Exploring the interplay of weight-based teasing and sociodemographic factors in adolescent weight bias internalization.

OBJECTIVE: Research has highlighted the potential adverse effects of weight bias internalization (WBI) on adolescents, but there has been little examination of WBI and sources of weight teasing (family, peers, or both) or across racial/ethnic diversity of adolescents. We aimed to examine the relationship between WBI and sources of weight teasing across sociodemographic characteristics and weight status in a diverse community sample of adolescents. METHODS: Data were collected from a U.S. sample of 1859 adolescents aged 10-17 years (59% female; 43% White, 27% Black or African American, and 25% Latino). An online questionnaire was used to assess participants' experiences of weight teasing from family members, peers, or both, and their weight status, weight-related goals, WBI, and sociodemographic characteristics. RESULTS: Adolescents experiencing weight teasing from both family and peers reported the highest levels of WBI, while those reporting no teasing exhibited the lowest levels. These patterns were observed across sex, race/ethnicity, weight status, and weight goals, and persisted after controlling for depressive symptoms. Notably, family influences played a salient role, with adolescents reporting higher WBI if teased by family only compared to teasing from peers only. Sex and racial differences were also observed in adolescents' experiences with weight-based teasing. CONCLUSION: Our study reveals associations between adolescent weight-based teasing, WBI, and sociodemographic factors. Weight-based teasing, whether from family and peers or from family only, was associated with increased WBI. Interventions targeting weight stigma in youth should not be limited to peer-focused efforts, but should also emphasize supportive family communication.

Bias-based bullying, self-esteem, queer identity pride, and disordered eating behaviors among sexually and gender diverse adolescents.

OBJECTIVE: Limited research incorporates an intersectional approach when evaluating disordered eating behaviors among those holding minoritized social positions, such as lesbian, gay, bisexual, queer, questioning, and/or transgender/gender diverse (LGBTQ) adolescents. The current study assessed stigma experiences from peers at school, self-esteem, LGBTQ pride, and overlapping social positions as they relate to disordered eating behaviors among LGBTQ adolescents. METHOD: Participants included 11,083 adolescents (Mage = 15.6, SD = 1.3; 34.8% transgender/gender diverse) from a large national survey study of LGBTQ adolescents from 2017. Exhaustive Chi-square Automatic Interaction Detection analysis was used to identify bias-based bullying experiences (i.e., weight-based, identity-based), self-esteem, LGBTQ pride, and overlapping social positions (i.e., gender identity, sexual identity, race/ethnicity, body mass index (BMI) percentile) associated with the highest prevalence of unhealthy weight control behaviors, extreme unhealthy weight control behaviors, and past year binge eating. RESULTS: Adolescents in the 28 identified groups with a high prevalence of disordered eating behavior held at least one structurally marginalized social position (e.g., high BMI), bias-based bullying experience, low self-esteem, or low LGBTQ pride in addition to being LGBTQ. Weight-based bullying was a salient risk-factor for disordered eating across social positions. Among adolescents with the same social positions, levels of self-esteem, LGBTQ pride, but no bias-based bullying experience, prevalence estimates of disordered eating were, on average, 23% lower. DISCUSSION: LGBTQ adolescents with multiple marginalized social positions and related factors engage in disproportionately high prevalence disordered eating. Findings underscore the importance of addressing intersecting experiences of stigma to reduce disordered eating and promote health equity among adolescents. PUBLIC SIGNIFICANCE: Multiply marginalized LGBTQ adolescents, most of whom also reported experiencing bias-based bullying from peers at school, reported disproportionately high prevalence disordered eating. In comparison groups of adolescents with no bias-based bullying experience, prevalence of disordered eating was, on average, 24% lower. Findings underscore the importance of addressing intersecting experiences of stigma to reduce disordered eating and promote health equity among adolescents.

'It's not me, it's them' - a report describing the weight-related attitudes towards obesity in pregnancy among maternal healthcare providers.

BACKGROUND: Occurrences of weight stigma have been documented in prenatal clinical settings from the perspective of pregnant patients, however little is known from the viewpoint of healthcare providers themselves. Reported experiences of weight stigma caused by maternal healthcare providers may be due to negative attitudes towards obesity in pregnancy and a lack of obesity specific education. The objective of this study was to assess weight-related attitudes and assumptions towards obesity in pregnancy among maternal healthcare providers in order to inform future interventions to mitigate weight stigma in prenatal clinical settings. METHODS: A cross-sectional survey was administered online for maternal healthcare providers in Canada that assessed weight-related attitudes and assumptions towards lifestyle behaviours in pregnancy for patients who have obesity. Participants indicated their level of agreement on a 5-point likert scale, and mean scores were calculated with higher scores indicating poorer attitudes. Participants reported whether they had observed weight stigma occur in clinical settings. Finally, participants were asked whether or not they had received obesity-specific training, and attitude scores were compared between the two groups. RESULTS: Seventy-two maternal healthcare providers (midwives, OBGYNs, residents, perinatal nurses, and family physicians) completed the survey, and 79.2% indicated that they had observed pregnant patients with obesity experience weight stigma in a clinical setting. Those who had obesity training perceived that their peers had poorer attitudes (3.7 ± 0.9) than those without training (3.1 ± 0.7; t(70) = 2.23, p = 0.029, Cohen's d = 0.86). CONCLUSIONS: Weight stigma occurs in prenatal clinical environments, and this was confirmed by maternal healthcare providers themselves. These findings support advocacy efforts to integrate weight stigma related content and mitigation strategies in medical education for health professionals, including maternal healthcare providers. Future work should include prospective examination of weight related attitudes among maternal healthcare providers and implications of obesity specific education, including strategies on mitigating weight stigma in the delivery of prenatal care.

Parent-Adolescent Weight Communication: Parental Psychosocial Correlates Among a Diverse National Sample.

Parental communication about body weight with their children is common across diverse families. The current study investigates how parents' feelings about their own bodies, beliefs about body weight, history of weight stigma, and weight-related characteristics contribute to the degree to which they talk about weight - both negatively and positively - with their adolescent children. The study sample was comprised of U.S. parents (N = 1936) from diverse racial/ethnic backgrounds with children aged 10-17 years old. Parents completed an online survey with measures assessing their frequency of engaging in negative and positive weight communication with their children, along with several relevant psychosocial factors (i.e. body satisfaction, experienced weight stigma, associative stigma, body appreciation, beliefs about weight controllability, weight bias internalization). Study findings paint a complex picture, including some psychosocial factors (e.g. weight bias internalization) that are related to both more frequent negative and positive weight communication. Notably, higher levels of associative stigma were related to more frequent negative parental weight comments, and less frequent positive weight socialization. Findings can inform healthcare professionals in raising parents' awareness about how their personal beliefs and feelings about their own weight and their child's weight can contribute to how they engage in communication about weight with their children.

An Examination of Parental Weight Stigma and Weight Talk Among Socioeconomically and Racially/Ethnically Diverse Parents.

Parental communication about body weight can influence children's emotional well-being and eating behaviors. However, little is known about the role of parental self-stigma concerning weight and social position variables (ie, race/ethnicity, income, and gender) in weight communication. This study examined how parents' self-stigmatization for their own weight (ie, weight bias internalization) and self-stigmatization for their child's weight (ie, affiliate stigma) relates to weight talk frequency with their children, and whether these associations vary across parental race/ethnicity, income, and gender. Parents (n = 408) completed a cross-sectional, online survey about their weight communication and self-stigmatization. Linear regression was used to examine the relationships among these variables, including interactions between the stigma variables and social position variables in predicting weight talk. Higher levels of weight bias internalization and affiliate stigma were strongly associated with increased parental weight talk frequency; parents who endorsed higher levels of internalized bias about their own weight expressed greater affiliate stigma for their child's weight, regardless of demographic characteristics or weight status. Associations between the stigma variables and weight talk outcomes were stronger among fathers and parents of higher income. Findings highlight the importance of considering weight stigma variables in parental weight communication research.

The economic and social costs of body dissatisfaction and appearance-based discrimination in the United States.

This study estimated the social and economic costs of body dissatisfaction and appearance-based discrimination (specifically, weight and skin-shade discrimination) in the United States (USA) in the 2019 calendar year. We used a prevalence-based approach and a cost-of-illness method to estimate the annual cost of harmful appearance ideals for cases of body dissatisfaction and discrimination based on weight and skin shade. Impacts on conditions/illnesses such as eating disorders that are attributable to body dissatisfaction, weight discrimination and skin-shade discrimination were identified through a quasi-systematic literature review, which captured financial, economic, and non-financial costs. For each impact attributable to body dissatisfaction or appearance-based discrimination, annual health system and productivity costs (or labor market costs) were primarily estimated by using a population attributable fraction methodology. Only direct costs that resulted from body dissatisfaction and appearance-based discrimination were included (for example, costs associated with conditions such as depression attributable to body dissatisfaction or appearance-based discrimination). In contrast, indirect costs (e.g. costs associated with a health condition developed following skin bleaching, which was undertaken as a result of body dissatisfaction) were not included. In 2019 body dissatisfaction incurred $84 billion in financial and economic costs and $221 billion through reduced well-being. Financial costs of weight discrimination and skin-shade discrimination were estimated to be $200 billion and $63 billion, respectively, and reduced well-being was estimated to be $206.7 billion due to weight discrimination and $8.4 billion due to skin-shade discrimination. Sensitivity testing revealed the costs likely range between $226 billion and $507 billion for body dissatisfaction, between $175 billion and $537 billion for skin-shade discrimination, and between $126 billion and $265 billion for weight discrimination. This study demonstrates that the prevalence and economic costs of body dissatisfaction and weight and skin-shade discrimination are substantial, which underscores the urgency of identifying policy actions designed to promote prevention.

Appearance ideals in the USA have been widely critiqued for placing unfair burden on people of color and women of all race/ethnicity groups, but little is known about the economic consequences of biased appearance standards. To attain a comprehensive understanding of the economic impact of these harmful appearance ideals on the US economy, we estimated the one-year financial, economic and non-financial costs to the economy caused by body dissatisfaction, weight discrimination, and skin-shade discrimination. We considered a wide range of costs, including costs to the healthcare system, workplace, and other costs for individuals, households, employers, and government. We found that the impact of harmful appearance ideals on the USA economy is substantial. In 2019 body dissatisfaction incurred $84 billion in financial and economic costs and $221 billion through reduced well-being. Financial costs of weight discrimination and skin-shade discrimination were estimated to be $200 billion and $63 billion, respectively, and reduced well-being was estimated to be $207 billion due to weight discrimination and $8 billion due to skin-shade discrimination. Women of all race/ethnicity groups bore the bulk of the burden, shouldering 58% of the costs for body dissatisfaction and 66% for weight discrimination. Women bore 50% of the costs for skin-shade discrimination. These costs are substantial and underscore the urgency of identifying effective policy actions to reduce the damaging effects of harmful appearance ideals.

Parental Communication About Body Weight and Adolescent Health: The Role of Positive and Negative Weight-Related Comments.

OBJECTIVE: Research has consistently documented adverse effects of parent weight-related comments on adolescent health. However, little empirical attention has focused on isolating the impact of weight-related comments from mothers versus fathers, and the valence of their comments. The present study examined the extent to which positive and negative weight-related comments from mothers and fathers are related to adolescent health and wellbeing, and whether these associations differ according to adolescent sociodemographic characteristics. METHODS: Data were collected from a diverse sample of 2032 U.S.-based adolescents aged 10-17 years (59% female; 40% White, 25% Black or African American, 23% Latinx). Online questionnaires assessed perceived frequency of negative and positive weight-related comments from mothers and fathers, as well as four indicators of adolescent health and wellbeing: depression, unhealthy weight control behaviors, weight bias internalization (WBI), and body appreciation. RESULTS: More frequent negative weight-related comments from parents were associated with poorer adolescent health and wellbeing, while positive comments contributed to lower levels of WBI and body appreciation; these associations were documented regardless of whether mothers or fathers were the source of such comments, and considerable consistency was demonstrated across adolescent sociodemographic characteristics. CONCLUSION: Findings highlight differences in adolescent health based on how parents discuss their body weight (i.e., negatively or positively), and similarity in associations regardless of whether mothers or fathers are the source of weight communication. These findings reiterate the importance of efforts to educate parents on ways to engage in supportive communication about weight-related health with their children.

Does Diagnostic Certainty Matter?: Pain-Related Stigma in Adolescents with Juvenile Idiopathic Arthritis.

OBJECTIVES: Childhood chronic pain conditions are common and vulnerable to stigma. Adolescents with chronic primary pain experience diagnostic uncertainty and describe pain-related stigma experiences across multiple social contexts. Juvenile idiopathic arthritis (JIA) is a childhood autoimmune, inflammatory condition with associated chronic pain, but with well-defined diagnostic criteria. The current study examined pain-related stigma experiences in adolescents with JIA. METHODS: Four focus groups of 3-7 adolescents with JIA (N = 16), ages 12-17 (Mage = 15.42, SD = 1.82), and parents (N = 13) were conducted to examine experiences of, and reaction to, pain-related stigma. Patients were recruited from an outpatient pediatric rheumatology clinic. Focus group length ranged from 28 to 99 minutes long. Two coders used directed content analysis resulting in 82.17% inter-rater level of agreement. RESULTS: Adolescents with JIA described pain-related stigma experiences predominantly from school teachers and peers, and less from medical providers (e.g., school nurses), and family members after a diagnosis. The primary categories that emerged were (1) Felt Stigma, (2) Internalized Stigma, (3) Anticipatory Stigma/Concealment, and (4) Contributions to Pain-Related Stigma. A common experience of pain-related stigma was the perception by others that the adolescent was too young to have arthritis. CONCLUSIONS: In common with adolescents with unexplained chronic pain, our findings indicate that adolescents with JIA experience pain-related stigma in certain social contexts. Diagnostic certainty may contribute to greater support among medical providers and within families. Future research should investigate the impact of pain-related stigma across childhood pain conditions.

Experienced weight stigma, internalized weight bias, and clinical attrition in a medical weight loss patient sample.

BACKGROUND: Limited research has explored the relationship between weight bias and clinical attrition, despite weight bias being associated with negative health outcomes. PARTICIPANTS/METHOD: Experienced weight stigma (EWS), internalized weight bias (IWB), and clinical attrition were studied in a Medical Weight Loss clinic, which combines pharmacological and behavioral weight loss. Patient sociodemographic, medical, and psychological (depression) variables were measured at consultation, and clinic follow-ups were monitored for 6 months. IWB was assessed with the Weight Bias Internalization Scale Modified (WBIS-M). RESULTS: Two-thirds (66%) of study participants returned for follow-up appointments during the 6-month period ("continuers"), while 34% did not return after the initial consultation ("dropouts"). Clinic "dropouts" had higher WBIS-M scores at initial consultation than "continuers," (χ2(1) = 4.56; p < 0.05). No other variables were related to clinical attrition. Average WBIS-M scores (4.57) were similar to other bariatric patient studies, and were associated with younger age (t = -2.27, p < 0.05), higher depression (t = 2.65, p < 0.01), and history of EWS (t = 2.14, p < 0.05). CONCLUSION: Study findings indicate that IWB has significant associations with clinical attrition. Additional research is warranted to further explore the relationships between EWS, IWB, and medical clinic engagement.

"There's Nothing Wrong With You": Pain-Related Stigma in Adolescents With Chronic Pain.

OBJECTIVE: Adolescents with chronic pain often experience symptom disbelief and social rejection by others secondary to "medically unexplained" symptoms. Although chronic pain is common in adolescents, limited research has conceptualized these social experiences as pain-related stigma in this population. The purpose of this study was to identify and describe pain-related stigma among adolescents with chronic pain and their parents using focus group methodology. METHODS: Five adolescent focus groups (N = 18; Age M = 15.33 years, SD = 1.28) and three parent focus groups (N = 9) were conducted. Directed content analysis was used to analyze focus group transcripts. Stigma categories were developed a priori (Felt Stigma, Anticipated Stigma, Internalized Stigma, Concealment, and Controllability) and new categories emerged during analysis. Two coders reached 87.16% agreement for all groups (adolescent group: 90.34%; Parent group: 79.55%) and consensus was achieved for discordant codes. RESULTS: Adolescents and their parents endorsed pain-related stigma across all social domains. Analyses revealed four main categories for both groups (a) Felt Stigma (subcategories: pain dismissal, faking or exaggerating, and mental health stigma), (b) Anticipated Stigma and Concealment, (c) Internalized Stigma, and (d) Sources of Pain-Related Stigma (subcategories: pain invisibility, lack of chronic pain knowledge, lack of understanding, and controllability). CONCLUSIONS: Adolescents with chronic pain experience pain-related stigma from medical providers, school personnel, family members, and peers, which may have negative social and health implications. More research is needed to evaluate the link between pain-related stigma and health outcomes for adolescents with chronic pain. Clinical approaches targeting pain-related stigma are discussed.

Sexual and gender minority (SGM) adolescents' disordered eating: Exploring general and SGM-specific factors.

OBJECTIVE: Sexual and gender minority (SGM) adolescents disproportionately report disordered eating, yet have primarily been considered under a larger SGM umbrella. The current study 1) compared disordered eating between sexual minority (SM) and gender minority (GM) adolescents; 2) examined how general psychological factors (self-esteem, depression, and stress) and SGM-specific factors (e.g., feelings about SGM identity, access to SGM resources) were associated with disordered eating; and 3) examined whether associations between these factors differed for SM versus GM adolescents. METHOD: SGM adolescents in the U.S. (N = 8814; 35.0% GM; 43.7% cisgender girls; 66.9% White; Mage  = 15.6) reported their disordered eating, depressive symptoms, stress, self-esteem, and SGM-related experiences on an anonymous, cross-sectional online survey. RESULTS: GM adolescents exhibited a higher prevalence of clinical threshold disordered eating than SM adolescents. Self-esteem was associated with lower odds of caloric restriction, purging, and binge eating. Depression was associated with higher odds of caloric restriction, diet pill use, purging, laxatives, and binge eating. Stress was associated with higher odds of purging. Associations were stronger for GM adolescents' caloric restriction. Positive feelings about SGM identity were associated with lower odds of caloric restriction, purging, and binge eating, whereas greater stress of "coming out" was associated with higher odds of caloric restriction, purging, and binge eating. DISCUSSION: These results suggest that SGM adolescents' disordered eating is associated with both general psychological factors and unique SGM experiences. Results highlight the importance of considering how the unique experiences of SGM youth may leave them vulnerable to disordered eating behaviors. PUBLIC SIGNIFICANCE STATEMENT: Sexual and gender minority (SGM) youth are disproportionately affected by disordered eating. The current study found that higher depression and stress, and lower self-esteem, were associated with SGM adolescents' disordered eating. Furthermore, unique SGM experiences, such as stress about coming out, were also associated with eating pathology. Results highlight the importance of considering SGM adolescents' perceptions of their identity and social support.

Weight Stigma and Diabetes Stigma: Implications for Weight-Related Health Behaviors in Adults With Type 2 Diabetes.

There has been little recognition that people with type 2 diabetes are vulnerable to weight stigma and diabetes stigma and almost no research examining the implications of these forms of stigma for their health and well-being. This study examined health behavior correlates of weight stigma and diabetes stigma in 1,227 adults with type 2 diabetes. Results showed that experiencing weight stigma in health care, experiencing differential treatment from others because of their diabetes, and engaging in self-stigma for diabetes and body weight were each significantly associated with increased frequency of binge eating and eating as a coping strategy to deal with negative feelings. Internalizing weight stigma was also significantly associated with lower levels of physical activity and worse self-rated health. These findings suggest that initiatives to improve the health and well-being of people with type 2 diabetes must consider the potentially harmful roles of weight stigma and diabetes stigma.

International comparisons of weight stigma: addressing a void in the field.

BACKGROUND/OBJECTIVES: Despite substantial evidence documenting weight stigma toward people with higher body weight, international comparative studies are lacking in this field. The few studies that have compared weight stigma across different countries focus on explicit weight-biased attitudes rather than people's experiences of weight stigma. The present study conducted a multinational systematic comparison of weight stigma in six countries to assess experiences and interpersonal sources of weight stigma. SUBJECTS/METHODS: Adults (N = 13,996) enrolled in WW International (formerly Weight Watchers), residing in Australia, Canada, France, Germany, the UK, and the US completed identical online anonymous surveys in the dominant language for their country. Surveys assessed their history of experiencing weight stigma, the onset of stigmatizing experiences and associated distress from stigma in different time periods, and interpersonal sources of weight stigma. RESULTS: More than half of participants (55.6-61.3%) across countries reported experiencing weight stigma. Participants with higher BMI were significantly more likely to report weight-stigmatizing experiences than individuals with lower BMI. In all countries, weight stigma experiences were most frequent in childhood and adolescence, with associated distress highest during these time periods. Participants in Germany reported a higher frequency of weight stigma across their whole life, but lower distress associated with stigmatizing experiences, compared to participants in the other five countries. High percentages of participants in each country experienced weight stigma from family members (76.0-87.8%), classmates (72.0-80.9%), doctors (62.6-73.5%), co-workers (54.1-61.7%), and friends (48.8-66.2%). CONCLUSIONS: Weight stigma is prevalent for adults actively engaged in weight management across different Western countries. There were more similarities than differences in the nature, frequency, and interpersonal sources of people's experiences of weight stigma across the six countries in this study. Findings underscore the need for multinational initiatives to address weight stigma and interventions to support individuals engaged in weight management who experience weight mistreatment.

Adolescents' Exposure to and Experiences of Weight Stigma During the COVID-19 Pandemic.

OBJECTIVE: The COVID-19 pandemic has increased attention to the proliferation of pediatric obesity amidst significant changes in weight-related health functioning (e.g., compromised physical activity, limited food access, increased stress). The present cross-sectional study investigated adolescents' feelings about their bodies and perceived changes in weight stigma from peers, parents, and social media during the pandemic. METHODS: Four hundred fifty-two adolescents (11-17 years old) completed an online survey during the Fall of 2020. Measures assessed perceived changes in exposure to weight stigmatizing social media content (stress eating jokes, weight gain memes) and experiences of weight stigma (weight-based bullying, teasing, hurtful comments) by parents and peers, as well as body dissatisfaction, during the COVID-19 pandemic. Weight status and gender were examined as individual difference variables. RESULTS: The majority (53%) of adolescents reported increased exposure to at least one form of weight stigmatizing social media content during the pandemic. Additionally, pandemic-related increases in body dissatisfaction were prevalent (41%), especially among girls with higher body mass index (≥85th percentile; 67%). On average, the extent to which adolescents experienced weight-based mistreatment from parents and peers remained consistent with their pre-pandemic experiences. CONCLUSIONS: Overall, these findings highlight changes in the social messages that adolescents receive about their bodies, as well as their subjective body satisfaction, during the pandemic. Results underscore the need for healthcare providers and mental health professionals to be aware of the potential rise in weight stigma during the pandemic, and encourage families and schools to engage in supportive, rather than stigmatizing, weight-related communication with youth.

Examining the relationship between weight controllability beliefs and eating behaviors: The role of internalized weight stigma and BMI.

Body weight is often viewed as personally controllable. This belief, however, ignores the complex etiology of body weight. While such attributions of personal willpower may help some individuals regulate their eating patterns, they have also been associated with increased internalized weight stigma which, itself, is associated with more disinhibited eating. The current investigation aimed to examine how internalized weight stigma, along with BMI, may explain the effect of weight controllability beliefs on disparate dietary behaviors. A community sample of 2702 U.S. adults completed an online survey about their weight controllability beliefs, eating behaviors, and internalized weight stigma, as well as demographic items and self-reported BMI. Results showed that greater weight controllability beliefs were positively related to both more restricted eating, ß = 0.135, p < .001, and more disinhibited eating, ß = 0.123, p < .001. This ironic effect was partially explained by increased internalized weight stigma. Moreover, BMI moderated the relationship, such that individuals with lower weights demonstrated stronger effects for two of the three eating outcomes than those with higher weights. These findings advance our understanding of the relationship between attributions of personal control for body weight and subsequent health behaviors, and further underscore the need to target internalized weight stigma in dietary interventions.

Teacher Support, Victimization, and Alcohol Use Among Sexual and Gender Minority Youth: Considering Ethnoracial Identity.

Although scholarship continues to document higher rates of alcohol use for sexual and gender minority (SGM) youth compared with heterosexual and cisgender youth, research identifying factors that mitigate SGM youths' risk is nascent. Youth spend substantial time in schools; therefore, teachers could play significant roles in attenuating these health concerns. We used data from a nationwide survey of 11,189 SGM youth (Mage = 15.52; 67.7% White) to explore whether perceived teacher social-emotional support attenuated the association between victimization and alcohol use, further conditioned by youths' specific ethnoracial identity. As expected, victimization was associated with more frequent alcohol use; however, greater perceived teacher support attenuated this association. The attenuating effect of perceived teacher support was significantly stronger for Hispanic/Latinx youth than White youth. Our findings have implications for alcohol use prevention among SGM youth, who face significant marginalization in schools and society. If we are to prevent alcohol use disparities among SGM youth, scholars and stakeholders (e.g., school administrators, teachers) should invest in building teacher efficacy to intervene in SGM-specific victimization.

Weight Stigma as a Predictor of Distress and Maladaptive Eating Behaviors During COVID-19: Longitudinal Findings From the EAT Study.

BACKGROUND: Weight stigma is common for people with obesity and harmful to health. Links between obesity and complications from COVID-19 have been identified, but it is unknown whether weight stigma poses adverse health implications during this pandemic. PURPOSE: We examined longitudinal associations between prepandemic experiences of weight stigma and eating behaviors, psychological distress, and physical activity during the COVID-19 pandemic in a diverse sample of emerging adults. METHODS: Participants (N = 584, 64% female, mean age = 24.6 ± 2.0 years, mean body mass index [BMI] = 28.2) in the COVID-19 Eating and Activity over Time (C-EAT) study were cohort members of the population-based longitudinal study EAT 2010-2018. Weight stigma reported by participants in 2018 was examined as a predictor of binge eating, eating to cope, physical activity, depressive symptoms, and stress during COVID-19. Data were collected via online surveys during the U.S. outbreak of COVID-19 in 2020. RESULTS: Prepandemic experiences of weight stigma predicted higher levels of depressive symptoms (ß = 0.15, p < .001), stress (ß = 0.15, p = .001), eating as a coping strategy (ß = 0.16, p < .001), and an increased likelihood of binge eating (odds ratio = 2.88, p < .001) among young adults during the COVID-19 pandemic but were unrelated to physical activity. Although associations remained after accounting for demographic characteristics and BMI, the magnitude of longitudinal associations was attenuated after adjusting for prior levels of the outcome variables. CONCLUSIONS: Young adults who have experienced weight stigma may have increased vulnerability to distress and maladaptive eating during this pandemic. Public health messaging could be improved to support people of diverse body sizes and reduce the harmful consequences of weight stigma.

Weight Stigma and Weight-Related Health: Associations of Self-Report Measures Among Adults in Weight Management.

BACKGROUND: Weight stigma impairs health. Few studies have disentangled the associations of experienced versus internalized stigma with weight-related outcomes. PURPOSE: To examine weight and health variables associated with weight stigma experiences and internalization in the largest-to-date sample of adults in weight management. METHODS: WW (formerly Weight Watchers) members (N = 18,769, 94.6% female, 91.1% white) completed an online survey from 2017 to 2018. Participants reported whether they had experienced weight stigma and, if so, the onset, past-year frequency and distress, and interpersonal sources of stigma. Participants completed the Modified Weight Bias Internalization Scale (WBIS-M) and self-reported: past-year weight and lifetime weight cycles; current self-monitoring behaviors; eating self-efficacy; physical activity; perceived stress; eating to cope; body image; and mental and physical health-related quality-of-life (HRQOL). Participants reported their demographic characteristics, including height and weight to compute body mass index. RESULTS: In logistic and linear regression analyses (controlling for participant characteristics), WBIS-M scores were negatively associated with weight loss, self-monitoring, eating self-efficacy, body image, and mental HRQOL and positively associated with weight gain, weight cycling, perceived stress, and eating to cope (p < .001). Experiencing weight stigma was associated with greater weight loss and less weight gain, although associations with other variables had small effect sizes (absolute ß values < 0.10). WBIS-M scores remained significantly associated with all variables when including stigma onset, frequency/distress, and sources. CONCLUSIONS: Internalized, but not experienced, weight stigma was consistently associated with adverse weight and health factors. Developing and testing interventions targeting internalized stigma in the context of weight management should be a research priority.

Coping with Weight Stigma Among Adults in a Commercial Weight Management Sample.

BACKGROUND: Coping responses to weight stigma can adversely affect health. Using data from a large commercial weight management sample, this study examined how adults cope with weight stigma, relationships among experienced weight stigma, weight bias internalization, and coping, as well as coping strategies as mediators of the stigma-health relationship. METHOD: Participants were adults enrolled in WW (formerly Weight Watchers) who reported at least one lifetime experience of weight stigma (N = 11,924). Participants completed questionnaires about the type and frequency of stigma experiences, weight bias internalization, strategies used to cope with weight stigma, and health-related quality of life. RESULTS: Active coping, planning, positive reframing, acceptance, emotional support, and exercise avoidance were the most common coping strategies employed in response to acute weight stigma experiences. Weight bias internalization was more strongly associated with coping strategies likely to exacerbate health (e.g., disordered eating, substance use, self-blame) than positive reframing, acceptance, and emotional support. More types of experienced weight stigma (e.g., teasing, unfair treatment) were associated with more frequent use of all coping strategies. Coping strategies did not mediate the stigma-health relationship, and several strategies were associated with poor mental health. CONCLUSION: More types of experiences with weight stigma were associated with more attempts to cope generally, while weight bias internalization was associated with coping strategies which were in turn associated with poor mental health. Developing effective approaches for identifying individuals likely to internalize weight stigma and helping individuals adopt effective coping strategies in response to stigma are important avenues of future research.

Evidence of Diverse Identities in a Large National Sample of Sexual and Gender Minority Adolescents.

Adolescence is a time of identity exploration, and preliminary evidence indicates the ways adolescents are describing their sexual and gender identities (SOGI) are changing. A nuanced understanding of SOGI is necessary for valid assessment in developmental research. Current measures do not capture the diversity of emerging identities among young people. Our study analyzed a national sample of 17,112 sexual and gender minority adolescents (13-17 years) to better understand how identity labels are reported across sexual, gender, and ethnoracial minorities. Adolescents reported 26 distinct SOGI categories; 24% of adolescents utilized nontraditional SOGI labels, such as pansexual and nonbinary. These identifications varied significantly as a function of ethnoracial identity. Results have implications for how scholars conceptualize and measure SOGI among adolescents.