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.

[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.

Associations among enacted weight stigma, weight self-stigma, and multiple physical health outcomes, healthcare utilization, and selected health behaviors.

BACKGROUND: This study examined the relationship among enacted weight stigma, weight self-stigma, and multiple health outcomes. Weight stigma, a stressor experienced across all body sizes, may contribute to poorer physical health outcomes by activating the nervous and endocrine system or by triggering counterproductive health behaviors like lower physical activity, maladaptive eating patterns, and delayed health care, as well as provider bias that may cause a medical concern to be discounted. While associations of weight stigma with mental health issues are well documented, less is known about its association with physical health. METHODS: We enrolled 3821 adults who completed an online survey assessing enacted weight stigma, weight self-stigma, multiple self-reported physical health outcomes, healthcare utilization, and selected health behaviors. RESULTS: After controlling for BMI, health care delay or avoidance, sedentary behavior, and selected demographic characteristics, enacted weight stigma, significantly increased the odds of six physical health problems including hypertension (OR 1.36; CI 1.08, 1.72), hyperglycemia (OR 1.73; CI 1.29, 2.31), thyroid disorder, (OR 1.65; CI 1.27, 2.13), any arthritis (OR 1.70; CI 1.27, 2.26), non-arthritic chronic pain (OR 1.76; CI 1.4, 2.29), and infertility (OR 1.53; CI 1.14, 2.05). Weight self-stigma significantly increased the odds for three physical health problems including hypertension (OR 1.43; CI 1.16, 1.76), hyperglycemia (OR 1.37; CI 1.03, 1.81), and non-arthritic chronic pain (OR 1.5; CI 1.2,1.87). Enacted stigma was associated with more than a four-fold increase in odds of believing that a medical concern was disregarded by a health care provider. CONCLUSIONS: In this study, enacted stigma and weight self-stigma were independently associated with heightened risk for multiple physical health problems, as well as, believing health concerns were discounted by providers. Reducing weight stigma may be an important component of managing multiple physical health conditions.

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.

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.

Internalised weight stigma as a mediator of the relationship between experienced/perceived weight stigma and biopsychosocial outcomes: a systematic review.

OBJECTIVE: To systematically review studies that have assessed the mediating role of internalised weight stigma on the relationship between experienced/perceived weight stigma and any biopsychosocial outcomes. METHODS: PsycINFO, PsycExtra, Web of Science, CINAHL, Medline and Embase were systematically searched. Identified studies were double screened (HB and XPG). RESULTS: Seventeen studies (across 16 articles) met our inclusion criteria (N = 21,172), and almost all studies measured only psychological outcomes (n = 15). Eight studies found consistent evidence for internalised weight stigma as a mediator of the relationship between experienced/perceived weight stigma and disordered eating outcomes. Preliminary evidence was found for the mediating role of internalised weight stigma on the relationship between experienced/perceived weight stigma and body shame, body dissatisfaction, exercise behaviour, healthcare experiences and behaviours, bodily pain and parental weight talk. However, the findings were inconsistent for depression and anxiety, although only two studies reported these. CONCLUSION: This review provides preliminary evidence for internalised weight stigma as an intervening variable in the relationship between experienced/perceived weight stigma and adverse health outcomes. Results suggest that there are potential benefits of interventions addressing internalised weight stigma to improve health outcomes. However, these findings must be considered in the context of the psychometric limitations of the Weight Bias Internalisation Scale, which was used in all but one study.

Experienced weight stigma, internalized weight bias, and maladaptive eating patterns among heterosexual and sexual minority individuals.

PURPOSE: The current study examined experienced weight stigma (EWS), internalized weight bias (IWB), and maladaptive eating patterns (ME) among sexual minority (SM) and heterosexual individuals. METHODS: The sample consisted of cisgender heterosexual and SM men and women. Participants were drawn from introductory psychology classes and a variety of supplemental recruitment methods (Facebook, Instagram, MTURK, etc.). RESULTS: SM individuals reported higher levels of EWS, IWB, and maladaptive eating patterns than heterosexual individuals. Heterosexual men reported the lowest levels of EWS, IWB, and ME compared to all other groups. Additionally, there was a significant association between greater EWS and IWB and greater ME. Gender identity and sexual orientation impacted the strength of the relationship between IWB and ME and, to a lesser extent, EWS and ME. CONCLUSION: This investigation contributes to knowledge of the impact of gender identity and sexual orientation on EWS and IWB, and demonstrates that IWB and EWS are significant concerns for the SM community, especially in relation to ME. LEVEL OF EVIDENCE: Level IV, cross-sectional study.

The role of social exposure in predicting weight bias and weight bias internalisation: an international study.

BACKGROUND: Whilst the consequences of weight bias and weight bias internalisation (WBI) have been explored, less is known about the factors contributing to their development. Some research has explored the role of social exposure in weight bias and WBI but has been limited in its definition of exposure and focused solely on western countries. The present study therefore aimed to assess the role of social exposure defined in terms of both population and personal exposure in predicting weight bias and WBI, in an international sample. METHODS: Participants (N = 1041) from 33 countries, aged 18-85 years completed online measures of demographics, weight bias, WBI, and population and personal social exposure. Population exposure was defined using national obesity prevalence data from the World Health Organisation to classify countries as low (obesity rates ≤19.9%; n = 162), medium (20.0-29.9%; n = 672) or high prevalence (≥30%; n = 192). Personal exposure was defined in terms of personal contact and health and attractiveness normalisation. RESULTS: Using regression analysis, greater weight bias was significantly predicted by being younger, male, less educated, and personal exposure in terms of normalisation beliefs that thinner body types are healthier and more attractive, greater daily exposure and overall exposure to thinner friends. The strongest predictors of weight bias (adj R2 = 13%) were gender (ß = -0.24, p < .001), and personal exposure in terms of normalisation beliefs that thinner body types are more attractive (ß = -0.13, p = .001). The strongest predictors of WBI (adj R2 = 6%) were attractiveness normalisation (ß = -0.23, p < 0.001) and participants' perceived body shape (ß = -0.27, p < 0.001). Population exposure did not predict either weight bias or WBI. CONCLUSIONS: Personal exposure is more important than population exposure in predicting both weight bias and WBI. Findings hold implications for improving the wellbeing and lived experiences of those living with overweight and obesity.

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.

Impact of exposure to counterstereotypic causality of obesity on beliefs about weight controllability and obesity bias.

Individuals with obesity often report experiencing prejudice and discrimination due to their weight. Past research on obesity bias reduction strategies have yielded mixed results. The present study investigated the effectiveness of manipulating information about weight controllability in reducing obesity bias. Participants (N = 350) were randomly assigned into one of three conditions: counterstereotypic, stereotypic, or control. Each condition consisted of four short vignettes. The counterstereotypic condition provided an uncontrollable explanation of obesity (e.g., genetics) in each vignette describing a person with obesity, while the stereotypic condition emphasized lifestyle choices as the main cause of obesity. The control condition included a vignette in which weight was not addressed. Participants completed questionnaires about weight controllability and obesity bias pre- and post-exposure. There was a significant interaction between time and condition on beliefs about weight controllability and obesity bias. Participants in the counterstereotypic condition increased in belief about the uncontrollability of weight and decreased in obesity bias, while participants in the stereotypic condition decreased in belief about the uncontrollability of weight and increased in obesity bias. Obesity bias reduction strategies that utilize information about weight controllability can be effective. However, perpetuating stereotypic causes of obesity can worsen the problem.

Mediated effects of eating disturbances in the association of perceived weight stigma and emotional distress.

PURPOSE: This study aimed to examine the relationships between perceived weight stigma, eating disturbances, and emotional distress across individuals with different self-perceived weight status. METHODS: University students from Hong Kong (n = 400) and Taiwan (n = 307) participated in this study and completed several questionnaires: Perceived Weight Stigma questionnaire; Three-factor Eating Questionnaire; Hospital Anxiety and Depression Scale. Each participant self-reported their height, weight, and self-perceived weight status. RESULTS: After controlling for demographics, perceived weight stigma was associated with eating disturbances (ß = 0.223, p < 0.001), depression (ß = 0.143, p < 0.001), and anxiety (ß = 0.193, p < 0.001); and eating disturbances was associated with depression (ß = 0.147, p < 0.001) and anxiety (ß = 0.300, p < 0.001) in the whole sample. Additionally, eating disturbances mediated the association between perceived weight stigma and emotional distress. Similar findings were shown in the subsamples who perceived themselves as higher weight or normal weight and in the male and female subsamples. However, in the subsamples who perceived themselves as lower weight, only the links between eating disturbances and emotional distress were significant. CONCLUSION: Perceived weight stigma was associated with eating disturbances and emotional distress in young adults with both higher and normal weight. Eating disturbances were associated with emotional distress regardless of participants' weight status. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

The shame of fat shaming in public health: moving past racism to embrace indigenous solutions.

OBJECTIVES: The aim of this article is to explore perceptions of weight and racism towards Maori, as an indigenous group, and the association between the two. We then propose indigenous solutions as pathways out of fat shaming. STUDY DESIGN: This is a conceptual article supported by a review of literature in the fields of weight stigma, racism and indigenous (Maori) health. METHODS: This article is taken from the perspective of three researchers involved in Maori health research, studies on institutional and societal racism and critical research on weight stigma and the weight loss industry. Indigenous peoples in developed nations are more likely to be overweight, obese and disproportionately affected by the comorbidities and physical disorders associated with weight when compared with their counterparts. Beyond the physical ailments are a variety of psychological, emotional and social issues, which are associated with being 'fat' and/or overweight and/or from subsequent stigmatisation. RESULTS: Long before this world's populations reached the current alarming level of obesity, indigenous peoples in colonised countries were stigmatised because of the colour of their skin, their beliefs and their culture. Stigma is nothing new to indigenous peoples, and so when Maori, or any other indigenous groups are told they are fat and less productive (or moral) because of 'fatness', there is no surprise because they have been told the same thing (albeit for a different reason) for generations. Considering the relatively high proportion of indigenous people in New Zealand, North America and beyond who do not fit the 'recommended weight range', the justification for racist sentiment is seemingly strengthened. CONCLUSIONS: A weight loss-centred approach to health has not improved the health of indigenous people. Initiatives that draw on, or are underpinned by local, traditional knowledge are more relevant for indigenous peoples and could lead to better health outcomes for these groups.

Is Weight Discrimination Associated With Physical Activity Among Middle Aged and Older Adults?

Older adults (> 65) are less physically active than all other adult age groups. Although experiences of weight discrimination have been inversely associated with physical activity in several studies of middle-aged and older adults, the role of weight discrimination in this relationship has not been sufficiently explicated. Using data from the Health and Retirement Study (a longitudinal panel study of U.S. adults aged 50 and older), we hypothesized that, among middle aged and older adults, weight discrimination would (a) be inversely related to respondents' reported level of physical activity; and (b) partially mediate the relationship between BMI and physical activity. Using multiple logistic regression analysis, we found an inverse relationship between weight discrimination and vigorous physical activity (OR = 0.79; 95% CI [0.66, 0.94]), as well as between weight discrimination and moderate physical activity (OR = 0.76; 95% CI [0.62, 0.92]). Weight discrimination mediated 13% of the relationship between BMI and vigorous physical activity, as well as 9% of the relationship between BMI and moderate physical activity. Weight discrimination may thus pose a barrier to regular physical activity among middle aged and older adults. Future research and interventions should identify effective ways of mitigating barriers experienced because of weight discrimination in the promotion of physical activity among these age groups, as well as how we may effectively reduce the perpetration of weight discrimination in various settings.

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.

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.

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.

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.

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.

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.

Peer effects and health impacts of different body cognitive biases in children: micro evidence from China.

Background: In China, children commonly display body cognitive biases, which constitute a significant yet hidden public health issue. These biases potentially jeopardize children's well-being, hinder the cultivation of human capital, and impede societal progress. However, limited research employs theoretical analysis and econometric testing to investigate the formation of different body cognitive biases among Chinese children and their health impacts. Methods: Based on a local average network model for theoretical analysis, this study utilizes a sample of 4,289 children from four phases of the China Health and Nutrition Survey (CHNS) conducted from 2004 to 2011. Utilizing Logit and IV Probit models, systematically evaluate the peer effect, heterogeneity of effects, and health impacts of children's different body cognitive biases. Results: (1) The peer effect contributes to the development of light- and heavy-body cognitive biases in Chinese children. (2) The heterogeneity analysis shows that the peer effect of body cognitive biases is more significant in rural and female children. (3) The influence of heavy-body cognitive bias is more pronounced in adolescent children. (4) The "eating-activity balance" is disrupted by the two body cognitive biases in children, leading to deviations from normal body type. (5) Specifically, the light-body cognitive bias leads children to intake more and burn fewer calories, increasing their risk of obesity. (6) Conversely, the heavy-body cognitive bias prompts children to intake less and expend more calories, resulting in a higher prevalence of thinness. Discussion: This study innovates by exploring peer effects on body cognitive biases in Chinese children, elucidating their direction and health implications. While overweight and obesity are recognized as overt health issues, the spread and impact of implicit issues like body cognitive biases should not be overlooked. Nevertheless, the issue is largely neglected in developing countries, such as China, where existing children's health policies are inadequate in addressing it. Promoting accurate body image perception and understanding of health prevention strategies among children requires adequate attention to peer effects.