Weight Bias and Stigma in Pediatric Obesity.

Weight stigma is pervasive during childhood and adolescent years. Well-established physical and psychosocial health consequences of weight stigma, like disordered eating behaviors, low self-esteem, and higher depressive symptoms, make it especially harmful during a critical period of development for youth. Lasting negative health impacts of these experiences highlight the importance of addressing weight stigma early on. The pediatric health care setting, both physical and social components, can be one of many sources of weight-stigmatizing experiences for youth. This observation has prompted calls for action in the health care setting to reduce weight biases and stigmatizing behavior among pediatric providers.

'My words would have more weight': exploring weight stigma in UK dietetic practice and dietitian's lived experiences of weight stigma.

BACKGROUND: Weight stigma is pervasive within healthcare and negatively impacts both access to care and the patient-practitioner relationship. There is limited evidence on weight stigma among registered dietitians, particularly in the United Kingdom, though data show weight-related prejudice towards people living with obesity. The aim of this study was to examine both explicit and implicit weight stigma in practicing dietitians in the United Kingdom, as well as the lived experience of weight stigma among dietitians, both towards themselves and towards others. METHODS: An online cross-sectional survey was disseminated between February and May 2022 using snowball sampling. Inclusion criteria were that participants were UK registered dietitians aged 20-70 years. RESULTS: Four hundred and two dietitians responded to the survey (female [94.1%], mean age 40.2 years [standard deviation (SD) 10.7]; White ethnicity [90%]; median 12 years [interquartile range (IQR) 6, 22] within dietetic practice). Mean self-reported body mass index was 25.1 kg/m² (SD 8.7). Most dietitians reported experiencing weight stigma prior to (51%) and postregistration (59.7%), whereas nearly a quarter (21.1%) felt that weight influenced their ability as a dietitian. Weight stigma was experienced across the weight spectrum. Overall participants reported explicit weight bias attitudes, moderate beliefs that obesity is controllable and implicit antifat bias. Within open-ended responses, dietitians reported three key themes related to their personal experiences of weight stigma: (1) experiences of stigma in dietetic practice, (2) impact of weight stigma and (3) perception of weight, appearance and job. CONCLUSION: This study shows that UK dietitians exhibit both explicit and implicit weight bias towards people living with obesity. Dietitians reported experiencing weight stigma, which impacted their career-related decisions and their perception of their own ability to perform as dietitians. The study highlights the need to address weight stigma and its implications within the dietetic profession.

The role of food reward in the associations between weight-based discrimination and feeding practices among caregivers of young children.

Certain caregiver feeding practices, including restrictive feeding for weight control, restrictive feeding for health, emotion regulation feeding, and reward feeding, are known to negatively influence short- and long-term child eating and health outcomes. Beyond body size, the precise psychosocial characteristics of caregivers more likely to engage in such feeding practices are unknown. In particular, caregivers who have experienced discrimination based on their weight, who have internalized those biased beliefs, or who find food to be very rewarding may be more likely to use restrictive or controlling feeding practices. The present study investigated the associations among experiences of weight-based discrimination, internalized weight bias, and food reward (i.e., reward-based eating drive) with use of restriction for weight control, restriction for health, emotion regulation feeding, and reward feeding in an online US sample of caregivers (M = 35.27 ± 9.08 y/o) of 2-5 year-old children (N = 305). About half (50.8%) of respondents self-identified as women and most as non-Hispanic (88.5%) and White (75.1%). There were significant positive correlations among caregivers' experience of weight-based discrimination, internalized weight bias, and use of all four feeding practices. Regression results showed that caregivers' food reward moderated the main effect of weight-based discrimination on restrictive feeding for weight control and emotion regulation feeding, such that caregivers who were high in food reward and who experienced discrimination were most likely to engage in these feeding practices. These results can inform interventions aimed at improving child food environments and health.

Weight bias among Canadians: Associations with sociodemographics, BMI and body image constructs.

This cross-sectional study examined the associations between sociodemographic characteristics, BMI, and body image constructs (body satisfaction and weight bias internalization; WBI) and explicit weight bias. A near-representative sample of 995 English-speaking Canadian adults (52% Female) completed a survey which assessed explicit weight bias (Anti-Fat Attitudes questionnaire), body satisfaction (Body Shape Satisfaction Scale), WBI (Modified Weight Bias Internalization Scale), and self-reported height and weight. Multiple linear regression analyses were run. Results showed that the variable that explained the most variance in explicit weight bias was WBI, followed by BMI. Higher levels of WBI and a lower BMI were both significantly associated with greater explicit weight bias. Male sex was associated with both disliking people with obesity and thinking obesity is attributable to lack of willpower, whereas female sex was associated with worrying about weight gain. The current findings emphasize the importance of future research efforts aimed at preventing or mitigating WBI to reduce negative attitudes about people with obesity.

The role of social norms, intergroup contact, and ingroup favoritism in weight stigma.

Although average body size in the U.S. has increased in recent decades, stigma directed at individuals with higher weight has not diminished. In this study, we explored this phenomenon by investigating the relationship between people's perceived social norms regarding higher weight and their reported levels of weight bias (i.e., anti-fat attitudes). Our predictions for perceived social norms drew on the concepts of intergroup contact and ingroup favoritism, which were also probed in this study. We hypothesized that both greater descriptive norms and more favorable injunctive norms regarding higher weight would be associated with lower reported weight bias. Individuals' quantity and quality of social contact with people with higher weight were also predicted to be associated with lower weight bias. Finally, we predicted that individuals who perceived themselves as heavier would display ingroup favoritism (i.e., report less weight bias). Participants (N = 272) from the United States completed a set of online questionnaires about their perceived social norms, social contact with people with higher weight, and explicit weight bias. We found support for each of these pre-registered predictions (ps < 0.03), and post hoc analyses revealed that quality, but not quantity, of social contact with individuals with higher weight was an important predictor of lower weight bias. Together, these findings provide insight into the social psychology of weight bias and help to lay a theoretical foundation for future efforts to reduce weight stigma.

[THE EFFECTS OF GENDER ON THE MANIFESTATIONS AND CONSEQUENCES OF WEIGHT STIGMA].

INTRODUCTION: Weight stigma, or weight bias, refers to biased beliefs and negative opinions towards people with excess weight. This phenomenon manifests in prejudice and negative attitudes towards people with obesity, including disrespectful treatment, bullying, discrimination and even abuse, and leading to long-term negative consequences on physical and mental health. The purpose of the current review was to examine the relationship between gender and manifestations of weight stigma. Studies listed in this review show that the phenomenon of weight stigma is more common and severe among women, in numerous life areas, which include education, employment, the healthcare system, social media, sports industry, and interpersonal relationships. Possible reasons for such differences include the existing discrimination against women in various areas of life, and the emphasis on external appearance and the ideal of thinness, which relates mainly to women. In light of the serious consequences of weight stigma on public health and individual well-being, efforts must be made to prevent weight stigma, including the education of the general population, changing policies of healthcare, education and media systems, and legislation to prevent weight-based discrimination.

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.

Young children's choices and thoughts about pro-social behaviour towards others with overweight.

OBJECTIVES: This study aimed to investigate weight bias within young children's pro-social choices between characters who differed in body size. METHODS: Seventy-six children aged 4-6 years read stories asking them to choose who they would first help, share with, comfort, and steal from, between a healthy weight and child with overweight. They also selected the one character they would most like to play with. Children's reasoning for these choices was recorded and analysed. RESULTS: The character with overweight was helped first in only a third of the choices made. Children chose the characters with overweight more often as the target for anti-social action. In friendship selections, children overwhelmingly rejected the characters with overweight. However, weight bias was not prominent in the reasons children gave for the choices. Most children were not negative about body shape, weight or appearance. Similarly, in friendship choices, these were mostly expressed positively to the character chosen. Only a small minority of children were explicitly negative about the character with overweight. CONCLUSIONS: A better understanding of weight bias acquisition and variation between children will benefit those working in health care and educational settings. Future research should link with developmental theory, such as on social categorization and theory of mind.

Sociodemographic predictors of perceived weight discrimination.

BACKGROUND: Perceived weight discrimination is associated with increased risk for chronic diseases and reduced life expectancy. Nevertheless, little is known about perceived weight discrimination in racial, ethnic, and sexual minority groups or in individuals at the intersections of those groups. The goal of this study was to identify sociodemographic predictors of perceived weight discrimination. SUBJECTS/METHODS: A diverse sample of adults (37% Black/African American, 36% Latino, 29% sexual minority) with a body mass index (BMI) ≥ 18.5 kg/m2 were recruited from a national US panel to complete an online survey (N = 2454). Perceived weight discrimination was assessed with the Stigmatizing Situations Survey-Brief (SSI-B). Using hierarchical linear regression analysis, SSI-B scores were predicted from the four sociodemographic characteristics of interest (gender, race, ethnicity, and sexual orientation) while controlling for BMI, age, education, and income (Step 1). At Step 2, all two-way interactions between the four sociodemographic characteristics were added to the model. RESULTS: At Step 1, higher SSI-B scores were observed for Latino (vs. non-Latino) adults, sexual minority (vs. heterosexual) adults, younger (vs. older) adults, adults with higher (vs. lower) levels of education, and adults with higher (vs. lower) BMI. At Step 2, race interacted with gender, ethnicity, and sexual orientation to predict SSI-B scores such that relatively higher scores were observed for non-Black women, Black men, adults who identified as Black and Latino, and non-Black sexual minority adults. CONCLUSIONS: Perceived weight discrimination varied across sociodemographic groups, with some subgroups reporting relatively high frequency. Black race appeared to be protective for some subgroups (e.g., Black women), but risk-enhancing for others (e.g., Black men, individuals who identified as Black and Latino). Additional research is needed to identify specific factors that cause certain sociodemographic groups -and indeed, certain individuals-to perceive higher levels of weight discrimination than others.

Multiple marginalization, discrimination, and disordered eating among youth aged 10-11.

OBJECTIVE: Although rates of weight discrimination are on-par with racial, ethnic, and gender discrimination, comparatively less work has examined impacts of weight-based discrimination in youth, including on disordered eating. Knowing whether experiences of weight-based discrimination, including in youth with multiply-marginalized identities, are associated with disordered eating could identify vulnerable youth and inform intervention efforts. METHOD: Youth (N = 11,875) ages 10-11 were recruited through the Adolescent Brain Cognitive Development (ABCD) study. Logistic regressions using cross-sectional data examined discrimination experiences (weight, perceived sexual orientation, race/ethnicity, national origin) and disordered eating (binge-eating, vomiting, weight-gain fear, weight self-worth). Models included race/ethnicity, age, sex, parental income, and degree of elevated weight. Raked poststratification weights were used. RESULTS: Rates of weight-based discrimination (6.2%) were similar to rates of race/ethnicity (4.4%) and sexual orientation discrimination (4.5%). Weight-based discrimination was associated with more disordered eating. Youth reporting multiple experiences of discrimination had significantly increased disordered eating compared to youth who did not report discrimination. DISCUSSION: Weight-based discrimination is common in youth and associated with disordered eating. Youth with elevated weight are more likely to be multiply marginalized and experience disordered eating. These findings suggest discrimination, including weight-based discrimination, is a critical intervention target to prevent and treat eating disorders. PUBLIC SIGNIFICANCE: Experiences of discrimination contribute to poorer health; however, weight-based discrimination is relatively understudied. Data from a large sample of youth ages 10-11 showed that youth with elevated weight reported experiencing multiple types of discrimination, and multiply-marginalized youth had increased odds of disordered eating with each additional type of discrimination. Together, this suggests that weight-based discrimination is a critical target to prevent and treat eating disorders, especially in multiply-marginalized youth.

Weight-related discrimination, perceived stress and psychological and physical well-being of persons with type 2 diabetes: A mediation analysis.

AIMS: The aim of the study was to examine perceived stress as a mediator of the association between weight-related discrimination and physical and psychological well-being among persons with type 2 diabetes (T2D). METHODS: Data were obtained from 5104 persons with self-reported T2D participating in the All of Us research programme in the United States. The Everyday Discrimination Scale, Cohen's Perceived Stress Scale (PSS) and PROMIS Global Health Scale were used to measure weight-related discrimination, perceived stress and health outcomes (physical and psychological), respectively. Mediation effects of PSS were tested by bootstrapping with 5000 random samples. RESULTS: Participants were, on average, 63.62 (SD 11.38) years old. Majority of them were female (55.53%), non-Hispanic White (72.61%), married or living with a partner (56.92%), had a household income of <$35,000 (31.99%) and had some college education (33.54%). We found that approximately 18% of study participants reported having experienced weight-related discrimination. We also found that weight-related discrimination was independently associated with poor physical and psychological well-being. These associations were partially mediated by perceived stress such that weight-related discrimination was associated with greater perceived stress, which was in turn associated with poorer physical and psychological well-being. CONCLUSIONS: Given that weight-related discrimination is associated with poor outcomes through elevated stress, interventions that target stress may disrupt this pathway thereby helping to reduce the health impact of weight-related discrimination. This assertion should, however, be tested in future studies.

Exploring the association between internalized weight bias and mental health among Canadian adolescents.

BACKGROUND: Internalized weight bias (IWB) has been identified as a correlate of higher depressive and anxiety symptoms in adolescents with higher weights. However, there has been limited investigation into how IWB relates to positive mental health and whether these associations differ across genders. OBJECTIVES: To examine the associations between IWB and mental health (depression, anxiety, flourishing) in adolescents with higher weights, and to test the potential moderating role of gender. METHODS: Canadian adolescents with higher weights (N = 7538, 60% boys, 36% girls, 4% gender diverse, ages 12-19) from the COMPASS study completed a survey during the 2021-2022 school year. Data were analysed using generalized linear models. RESULTS: Highest IWB and poorest mental health were noted within gender diverse adolescents, followed by girls then boys. Gender moderated the relationship between higher IWB and higher depression, higher anxiety and lower flourishing, with the strongest relationships noted among girls. CONCLUSION: IWB interventions should be tailored to gender subgroups that may be particularly vulnerable to maladaptive mental health outcomes associated with IWB. System-level changes that mitigate perpetuation of weight bias and discrimination which lead to IWB are also essential, particularly for girls.

Sexual orientation moderates the relationship between internalized weight bias and binge eating symptoms among adults pursuing bariatric surgery.

BACKGROUND: Sexual minorities have higher rates of anxiety, depression, and binge eating compared to heterosexual peers. Internalized weight bias (IWB) is also higher for sexual minorities when compared to heterosexual peers. However, research has not examined whether the relationships between IWB and anxiety, depression, and binge eating differ among heterosexual and sexual minority adults pursuing bariatric surgery. OBJECTIVES: To examine whether sexual orientation (heterosexual or sexual minority) moderated the relationships between IWB and anxiety, depression, and binge eating among adults pursuing bariatric surgery. SETTING: University hospital, United States METHODS: Participants included 811 adults who presented for bariatric surgery, 45 (5.5%) of which identified as a sexual minority. Self-reported data were collected as part of a standard preoperative psychological evaluation for surgical clearance. Three separate moderation models were run to test hypotheses. RESULTS: Sexual orientation did not moderate the association of IWB with anxiety or depression. The IWB by sexual orientation interaction was significant for binge eating (F 1856) = 4.84, P = .03, R2 = .27 such that the association between IWB and binge eating was significantly stronger for sexual minority patients (b = .54, 95% confidence interval {CI} [.36, .70]), compared to heterosexual patients (b = .33, 95% CI [.30, .38]). CONCLUSIONS: Minority stress from identifying as a sexual minority may increase vulnerability to binge eating from IWB among bariatric candidates. Future research examining the directionality of the relationship between IWB and binge eating among sexual minorities is warranted.

Sexual Assault Among College Women: The Role of Survivor Acknowledgment, Rape Myth Acceptance, Weight Bias, and Body Appreciation.

Approximately one in five college women experience a sexual assault (SA), though a meaningful percentage of survivors do not acknowledge or label their experience as such. Research indicates that acknowledgment status is often influenced by how closely SA incidents align with the "real rape" script and degree of survivor rape myth acceptance (RMA). However, studies evaluating acknowledgment paired with other attitudes and health outcomes among survivors is sparse. The current study examined the relation between acknowledgment status, RMA, weight-related constructs, and psychological well-being among three groups of college women (N = 584): non-survivors, unacknowledged survivors, and acknowledged survivors. Findings indicate that, among survivors, acknowledged compared to unacknowledged SA is significantly associated with diminished body appreciation, self-esteem, and increased internalized weight bias, though no differences in psychological distress were found.

Fat Shame-Inside and Out.

In this narrative medicine essay, a family medicine physician shares her personal story as someone who is obese and disabled. She talks about her own process of addressing stigma and bias around obesity and how she is now helping patients work toward improved physical function and overall health goals.

Family-based weight stigma and psychosocial health: A multinational comparison.

OBJECTIVE: Family-based weight stigma can be expressed as criticism, judgment, teasing, and mistreatment by family members because of an individual's body weight. The current study compared the prevalence and psychosocial correlates of family-based weight stigma among adult members of a weight-management program living in Australia, Canada, France, Germany, the UK, and the US. METHODS: Participants (N = 8100 adults who reported having ever experienced weight stigma; 95% female; 94% White) completed an identical online survey in their country's dominant language that assessed their experiences of weight stigma from 16 different family member sources, as well as internalized weight bias, body image, eating behaviors, perceived stress, and self-rated health. RESULTS: Family-based weight stigma, especially from mothers (49%-62%), spouses/romantic partners (40%-57%), and fathers (35%-48%), was highly prevalent across countries. Weight stigma from one's immediate family members was associated with indices of poorer psychosocial health across the six countries (ß coefficients = |0.08-0.13|). CONCLUSIONS: Findings highlight the need for weight stigma-reduction efforts to help family members distinguish between supportive, encouraging discourse and potentially weight-stigmatizing communication. Future research should examine the prevalence and correlates of family-based weight stigma in more diverse community samples, including among racially/ethnically and gender diverse adults, and in non-Western countries.

Weight Discrimination and Health Risk Behavior in Racial, Ethnic, and Sexual Minority Adults.

BACKGROUND: People with obesity face significant discrimination due to their weight. Exposure to such discrimination is associated with poor health outcomes. Little is known about pathways that explain that association, and even less is known about those pathways in racial, ethnic, and sexual minorities. Health risk behaviors may serve as one such pathway. PURPOSE: We examined associations between weight discrimination and health risk behaviors and assessed whether associations are moderated by gender, race, ethnicity, or sexual orientation. METHODS: Quota sampling was used to oversample Black (36%), Latino (36%), and sexual minority (29%) adults (n = 2,632) who completed an online survey. Using regression analysis, health risk behaviors (maladaptive eating behaviors, physical inactivity, sitting, smoking, alcohol use, and sleep disturbance) were predicted from previous experience with weight discrimination while controlling for demographic characteristics, BMI, and depressive symptoms. Additional analyses tested for interactions between weight discrimination and key demographic variables (i.e., gender, race, ethnicity, and sexual minority status). RESULTS: Weight discrimination was associated with greater emotional eating, binge eating, unhealthy weight control behaviors, cigarette smoking, problematic alcohol use, and sleep disturbance. Gender moderated the association between weight discrimination and binge eating, alcohol use, and physical activity, with stronger effects observed in men than women. Exploratory analyses provided limited evidence for differential effects of weight discrimination across specific combinations of intersecting identities. CONCLUSIONS: Weight discrimination was associated with engagement in unhealthy behaviors and relationships were largely similar across diverse demographic groups. Health risk behaviors may represent a key pathway through which weight discrimination harms health.

People with high body weight remain one of the most stigmatized groups in the USA and face significant discrimination due to their weight. Experiencing weight discrimination is associated with poor health, yet little is known about the underlying pathways that explain this association and even less is known about those pathways in socially marginalized groups. We investigated unhealthy behavior as a possible a pathway by assessing associations between weight discrimination and several health risk behaviors and identifying whether those associations vary by gender, race, ethnicity, or sexual orientation. A diverse sample of 2,632 U.S. adults completed an online survey. Previous experience with weight discrimination was found to be associated with greater emotional eating, binge eating, unhealthy weight control behaviors, cigarette smoking, problematic alcohol use, and poor sleep. The association between weight discrimination and binge eating, alcohol use, and physical activity was stronger in men than in women, yet exploratory analyses provided limited evidence for differential effects of weight discrimination across specific combinations of intersecting identities. Weight discrimination was associated with engagement in unhealthy behaviors and associations were largely similar across participants from diverse demographic groups. Health risk behaviors may represent a key pathway through which weight discrimination harms health.

Association of Weight-Related Stigmas With Daily Pain Symptoms Among Individuals With Obesity.

BACKGROUND: Individuals with obesity are disproportionately impacted by pain-related symptoms. PURPOSE: This study evaluated experienced weight stigma and internalized weight bias (IWB) as predictors of pain symptoms in daily life among individuals with obesity. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.