institutional practices, manifesting in various contexts, such as educational settings [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], social media [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], and healthcare services [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the healthcare field, fatphobia influences interactions between healthcare professionals and patients with fat bodies, resulting in delayed diagnoses, reduced quality of care, and negative health outcomes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The use of stigmatizing language and the belief that weight is entirely controllable through individual effort compromise the therapeutic bond and hinder treatment adherence, even among children and adolescents [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. As a result, overweight individuals often delay or avoid seeking medical care, even when faced with serious and treatable conditions, due to fear of judgment or previous negative experiences [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe literature indicates that professionals recognize limitations in their competencies to address larger bodies, reporting insecurity and a lack of adequate educational training [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Education about fatphobia and obesity is limited in both content and depth in the curricula of health professional training programs. Programs still do not adequately address the multifactorial determinants of body weight, the psychosocial implications of fatphobia, or practical strategies to reduce it [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFatphobia among undergraduate health students is present even at the beginning of their studies, with negative weight stereotypes attributed primarily to personal flaws or lack of willpower [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A study comparing health students at different stages of their studies found that students with lower educational levels (high school) were more likely to show fatphobia than those pursuing or completing a master's degree [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, a systematic literature review indicates that the influence of education on fatphobia remains inconclusive, as studies have shown conflicting results [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn social media, adolescents are more exposed to fatphobia, with this exposure influenced by both the time spent using the platform and the type of content consumed by this audience [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Furthermore, the idealization of thin bodies on social media intensifies body dissatisfaction, negatively impacting adolescents' physical and mental health [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdolescents in professional training in the health field are a target group for further study, as they are most affected by social media exposure and will also be future care agents capable of reproducing or modifying fatphobia practices. Therefore, this study aimed to analyze the perceptions of adolescent students in professional technical courses in the health field regarding fatphobia and its relationship with social media.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis is a qualitative study guided by the theoretical framework of Transdisciplinary Studies of Fat Corporalities in Brazil, an epistemological field that questions the structural prejudice sustained by the biomedical paradigm of obesity and proposes new ways of understanding fat bodies [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used as methodological guidance to improve the structure and credibility of this study [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The project was approved by the Research Ethics Committee of the University of Fortaleza, under ruling No. 5,885,073.\u003c/p\u003e \u003cp\u003eThe research was conducted in the city of Fortaleza, the capital of the state of Cear\u0026aacute;, located in the Northeast region of Brazil. Participants included students from a technical-vocational high school enrolled in Nursing and Aesthetics programs. In the state of Cear\u0026aacute;, secondary technical training is predominantly offered by State Schools of Vocational Education (EEEPs), institutions that integrate the high school curriculum with full-time technical training, focusing on professional qualifications.\u003c/p\u003e \u003cp\u003eData collection was conducted in October and November 2022. The participating school was selected because it already had a prior partnership with one of the researchers and because it offered professional training courses in the health field, aligning with the study objectives.\u003c/p\u003e \u003cp\u003eTwo focus groups (FG) were conducted, one with Nursing students and the other with Aesthetics students, each composed of 12 participants, making a total of 24 students. The sessions were led by a physiotherapist, a doctoral student in Public Health, accompanied by a Scientific Initiation scholarship holder from the Physiotherapy program, who acted as observer and reporter.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were: adolescents between 14 and 18 years old, regularly enrolled in the educational institution, starting in the first year of high school, regardless of gender, with parental permission. Students with any cognitive impairment were excluded. The participants were randomly selected in the classroom from among students who met the inclusion criteria, proportionally considering courses and school years. In the Nursing program, students from the first, second, and third years participated (4 per class), while in the Aesthetics program, students from the second and third years participated (6 per class). Minimum and maximum group sizes were defined as 6 to 12 participants. The focus groups took place in a private room provided by the school administration, led by a moderator and accompanied by an observer/reporter. A semi-structured script guided the discussions, addressing the following questions:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e\"What does fatphobia mean to you, and how does it relate to your course?\"\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e\"Have you ever experienced any fatphobic situations in your daily life (personal or observed)?\";\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e\"How do you perceive the use of filters on social media, and what do people try to change with them?\";\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e\"What influence does social media have on the ideal body shape?\"; and\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e\"Do you consider yourself to have fatphobia?\"\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe sessions were held separately by course, on previously scheduled dates and times, lasting an average of 75 minutes. The meetings were audio-recorded, transcribed verbatim, and stored in a secure digital environment with restricted access to the researchers. The corpus for analysis consisted of transcripts of the 24 participants' responses and was subjected to Descending Hierarchical Classification (DHC) with the aid of the IRaMuTeQ software [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This technique allows for the grouping of textual segments based on their frequency and statistical association (chi-square test), forming content classes that are similar to each other and distinct from others. Words with a frequency greater than four and a statistical significance of χ\u0026sup2; \u0026gt; 3.84 (df\u0026thinsp;=\u0026thinsp;1) were considered for interpretation [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eTwenty-four students participated in the study, evenly distributed between the Nursing and Aesthetics technical programs. Participants were adolescents aged between 15 and 17, predominantly female (n\u0026thinsp;=\u0026thinsp;20; 83%), enrolled in the 1st to 3rd year of high school.\u003c/p\u003e \u003cp\u003eThe analytical corpus, titled \"Fatphobia among Adolescents,\" consisted of 24 texts, totaling 363 text segments (TSs), of which 294 (80.99%) were retained by the IRaMuTeQ software for analysis. Descending Hierarchical Classification (DHC) resulted in the identification of five thematic content classes, which summarize the main discursive axes emerging from the participants' statements. Figure\u0026nbsp;1 presents the DHC dendrogram, with the class names, the most frequent words and their respective chi-square values, in addition to associated variables, when present.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 1\u003c/b\u003e \u003c/p\u003e \u003cp\u003eDendrogram of the DHC corpus \"Fatphobia among adolescents\"\u003c/p\u003e\n\u003ch3\u003eRecognition and Reproduction of Weight Stigma\u003c/h3\u003e\n\u003cp\u003eClass 1, composed of 59 text segments (20.07%), showed nursing as an associated variable, revealing that adolescents recognize that the reproduction of discriminatory discourse and behaviors against fat people often occurs without explicit intention to offend, but rather as a reflection of established societal norms and values. This class also highlights the recognition of students' own involvement in fatphobia attitudes and the need to address this type of discrimination.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eWe take action and don't recognize that we're being fatphobic. And with some comments we make we don't realize how wrong and harmful they are, which is why I consider myself fatphobic (P02, Nursing, female).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eI think because it's so \"normal\" for people to joke about it (fat people), I end up laughing and agreeing with fatphobic behavior. Most of the people here (professional technical course students, in general), I believe, have experienced some kind of fatphobic behavior at least once in their lives (P13, Nursing, female).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eIf we don't assert ourselves, if we don't say that this bothers us, that this is wrong, that this isn't right, it won't stop. What's also missing is saying no, don't do that. That's why it's important for this person, this victim, to speak up. Mainly, defending yourself, because otherwise this won't stop. If you don't assert yourself, if we don't say that it's bothering you, that it's wrong, that it's not right, it won't stop (P15, Nursing, female).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eExperience of Fatphobia\u003c/h3\u003e\n\u003cp\u003eClass 2 consisted of 67 text segments (22.79%), and showed the male gender as an associated variable, gathering accounts of situations of prejudice experienced or witnessed by the students. The statements demonstrate the students' empathy when experiencing situations of fatphobia in public and family spaces, also revealing how this form of violence is normalized in everyday life and disguised as a form of humor.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eYesterday, a young man was on the bus, speaking loudly for everyone on the bus to hear. He said, \"Hold on, the whale is getting on.\" This was a conversation about an obese man who got on the bus (P21, Nursing, male).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eI was on the bus once, and there was a person next to me in the back seat, a little chubby, but the guy didn't want to sit next to her because he was saying that fat people smell (P23, Nursing, male).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eWhen I was a child, in my family, my mother and my aunts would tell me to stop eating because otherwise I would roll around like a ball (P07, Aesthetics, female).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eSocial Construction of the Ideal Body\u003c/h3\u003e\n\u003cp\u003eClass 3, consisting of 53 text segments (18.03%), showed the nursing course as an associated variable, addressing the social perception of the \"ideal body\" and the exclusion of bodies that deviate from the norm. The statements highlight how society associates thinness with beauty and health, while fatness is seen as synonymous with ugliness and illness. The content of the statements highlights the participants' critical thinking regarding the difficulty of body acceptance in a context that values ​​aesthetic standardization over physical diversity and health.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eIt's about being perfect according to their standards (valuing large breasts, a flat stomach, wide hips), which is why we're often sought out, not for health reasons, but rather in search of that standard of a flat stomach and a slim waist (P06, Aesthetics, female).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eThe problem is that the eyes of those looking have this prejudice that fat people are ugly and thin people are beautiful (P13, Nursing, female).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eYou can't be fat, you can't be obese. You think people won't accept you, they won't accept you if you're obese (P15, Nursing, female).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eThe Fat Body and the Reinterpretation of Health\u003c/h3\u003e\n\u003cp\u003eClass 4, comprising 47 text segments (15.99%), presents the relationship between the fat body, health, and disease, problematizing biomedical discourses. The students demonstrate an understanding that body weight should not be treated as the sole indicator of health and that overweight people can maintain healthy habits and a good quality of life, reinforcing the importance of an empathetic and unbiased approach to healthcare.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eObesity is a serious issue; it can lead to cardiovascular problems. However, if you like your body even if it's a little heavier and you eat a healthy diet, there's no problem. The problem is when it starts to affect your health (P13, Nursing, female).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eYou have to lose weight to improve your health, but the person doesn't have a health problem. This happened in my family, and the person didn't have any health problems. Especially because Nursing is about empathy, and the nursing professional's job is to care for the sick person (P17, Nursing, female).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eInfluence of social media and use of digital filters\u003c/h2\u003e \u003cp\u003eClass 5, composed of 68 text segments (23.13%), showed the female gender and nursing course as associated variables, highlighting the influence of social media in the construction and maintenance of aesthetic standards considered unattainable. Participants discussed the use of digital image filters as a common practice, related to the attempt to meet beauty expectations disseminated on social media, and the impact of constant comparison with edited images, generating feelings of inadequacy and low self-esteem.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eMany people use filters to slim their waists to make their bodies, buttocks, and breasts look bigger. I don't know how to take photos without filters (P01, Aesthetics, female).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eThey post completely edited photos to attract attention, so everyone thinks, \"Oh my God, I want to be like that.\" They choose someone, for example, Virg\u0026iacute;nia\u003c/em\u003e [a digital influencer from Brazil], \u003cem\u003eand sell a product that won't work (P03, Aesthetics, female).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003eAnd today I realize that wasn't it. I wasn't less beautiful than them. Everyone is equal. No one was better than me, and I wasn't better than them because of my body or the things people say about me (P12, Aesthetics, female).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eBut then we have to understand that we have different bodies, different metabolisms; it's a whole different issue (P16, Nursing, female).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eNowadays, I feel beautiful just the way I am, and I don't care if someone says so; I just cut them off (P13, Nursing, female).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAdolescents recognize the negative impacts of fatphobia and acknowledge it as a structural phenomenon, reinforced by social media, while also admitting to reproducing fatphobic discourses. This duality of perceptions highlights the internalization of aesthetic standards and a developing critical consciousness, possibly influenced by adolescence itself and the educational context in health programs.\u003c/p\u003e \u003cp\u003eStudents identified that fatphobic behaviors are often naturalized and interpreted as \"jokes\" or harmless comments. This situation is similar to Pierre Bourdieu's [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] concept of symbolic violence, which describes subtle forms of domination based on the unconscious acceptance of values ​​and hierarchies imposed by the dominant culture. In the context of fatphobis, this violence is related to practices such as attributing negative characteristics to people with fat bodies (e.g., lack of self-control or incompetence), which become socially acceptable and even legitimized [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Reports of personal or witnessed experiences of discrimination in public and family spaces reinforce that fatphobia acts as a form of everyday violence. Family members, especially parents, and siblings, can be common sources of fatphobia, often manifested through criticism, judgment, jokes, and weight-related teasing [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In public spaces, the lack of physical adaptations causes embarrassment and limits participation in common activities such as access to health services, leisure, and transportation. Therefore, overweight people often avoid public environments or situations where they may be exposed to judgment or physical inadequacy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The presence of empathy and indignation in situations of fatphobia in the adolescents' statements demonstrates that awareness exists, albeit in its infancy, and can be strengthened by educational initiatives in the educational environment, focused on respect for body diversity [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Although the participants critically acknowledge fatphobia, they also reproduce the same discourses they seek to deconstruct. This situation is consistent with adolescence, when body identity is still being constructed and is influenced by social norms and group belonging [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe ideal of a thin and curvy body is presented in the adolescents' statements. This standard, known as slim-thick, is considered more harmful to mental health than the traditional thin ideal, as it requires the simultaneous pursuit of thinness and curves, a goal difficult to achieve without invasive interventions or unhealthy practices [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The search for this type of body is influenced by advertising, social media and digital influencers, leading teenagers, especially females, to seek not only thinness, but also curves in specific areas of the body [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBy pointing out that weight should not be the sole indicator of health, adolescents demonstrate an affinity with approaches such as Health At Every Size (HAES), which proposes a non-pathologizing understanding of fat bodies and emphasizes person-centered care rather than weight [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Body weight alone is not a reliable marker of health. Weight-based measures, such as the Body Mass Index (BMI), are independent of key metabolic markers (such as blood pressure, lipid profile, and glycated hemoglobin), thus, people with the same weight may present different metabolic health profiles [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Strategies that prioritize healthy behaviors and well-being are considered more effective for promoting comprehensive health [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdolescents report routinely using digital filters on social media to enhance desired physical characteristics, indicating a link between the beauty standards promoted on these platforms and dissatisfaction with self-image. The practice of manipulating photos with filters influences adolescents to negatively compare their bodies to edited versions of themselves or others [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Digital influencers intensify this process by promoting the \"ideal body\" as a consumer product, supposedly attainable through the use of weight-loss products and restrictive eating habits, and associating it with health, beauty, and happiness [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Constant exposure to this content contributes to the naturalization of unrealistic aesthetic standards, hindering the appreciation of body diversity and perpetuating fatphobia [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is possible to observe the attempt to resignify one's own image among students, as indicated by the statements that recognize their own beauty and the natural diversity of bodies. Body-positive content (a movement that promotes self-compassion and body acceptance) is growing on social media and is associated with increased positive self-image thinking [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. A study with adolescents and young adults revealed that these groups recognize the relevance of body-positive posts for self-acceptance, although some still demonstrate resistance to this type of content due to internalized beauty ideals [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. This coexistence of discourses highlights the complexity of social media interactions and their contribution to the formation of divergent perceptions regarding the body.\u003c/p\u003e \u003cp\u003eLike all qualitative research, this study does not seek to generalize the results, but rather to gain a deeper understanding of the perceptions of adolescents undergoing technical training in the health field regarding fatphobia. The sample restricted to a single educational institution limits the generalizability of the findings to other social and cultural contexts. The use of focus groups and analysis using the IRaMuTeQ software favored greater depth in the interpretation of the statements, revealing symbolic aspects of fatphobia that would be difficult to capture through quantitative approaches.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAdolescents undergoing technical training in healthcare recognize the existence and impacts of fatphobia, both individually and structurally. While demonstrating critical awareness of the discrimination faced by fat people, participants also recognize their own participation in the reproduction of fatphobic practices. The influence of social media, particularly through the use of filters and the propagation of difficult-to-achieve aesthetic standards, was recognized as an important factor in the construction of self-image and the perception of the ideal body, reinforcing discriminatory behaviors.\u003c/p\u003e \u003cp\u003eThe adolescents' statements highlight the need for educational approaches that promote respect for body diversity and the deconstruction of fatphobia. Vocational schools, as spaces for professional and critical training, can be a strategic environment for developing more inclusive and anti-discriminatory care practices. It is essential that these institutions incorporate content and pedagogical practices that enable future professionals to recognize and avoid fatphobic practices within healthcare settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe project was approved by the Research Ethics Committee of the University of Fortaleza, under ruling No. 5,885,073., and all participants provided written informed consent in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCSVF contributed to data collection, performed formal analysis, and drafted the manuscript. BBB contributed to writing the original draft and to the review and editing process. CMAPM was responsible for data collection and participated in revising the manuscript. GMP, LLS, and LRP contributed to writing the manuscript and provided critical review and editing. GMP also analyzed the qualitative data and contributed to both the manuscript writing and the interpretation of the findings. AAFC contributed to writing the manuscript and critical review and editing, coordinated the research project, and supervised all stages of the study. All authors have read and approved the final version of the manuscript and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the participants in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTomiyama AJ, Carr D, Granberg EM, Major B, Robinson E, Sutin AR, et al. How and why weight stigma drives the obesity \u0026lsquo;epidemic\u0026rsquo; and harms health. BMC Med. 2018;16:1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12916-018-1116-5\u003c/span\u003e\u003cspan address=\"10.1186/s12916-018-1116-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, et al. 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Body Image. 2025;54:101938. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.bodyim.2025.101938\u003c/span\u003e\u003cspan address=\"10.1016/j.bodyim.2025.101938\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"weight stigma, adolescents, social media, body dissatisfaction, professional training in health","lastPublishedDoi":"10.21203/rs.3.rs-8116421/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8116421/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Fatphobia is a pervasive form of discrimination that negatively affects physical, psychological, and social well-being. Adolescents undergoing technical education in the health field are simultaneously vulnerable to weight-related stigma especially through social media, and in training for future health professions, where discriminatory practices may be reproduced or challenged. This study aimed to explore how adolescent students enrolled in professional technical health courses perceive fatphobia and its relationship with social media.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis qualitative study was conducted with 24 adolescents aged 15 to 17 years enrolled in Nursing and Aesthetics technical programs at a public technical school in Fortaleza, Brazil. Two focus group sessions were held, one for each program, using a semi-structured guide. Sessions were audio-recorded, transcribed verbatim, and analyzed using Descending Hierarchical Classification with the IRaMuTeQ software. The analysis sought to identify thematic patterns based on the frequency and association of textual segments. The study followed established qualitative reporting criteria to ensure transparency and rigor.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eFive thematic classes emerged from the analysis: 1. Recognition and reproduction of weight stigma; 2. Personal and witnessed experiences of fatphobia; 3. Social construction of the “ideal body”; 4. Reinterpretation of health and critical perspectives on biomedical weight-centered discourse; and 5. Influence of social media and use of digital filters. Students recognized the existence and harmful effects of weight stigma but also acknowledged reproducing stigmatizing comments and behaviors, often perceived as normalized or humorous. Students demonstrated nuanced views about the relationship between body size and health, challenging weight-centered biomedical interpretations. Social media was described as a powerful driver of unrealistic aesthetic expectations, particularly through the use of digital filters, edited images, and influencer content that intensifies self-comparison and body dissatisfaction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eAdolescents in technical health training recognize fatphobia as both an individual and structural issue, shaped by social norms and amplified by social media. Although they express empathy toward people with larger bodies, many simultaneously reproduce weight-stigmatizing practices. Technical-vocational schools represent strategic spaces for integrating educational interventions that promote body diversity, challenge weight-based prejudice, and support the development of more inclusive future health professionals.\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e","manuscriptTitle":"Fatphobia Among Adolescents: how future health professionals perceive weight-related violence and the influence of social media","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 00:20:30","doi":"10.21203/rs.3.rs-8116421/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-30T06:42:19+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-29T14:37:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-22T14:18:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"157392331862445653178691414859991158937","date":"2025-12-21T15:17:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"56989827628621456972775438669587330582","date":"2025-12-21T13:26:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158713731683840196635343573416378808522","date":"2025-12-19T13:53:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-19T12:50:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-25T13:50:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-25T02:40:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-25T02:40:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-11-14T15:11:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"922c349d-14b0-409e-9ce0-daec9cbcb323","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T16:07:01+00:00","versionOfRecord":{"articleIdentity":"rs-8116421","link":"https://doi.org/10.1186/s12909-026-08747-1","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2026-02-04 15:59:49","publishedOnDateReadable":"February 4th, 2026"},"versionCreatedAt":"2025-12-30 00:20:30","video":"","vorDoi":"10.1186/s12909-026-08747-1","vorDoiUrl":"https://doi.org/10.1186/s12909-026-08747-1","workflowStages":[]},"version":"v1","identity":"rs-8116421","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8116421","identity":"rs-8116421","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}