The association between stigma consciousness and weight stigma, psychological well-being, positive body image, and eating behaviors.

Weight Bias Internalization Statistically Mediates the Association Between Positive Body Image and Intuitive Eating: A Cross-Sectional Study.

The bulk of weight stigma research examines how weight stigma contributes to negative body image (e.g., body dissatisfaction); however, few studies have explored how weight stigma relates to positive body image (e.g., body appreciation). Longitudinal examinations of the relationships between these constructs can answer important questions to inform intervention development, for example: does holding appreciation for one’s body provide protection against weight stigma? To investigate, we modelled the longitudinal bidirectional relationships of positive body image and weight stigma among 394 sexual minority (e.g., gay, bisexual) men. This is a secondary analysis of a subset of data from a large cohort study of sexual minority men’s body image and has been pre-registered on the Open Science Framework (https://osf.io/p9rk8). We found that internalized weight bias inversely predicted body appreciation over time: men who had low levels of internalized weight bias (relative to others) experienced increases in body appreciation at the next timepoint (ß=-0.30). Body appreciation did not longitudinally predict internalized weight bias. Our results suggest that initiatives to decrease internalized weight bias may be an avenue for enhancing sexual minority men’s appreciation of their bodies. Analyses are ongoing and will be expanded upon to explore the relationships between additional facets weight stigma (e.g., explicit weight bias) and positive body image (e.g., functionality appreciation).

The role of body appreciation, weight bias internalization, and disordered eating behaviors among presurgical bariatric patients.

The relationship between weight stigma and eating behavior is explained by weight bias internalization and psychological distress

A meta-analysis of associations between weight bias internalization and conceptually-related correlates: A step towards improving construct validity

The newly developed Fat Attitudes Assessment Toolkit was designed to capture facets of weight stigma-related phenomena that are consistent with Fat Acceptance beliefs and attitudes. The goal of the current investigation was to examine whether attitudes and beliefs consistent with the Fat Acceptance movement are associated with weight stigma-related constructs and or psychological well-being. Using a Qualtrics panel, we report on 295 individuals with an increased likelihood of experiencing weight stigma and internalizing weight bias (69.2% White; M age = 50.0, SD age = 16.6). We assessed Fat Acceptance attitudes and beliefs, weight stigma, internalized weight bias (IWB), experienced weight stigma (EWS), depression, and self-esteem via an online survey. Results showed that higher Fat Acceptance attitudes and beliefs were inversely associated with weight stigma. Additionally, higher Fat Acceptance attitudes and beliefs were only modestly associated with IWB and EWS. Fat Acceptance was not significantly associated with depressive symptoms and self-esteem and there was only modest evidence of moderation between EWS and Fat Acceptance predicting depressive symptoms. Further study is needed on novel Fat Acceptance measures, as well as qualitative research to construct an accurate depiction of the movement.

Prejudice, explicit bigotry, and implicit bias have become regular topics of national discourse in our current social and political environments. These discussions have included highly publicized examples of weight-based shaming (1), an unfortunate and frequent symptom of systemic weight stigmatization and discrimination in the United States. Despite increased public attention to weight stigma, few appreciate its extent and damaging impact on health. Weight-based stigmatization is a pervasive yet under-recognized health issue prevalent even in close interpersonal relationships, including parents, spouses, friends, teachers, and healthcare providers (2). Stemming in part from oversimplified and inaccurate beliefs about weight and obesity, weight stigma leads to societal devaluation, discrimination, and rejection of individuals with obesity and excess weight. In addition to damaging consequences for the mental health of those targeted, weight stigma adds insult to the direct injury of obesity, causing physiological stress, weight gain, disordered eating, and other maladaptive behaviors, and may increase mortality (3, 4). There is likely a bidirectional relationship between obesity and weight stigma; discrimination is a prominent consequence of living with obesity, and, paradoxically to some, experiencing weight stigma can contribute to further progression of obesity. Weight stigma may mediate relationships between excess weight and a range of negative health outcomes attributed to obesity, including decreased quality of life. In recent years, weight bias internalization (WBI)—self-directed shaming and negative weight-related attitudes and stereotypes about oneself—has been studied as a phenomenon distinct from experiencing stigma, and it may be particularly damaging to health and wellbeing. Epidemiologic and experimental evidence of the harms of WBI is mounting, including poorer self-reported health and health-related quality of life, binge eating, and maladaptive health behaviors, with some studies suggesting that WBI may have more negative effects than objectively stigmatizing events alone (5, 6). It should not be surprising that WBI is so pivotal, as modern psychology demonstrates that the meaning we assign to external events, not the objective events themselves, determine our emotional reactions and health outcomes. The article by Pearl and colleagues (7) in this issue of Obesity advances our limited understanding of WBI as a risk factor for adverse health outcomes, offering new insights about WBI and cardiometabolic risk factors. Among 178 weight loss treatment-seeking adults with obesity, those with higher levels of WBI (measured using the Weight Bias Internalization Scale) had 46% increased odds of meeting criteria for metabolic syndrome (often referred to interchangeably with "pre-diabetes"), a conglomerate of cardiovascular disease risk factors that strongly increases the risk for diabetes, heart disease, and stroke. Although the authors cautiously reported this result as nonsignificant (P = 0.052), the trend is compelling; given the sample size, a slightly altered response from a single participant could have shifted the result to significance. Analyzed categorically, individuals in the highest tertile of WBI, compared with the lowest tertile, had three times increased odds of metabolic syndrome (P = 0.039). The authors hypothesize that self-stigmatizing may increase physiological stress and arousal, which in turn increases risk for metabolic abnormalities and unhealthy coping strategies that promote adverse health. Further study, including more diverse samples, will be important to confirm and expand on these results. Two-thirds of Pearl's sample was composed of African-American individuals, who have lower propensity to WBI, and nearly 90% were women. Notably, the participants had surprisingly low metabolic risk, with just 32% having metabolic syndrome, less than half the expected amount for populations with obesity. Further studies should evaluate a wider range of baseline health status. The authors appropriately call for larger-scale and longitudinal investigations to include WBI assessment, so that future research can identify interrelationships between weight stigma and WBI covariates and further evaluate moderating and mediating relationships. Important in these efforts will be research to identify specific biological pathways through which WBI may lead to adverse physical health outcomes. Finally, despite the importance of developing more precise research data on weight stigma and WBI, it is not too soon to call for prioritizing societal and individual interventions for stigma prevention and treatment. Obesity treatment must go beyond weight loss. Clinical assessment for patients with obesity should routinely include experiences of stigma, shame, and WBI. Treatment should go beyond weight loss modalities to address the mental and physical effects of living a life with obesity, including shame and stigma reduction.

This study aimed to investigate the relationships between weight self-stigma, weight bias internalization, eating attitudes, and body appreciation in young adults, and to ascertain the distinct impact of these variables on body appreciation. A cross-sectional study was carried out including young adults aged 19 to 35 years, comprising 69.6% females and 30.4% males. Participants completed a questionnaire evaluating weight self-stigma, internalization of weight bias, eating attitudes, and body appreciation. Hierarchical multiple regression analyses were used to assess the additional impacts of weight-related stigma and eating attitudes on body appreciation, while adjusting for demographic and anthropometric factors. Weight self-stigma, particularly the internalization of weight bias, showed a significant negative association with body appreciation. Weight self-stigma and its subdimensions (self-devaluation and fear of enacted stigma) had substantial negative correlations with body appreciation. These correlations encompassed the subdimensions of body appreciation, specifically general body appreciation and body image investment. While eating attitudes did not show a significant correlation with body appreciation at the bivariate level, they became a significant predictor in the hierarchical regression model, suggesting a conditional (suppression) effect after accounting for weight-related stigma and BMI. The findings emphasize the important function of weight-related stigma in diminishing body appreciation among young adults and stress the necessity of examining eating attitudes in conjunction with stigma-related factors. Interventions designed to enhance positive body image should focus on both internalized weight stigma and maladaptive eating-related attitudes.

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

Conducted in a French clinical context, this study examines the association between experiences of weight stigma, internalized weight bias (IWB), coping strategies, quality of life (QoL), and obesity-specific self-efficacy (OSSE) among adults living with obesity. It also tests whether coping mediates the relationship between IWB and QoL or OSSE. A cross-sectional sample of 132 adults (mean age = 49.3 years; mean BMI = 41.5 kg/m2) completed questionnaires assessing experienced weight stigma, IWB, coping strategies (adaptive and maladaptive), QoL (Mental Health Continuum-Short Form), and OSSE. Analyses included Pearson correlations, linear regressions, and bootstrap mediation models. Experiences of weight stigma were positively associated with IWB. Higher IWB predicted lower QoL and reduced OSSE. It was linked to less use of adaptive coping strategies and greater use of maladaptive strategies. Mediation analyses showed that coping strategies fully mediated the relationship between IWB and QoL, explaining approximately 43.7% of the variance. Similar patterns were observed across emotional, social, and psychological subdimensions. With respect to OSSE, the effects of IWB on all subdimensions were completely mediated by coping; adaptive strategies were particularly important for interpersonal and emotional facets, whereas maladaptive strategies were more influential for behavioral facets. Internalized weight bias plays a central role in the relationship between weight stigma and psychosocial outcomes in individuals living with obesity. Coping strategies are key mechanisms linking IWB to QoL and OSSE. Interventions aimed at reducing internalization and strengthening adaptive coping may improve well-being and confidence in weight management.

Reciprocal associations between intuitive eating and positive body image components: A multi-wave, cross-lagged study

Background: Although 2/3 of US adults and nearly 1/3 of US children have overweight or obesity, weight stigma is common. Many with overweight or obesity ascribe negative ideas to themselves, resulting in internalized weight bias (IWB). In adults, IWB has been associated with psychosocial problems; however, this relationship has been studied little in children. This study aims to describe IWB in children with overweight and obesity and to study the association of children's IWB with experienced weight bias, self-esteem, and their parents' IWB. Methods: Children ages 9-18 with overweight or obesity completed the Weight Bias Internalization Scale (WBIS), Rosenberg Self-Esteem Scale, and Perception of Teasing Scale; parents completed the Weight Bias Internalization Scale-Modified and the Perceived Weight Discrimination Scale. Descriptive statistics were used to assess IWB, self-esteem, and experienced weight stigma. Chi-square and t-tests were used to examine associations between categorical and continuous variables, respectively. Multivariate linear regression was used to identify correlates of IWB in children. Results: Of 111 child participants, the median WBIS score was 2.8 out of 7. Higher IWB was associated with more peer teasing (p < 0.001) and lower self-esteem (p < 0.001). IWB in children was not associated with child BMI z-score (p = 0.590) or higher parent IWB (p = 0.287). Conclusions: Children with overweight and obesity who have experienced more teasing by peers or who have lower self-esteem are more likely to have a higher IWB. However, increasing child BMI z-score and parent IWB are not associated with higher child IWB.

Weight stigma, like eating disorders (1), tends to be overlooked and understudied in men. This practice is likely to change with the publication of Himmelstein, Puhl, and Quinn's (2) important finding that approximately 40% or more of men across three samples reported having experienced weight-based stigmatization. This finding challenges the notion that men are not affected by weight stigma and rightfully highlights the need to include them more fully in research on this problem. The report by Himmelstein and colleagues (2) addresses several gaps in the weight stigma literature and begins to develop a phenotype for men who report mistreatment because of their weight. Men were more likely to report weight-stigmatizing experiences if they were younger, unmarried, of lower income and higher education, and engaged in dieting behavior. They also had BMIs that fell in either the underweight or obesity range. This “U-shaped” pattern of weight stigma at the lowest and highest BMIs represents a key difference between men and women. Stigmatization of underweight men may contribute to reports of both greater body image dissatisfaction and symptoms of depression in this group compared with men of average weight (3, 4). As with eating disorders (1), male-specific experiences of weight stigmatization should be incorporated in future research surveys and in clinical assessments so that weight stigma is not overlooked in men. The phenotype can be further developed by examining the influence of race/ethnicity in more depth and by including additional factors such as sexual orientation. Himmelstein et al.'s (2) examination of the nature and timing of weight-stigmatizing experiences represents another empirical step forward. Currently, little is known about whether there are critical periods in which men (and women) are particularly vulnerable to weight stigma or how the type or source of stigma shapes its potentially adverse effects. For example, does being teased by a peer in adolescence potentially have different effects on psychological or physical health later in life than, say, being denied a job as an adult because of one's weight? Age of onset of obesity should also be considered in future research. Adults who have persistently faced weight stigma since early childhood may carry a greater burden of its ill effects than individuals who developed obesity later in life. A crucial next step for weight stigma research is to determine whether, in response to weight-stigmatizing experiences, men and women report comparable levels of distress and weight bias internalization (WBI). Women who strongly endorse having experienced weight stigma also report greater internalization of negative weight stereotypes and self-devaluation due to weight (5). Examination of how weight-stigmatizing experiences contribute to WBI among men is needed as well. In addition, some prior research has shown gender differences in the relationship between WBI and health outcomes, such as depression and eating pathology (6). More information about the degree and nature of distress caused by weight stigma in men will illuminate the circumstances in which clinical intervention is needed. Investigations of emerging psychological interventions for WBI, which have studied mostly female samples (7, 8), should increase efforts to include men. Overall, more detailed analyses of weight-stigmatizing experiences and their effects among diverse groups of men and women, as well as transgender and nonbinary people, will help to hone our understanding of the wide reach and adverse consequences of weight stigma.

Individuals with obesity are disproportionately impacted by pain-related symptoms. This study evaluated experienced weight stigma and internalized weight bias (IWB) as predictors of pain symptoms in daily life among individuals with obesity. Adults with obesity (n = 39; 51% female, 67% White, 43.8 ± 11.6 years old, BMI = 36.8 ± 6.7 kg/m2) completed a baseline assessment (demographics, experienced weight stigma, IWB) and a 14-day Ecological Momentary Assessment (EMA) period involving five daily prompts of pain/aches/joint pain, muscle soreness, experienced weight stigma, and IWB. Generalized linear models were used to assess experienced weight stigma and IWB at baseline as prospective predictors of EMA pain/soreness symptoms. Multi-level models were used to test the association of momentary weight stigma experiences and IWB with pain/soreness at the same and subsequent EMA prompts. IWB at baseline, but not experienced weight stigma, was associated with more frequent pain symptoms (p < .05) and muscle soreness (p < .01) during EMA. Momentary IWB (but not experienced stigma) was associated with more pain/aches/joint pain and muscle soreness at the same and subsequent prompt. Internalized (but not experienced) weight bias was prospectively associated with pain symptoms in daily life among individuals with obesity. Results are consistent with growing evidence that weight-related stigmas represent psychosocial factors that contribute to weight-related morbidity typically attributed to body size.

Introduction Weight stigma permeates women's reproductive experiences with significant psychological consequences, yet remains understudied across different reproductive stages and country contexts. This study addresses this gap by investigating weight stigma experiences and their associations with weight bias internalisation (WBI), feeling fat, and self-esteem across preconception, pregnancy, and postpartum (PPP) stages in Western and non-Western contexts. Methods In this cross-sectional study, a convenience sample of women aged 18–45 years from five countries completed an anonymous online survey assessing weight stigma experiences, WBI, feeling fat, and self-esteem. For exploratory comparison, countries were grouped into Western (Australia, United Kingdom, United States) and non-Western (Singapore, Philippines) contexts. Hierarchical regressions and mediation analyses examined relationships between variables. Results In total, 511 women completed the survey (preconception n = 216, pregnant n = 125, postpartum n = 170). Overall, 62.6% of women reported experiencing weight stigma, with sources varying by PPP stage. Weight stigma from the media was most prevalent during preconception, workplace during pregnancy, and family in postpartum. Women residing in Western countries reported more healthcare-related stigma (p = .01), while non-Western women reported more stigma from friends (p < .001) and workplace (p = .001). Weight bias internalisation, feeling fat, and self-esteem levels were similar across countries. Weight bias internalisation consistently mediated the relationship between weight stigma experiences and both feeling fat and self-esteem across all PPP stages; weight stigma promoted greater WBI, which in turn promoted higher scores on feeling fat and lower scores on self-esteem. Conclusion While sources of weight stigma differed by reproductive stage and between Western and non-Western contexts, WBI consistently mediated how these experiences related to both feeling fat and self-esteem. Interventions should target stage-specific stigma sources while addressing WBI as a key mediating mechanism to improve health and wellbeing outcomes for PPP women.