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Studies on Weight Stigma and Body Image in Higher-Weight Individuals: A Guide to Assessment, Treatment, and Prevention

Authors:

Abstract

Weight stigma is a form of social stigma that primarily targets higher-weight individuals in virtually every domain of daily living, and it is becoming the norm worldwide. In this chapter, we present an overview of the research linking weight stigma and body image, drawing upon evidence from cross-sectional, experimental, longitudinal, and intervention studies. We begin with a summary of two forms of target-directed weight stigma that constitute the focus of this chapter—experienced and internalized weight stigma, and their general correlates. Then we review, in turn, the evidence for the roles of experienced and internalized weight stigma in body image and eating disorder-related pathology. We then briefly review the small literature on ethnic and cultural differences in experienced and internalized weight stigma as they relate to body image. We conclude with a consideration of the gaps in the scientific literature and make several recommendations for future research that would help to close those gaps. A critical take-home message from this review is that the multiple injurious effects of weight stigma on body image and beyond are incontrovertible, but very little has been done to address it. In our final note, we recognize the need for body image and eating disorders scholars and practitioners to become part of the solution to ending weight bias in our communities and for our clients.
This manuscript is the final version approved by authors for inclusion in the book:
In: Cuzzolaro M., Fassino S. (eds) Body Image, Eating, and Weight. Springer, Cham
Chapter details:
Meadows A., Calogero R.M. (2018) Studies on Weight Stigma and Body Image in
Higher-Weight Individuals. In: Cuzzolaro M., Fassino S. (eds) Body Image, Eating, and
Weight. Springer, Cham
Chapter 28. Pages 381-400
First Online 04 November 2018
DOI: https://doi.org/10.1007/978-3-319-90817-5_28
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Chapter 28. Studies on weight stigma and body
image in higher-weight individuals
Angela Meadows
School of Psychology, University of Exeter, Exeter, UK
drameadows@gmail.com
Rachel M Calogero
Department of Psychology, Western University, London, Ontario, Canada
rcaloger@uwo.ca
Abstract
Weight stigma is a form of social stigma that primarily targets higher-weight individuals
in virtually every domain of daily living, and it is becoming the norm worldwide. In this
chapter, we present an overview of the research linking weight stigma and body image,
drawing upon evidence from cross-sectional, experimental, longitudinal, and intervention
studies. We begin with a summary of two forms of target-directed weight stigma that
constitute the focus of this chapterexperienced and internalized weight stigma, and
their general correlates. Then we review, in turn, the evidence for the roles of
experienced and internalized weight stigma in body image and eating disorder-related
pathology. We then briefly review the small literature on ethnic and cultural differences
in experienced and internalized weight stigma as they relate to body image. We conclude
with a consideration of the gaps in the scientific literature and make several
recommendations for future research that would help to close those gaps. A critical take-
home message from this review is that the multiple injurious effects of weight stigma on
body image and beyond are incontrovertible, but very little has been done to address it.
In our final note, we recognize the need for body image and eating disorders scholars and
practitioners to become part of the solution to ending weight bias in our communities and
for our clients.
Keywords
Body image, culture, higher-weight individuals, social stigma, weight stigma,
experienced weight stigma, internalized weight stigma,
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28.1 Introduction
Weight stigma can be broadly defined as negative attitudes and behaviours toward
higher-weight individuals because of their weight or size. Negative attitudes include
endorsement of stereotypes of higher-weight people, for example, that they are greedy,
lazy, or unintelligent. Stigmatizing behaviours can range from social exclusion to rude or
presumptuous comments, from staring or pointing to overt discrimination, or even verbal
and physical attacks.
Understanding the causes and consequences of weight stigma is essential for scholars
and practitioners in want of a more complete understanding of negative body image and
eating disorders. Fear of fat, negative evaluations of weight and body shape, and
overvaluations of body size and shape for self-worth constitute core features of eating
disordersfeatures that have not emerged in a vacuum but rather emerge in the context of
experienced and internalized forms of weight stigma in fat-phobic societies.
This chapter provides a summary of the scientific evidence for the relationship between
weight stigma and negative body image in higher-weight individuals
1
. Due to space
restraints, an exhaustive review of the literature on weight stigma and body image is
beyond the scope of the present chapter. Our aim is to highlight select studies that provide
a good representation of the research in this area. Where existing reviews are available, we
will direct your attention to these resources. We will also focus on two forms of target-
directed weight stigma experiencing stigma from others, and stigmatizing oneself. We
will not here consider the impact of outwardly directed anti-fat attitudes, i.e. dislike of fat
others.
28.2 Experienced weight stigma
Experienced weight stigma refers to public and private encounters of being stigmatized
by others because of your weight. Higher-weight individuals report experiencing weight
stigma in practically every domain of daily living, including at work, in education,
healthcare, and interpersonal relationships [for a review, see 1], and weight stigma appears
to be on the increase [2, 3]. The frequency of stigma experiences increases markedly with
increasing body weight, but most forms of weight stigma also occur more frequently in
women, and are prevalent at lower body weights than in men [2, 4]. Weight-related stigma
and bullying are also prevalent amongst children and adolescents. Weight is now one of
the most common targets for bullying in schools, with 92% of adolescents reported
observing weight-related bullying in one large US study [5].
1
In this chapter, I use the phrase “higher-weight” to describe individuals with a body
mass index in the “overweight” or “obese” categories, and avoid “person-first language.
For the rationale behind this usage and a discussion on best practice for avoiding
stigmatising terminology when describing larger bodies, see [95].
4
One difficulty when attempting to explore the impact of experienced weight stigma is
that, when considered retrospectively, it may be difficult to remember specific instances
that have occurred, sometimes many years previously. Additionally, without example of
what might constitute “stigma,” many instances of weight-related bias might not be
recognized as such by the victim, being written off as deserved, well meaning, simple
truths, or just innocent statements, especially when originating from children [6, 7]. This
is likely to be particularly true of the more subtle forms of stigma and discrimination
most people are likely to remember being physically attacked, for example, but people
making assumptions about your lifestyle based solely on your weight might not stand out.
Yet, for most people, their lifetime exposure to stigma will consist primarily of these
“lesser” but more pervasive incidents. Additionally, micro-aggressions sometimes-
ambiguous verbal, behavioral, or environmental “messages” that confer some form of
negative valuation or hostility toward higher-weight individuals, whether intentional or not
are commonplace and act as a cumulative stressor [8]. In a qualitative study of “obese”
Australian adults drawn from diverse community sources, half of the participants reported
experiencing environmental forms of stigma, two-thirds had experienced direct stigma,
and three-quarters discussed indirect forms of stigma [6]. These latter included experiences
such as feeling ignored by customer service staff, friends or family members ridiculing
other higher-weight individuals in front of them, and strangers peering inquisitively into
their supermarket trolleys. The participants found these subtle occurrences more difficult
to respond to, and felt that subtle forms of stigma had the most negative impact on their
health and wellbeing [6].
To partially address issues of recall and attribution, Myers & Rosen developed one of
the first complex measures of experienced weight stigma, the Stigmatizing Situations
Inventory (SSI) [9]. The SSI prompts respondents using a list of 50 specific situations,
across eleven different domains (family, strangers, employment, doctors, etc.), and
participants indicate how often they have ever experienced each type of stigma. Studies
using the SSI find that, overall, most people indicate having experienced some form of
stigma at least once in their lifetimes, with some studies reporting certain types of stigma
occurring as often as weekly. Even so, retrospective studies that rely on recall over a
lifetime likely underestimate the prevalence of weight stigma. In confirmation, a US study
in which 50 higher-weight women completed a daily diary each day for seven days,
indicating whether any of the 50 items of the SSI had occurred to them that day, resulted
in over 1000 incidents being recorded, or approximately 3 incidents per person over the
seven days [10]. Additionally, none of the currently used measures of experienced weight
stigma include the media as a possible source of stigma. Representations of higher-weight
bodies in both news and entertainment media are most often stigmatizing in nature [11,
12], and the media is frequently mentioned as a source of weight stigma in qualitative
studies [6, 13] and studies that capture stigma experiences in real-time [14]. Thus, in
addition to issues with the reliability of recall, it is likely that existing quantitative studies
of experienced weight stigma may further underestimate the extent of exposure to such
negative messages. In an Australian study of 46 higher-weight Australian adults, in which
the media was included as a potential source of stigma in the instructions to participants,
participants completed the SSI at the start of the study and reported, on average, having
5
experienced weight stigma “several times in [their] life”. By comparison, using a personal
digital assistant to record stigmatizing events as they occurred, these same participants
recorded an average of 11.1 episodes of weight stigma over the subsequent two-week study
period, or approximately 0.8 episodes per day [15].
28.3 Internalized weight stigma
When higher-weight individuals endorse negative stereotypes and ascribe those
negative attributes to themselves, they are said to express internalized weight stigma, or
weight-related self-stigma. Internalized weight stigma is most commonly defined as not
just awareness, or even endorsement, of negative stereotypes, but also as applying those
negative attributes to yourself and subsequently devaluing yourself because of it. This last
step is important. As a fat person, I may be aware that many people consider fat people to
be lazy; I may or may not agree that this is usually true (I don’t), and I may even happily
admit that I, myself, am indeed both fat and lazy. But if I do not judge myself morally for
this purported deficit, if my self-worth is unaffected by this admission, then I cannot be
said to have internalized weight stigma.
Unlike experienced weight stigma, internalized weight stigma appears to affect men
and women fairly equally, although a few studies have found slightly higher internalized
weight stigma scores in women [e.g., 16, 17]. Internalized weight stigma is related to the
construct of body image, involving, as it does, negative appearance evaluation, but differs
in key aspects. First, the negative judgments are specific to facets of body image related to
weight. Second, there is a strong element of self-blame involved. For example, while one
might have poor body image related to a specific body part, such as height, or a disliked
facial feature, this is unlikely to be tainted by a belief that one is to blame for that aspect
of one’s appearance.
Most studies of IWS have been conducted in adults. To date, only one study has
examined internalized weight stigma in children. In a German study of 1000 children aged
7–11 years, girls reported higher internalized weight stigma than boys, and “overweight”,
but not “non-overweight” children, tended to agree with self-stigmatizing statements [18].
28.4 Correlates of experienced and internalized weight stigma
Both experienced and internalized weight stigma have been linked with a range of
physical, psychological, and behavioral outcomes, even after controlling for body mass
index (BMI)
2
and other potential confounding factors, including disordered eating
patterns, reduced motivation to exercise, avoidant coping strategies, substance
2
All outcomes in included studies are controlled for BMI unless otherwise specified.
6
dependence, and social and behavioral problems in adolescents, including substance use,
self-harm, and suicidality. Weight stigma is also strongly associated with healthcare
avoidance among higher-weight individuals, including reduced engagement with
preventive screening programs [19]. Perceived weight discrimination is associated with
higher risk of chronic morbidity [20] and mortality [21], and with poorer self-reported
physical and psychological health and health-related quality of life [22]. Indeed, both
actual experience of stigma and simply fear of being stigmatized by others appears to
mediate the relationship between higher BMI and poorer self-reported health [23]. In
another study, the association between higher BMI and poorer physical health-related
quality of life was only observed in those individuals who also had high levels of
internalized weight stigma [24].
Importantly, internalized weight stigma appears to mediate the relationship between
experienced weight stigma and health and wellbeing outcomes in higher-weight
individuals, including depression and anxiety [25], low self-esteem, emotional and
externally-cued eating, as opposed to responding to internal hunger signals [26], binge
eating [27], and exercise behavior [26, 28]. That is, being stigmatized by others can lead
to more self-stigmatization, and it is this internalized weight stigma that then influences
health and behavioral outcomes, suggesting that targeting internalized weight stigma may
be a useful approach in health interventions.
28.5 Experienced Weight Stigma and Body Image
28.5.1 Cross-sectional studies
Despite the difficulties of reliably measuring experienced weight stigma, even studies
using relatively crude measures consistently indicate associations between stigma history
and body image, as well as other psychological outcomes. In a sample of 174 higher-
weight adults considering weight-loss surgery, a single-item question asking whether they
had been teased about their weight when they were a child identified significantly greater
weight and shape concern and body dissatisfaction among those with a history of
childhood weight teasing compared with those who had only minimal or no experience of
childhood weight-related teasing [29].
Most studies using the SSI use a composite score across all sources of stigma. Such
studies have found that frequency of stigmatizing experiences is strongly correlated with
body image distress in weight-loss treatment-seeking populations [9, 30], and the effect is
exacerbated when the targets also hold stronger anti-fat attitudes themselves [31]. In a
community sample of higher-weight individuals, 97% of the 111 participants reported
having ever experienced weight stigma, with half having such experiences at least once
per week. Scores were strongly correlated with body dissatisfaction, although the
7
relationship was attenuated a little when controlling for BMI [32]. An adapted version of
the SSI that examined experienced weight stigma at different life points found formative
experiences of weight stigma during childhood, in particular, have lingering effects on
adult body image problems [33].
A small number of studies have reported outcomes independently for the different
domains of the SSI, allowing for a more nuanced understanding of the impact of
experiencing different forms weight stigma. In an international sample of higher-weight
adults, social exclusion had the strongest impact on appearance evaluation, but poorer body
image was also linked with receiving rude comments from one’s family, from children, or
other people; embarrassment about your weight from loved ones; people making negative
assumptions about you; and experiencing work-based discrimination. Inappropriate
comments from doctors, experiencing physical barriers in daily life for example seats
too narrow, not being able to fit through turnstiles, being stared at in public, and even being
physically attacked were not significantly associated with body image in this sample [26].
While it is to be expected that interpersonal forms of weight stigma have a strong impact
on body image, it is a little surprising that some of the more systemic forms of stigma did
not have an effect.
One of the most common forms of experienced weight stigma, particularly among
younger people, is that of weight-related teasing. By its nature, teasing is most likely to
come from an individual’s immediate circle, such as family or friends, and thus can often
be a pervasive occurrence in daily life. In an extensive review and meta-analysis of the
literature between January 1991 and December 2009, Menzel and colleagues [34]
examined the evidence for a relationship between weight-related teasing and body image
in adults and children, and reported a medium-large effect overall, with the effects being
somewhat stronger in children than in adults, and in female than male samples. Studies
that used more comprehensive measures of teasing, rather than a single question about
teasing experience, reported higher effects still, suggesting that methodological limitations
of some studies may underestimate the true relationship between weight-related teasing
and body dissatisfaction. One limitation of these findings is that all but four of the studies
were conducted in all, or predominantly, “normal-weight” samples, making it unfeasible
to explore, or control for, the role of BMI in this relationship. Studies that independently
assess the effects of weight-based teasing across different weight groups have produced
conflicting results: while studies report significantly higher levels of weight-related teasing
in heavier students, one study that compared response to teasing by weight status found no
difference in affective responses to victimization, including body-related distress, between
weight groups [35], whereas in another study, heavier individuals reported greater distress
as a result of weight-based victimization than did slimmer individuals [36].
28.5.2 Longitudinal studies
To our knowledge, there are no longitudinal studies that prospectively assess the impact
of experienced weight stigma on body image in adults. However, a number of studies have
8
prospectively explored the impact of weight-related teasing in children and adolescents
over time. Cattarin and Thompson conducted the first such study, exploring the impact of
weight-related teasing in adolescence on subsequent body image and eating disturbances
[37]. The study took baseline measures from 210 adolescent girls, aged 10 to 15, although
only approximately 40% of this sample was available at three-year follow-up. Higher-
weight girls experienced significantly more weight-related teasing, which in turn predicted
subsequent global appearance dissatisfaction, although not dissatisfaction with specific
body sites, after controlling for age, weight, and maturational status. However, only body-
site dissatisfaction subsequently predicted restrictive and bulimic eating disturbances when
controlling for all other factors.
One of the longest-established cohorts in this field is the Eating and Activity in Teens
and Young Adults cohort (Project EAT), with the first wave of data collected from 4746
adolescent boys and girls at 31 middle and high schools in a Midwest US city in 1999 [38].
Second-wave data collection in 20032004 indicated that weight-related teasing at
baseline had a small but significant correlation with body dissatisfaction at 5-year follow-
up, but was not a significant independent predictor of body image after controlling for
baseline body dissatisfaction and BMI [39]. Thus, the detrimental impact of weight-related
teasing may be most profound during earlier adolescent body image development.
However, just published fourth-wave data collected in 2015 from 1830 participants, now
in young adulthood, indicated that women who had experienced weight-based teasing from
family or peers as adolescents reported poorer body image, as well as more binge eating
behavior, eating to cope, and unhealthy weight control practices 15 year later, even after
controlling for baseline BMI and other potential confounding factors, than did women who
had not experienced such teasing. Men who had experienced weight-related teasing from
peers also experienced more body dissatisfaction, although the long-term impact on
dysfunctional eating behaviors was not pronounced in males. Weight-related teasing from
family members did not appear to have the same effect in men as it did in women [40].
More recently, a prospective longitudinal study of intrapersonal development risk
factors in childhood assessed the impact of weight-related teasing and social exclusion in
1486 children (mean age 8.4 years) from 33 German primary schools on their body
dissatisfaction and disordered eating behaviours one year later [41]. The sample was
predominantly “normal weight”, with only 13.6% classified as “overweight” or “obese”
by BMI z-scores. Experiences of weight stigma were reported in over half of “obese
children, compared with just over one in four “overweight” children, and one in twelve
“normal weight” participants; higher-weight girls reported more stigma than higher-weight
boys, and also reported greater body dissatisfaction and disordered eating at follow-up.
Although baseline weight status significantly predicted body dissatisfaction one year later
in both genders, the significant relationship between experienced weight stigma and body
dissatisfaction at follow-up was present only in girls. Similarly, in girls, but not boys, body
dissatisfaction mediated the relationship between baseline weight stigma experience and
disordered eating behaviour one year later [41].
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28.5.3 Experimental studies
The field of weight stigma research has been largely dominated by cross-sectional studies,
which preclude drawing reliable inferences regarding causality. Recently, a number of
well-designed experimental manipulation studies have been published, which attempt to
elucidate the processes by which the harms associated with weight stigma are transmitted.
Such studies randomize participants to either a stigma condition or a control condition,
thus isolating exposure to the stigmatizing experience as the driver of any resultant
differences in outcome between the groups. However, to date, only one study has included
a measure of body image as an outcome of interest [42]. As this study explores the impact
of both experienced and internalized weight stigma, it will be discussed in detail in the
section on internalized weight stigma, below.
28.5.4 Intervention studies
A number of weight-stigma reduction interventions have been tested, with generally
unimpressive results [43], however few consider the body image of the intervention
participants as an outcome measure. Interventions aimed at increasing acceptance of size
diversity among higher-weight individuals themselves sometimes include content
targeting general anti-fat attitudes; however most of these interventions involve multiple
components, including content directed at changing self-directed attitudes. While these
complex approaches are likely to be more effective at producing changes in psychological
outcomes and wellbeing from a clinical point of view than are interventions targeting a
single construct or risk factor, it is then difficult to identify the effect of targeting weight
stigma per se on changing body image. School-based interventions aimed at reducing
weight-related bullying and harassment are another potential source of information. Most
school-based interventions also take a multivariate approach, targeting multiple risk
factors for body dissatisfaction and disordered eating, and some of these have successfully
improved student body image but failed to impact on weight-related teasing [44; for a
review, see 45]. To our knowledge, only one school-based intervention has specifically
targeted weight-related teasing as its primary outcome. The V.I.K. (Very Important Kids)
program is an extensive, multi-component intervention aiming to reduce weight-related
teasing in elementary schools, although the ultimate goal was prevention of unhealthy
weight-control behaviors. In a small pilot study, V.I.K. was trialed in 63 4th 6th graders
at an ethnically diverse, primarily low-income US Midwest school and their families.
Approximately half of the students were “overweight” or “obese” by BMI z-score. Eight
months after the intervention, weight-related teasing was significantly reduced at the
school, whereas a matched control school saw an increase in teasing over the same period.
Students in the intervention school also felt more confident in their ability to address
weight-related teasing if it occurred. However, the intervention did not have any effect on
body satisfaction, dieting behavior, or unhealthy weight control practices [46].
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28.6 Internalized Weight Stigma and Body Image
28.6.1 Cross-sectional studies
The majority of studies that have assessed internalized weight stigma have been cross-
sectional, which makes it impossible to elucidate the relationship between internalized
weight stigma and body image beyond saying they are strongly associated with each other.
In contrast, the relationship between both self-reported and objectively measured BMI
tends to only weakly correlate with measures of body image [17, 47]. That is, poor body
image is less related to actual body weight and shape, but is, rather, dependent upon
negative self-evaluation due to weight. In fact, in two separate studies conducted in higher-
weight community samples, BMI and general dislike of fat individuals accounted for only
a small amount of the variance in body image concerns, whereas internalized weight
stigma explained between a third and half of the variation in scores [48, 49].
The robust negative relationship between internalized weight stigma and body image
has been consistently replicated across studies using numerous different measures of body
image, including general appearance evaluation [26], weight-related body self-
consciousness [49], body satisfaction [50], weight dissatisfaction [51], weight and shape
concerns [52], body-related pride [53], and body shame and body image flexibility [54]
a form of distress tolerance defined as the ability to accept sometimes negative body-
related thoughts and feelings. The relationship is also consistent in clinical [49, 55] as well
as community samples, and in adolescents [56, 57] and children [58] as well as in adults.
Internalized weight stigma has also been shown to mediate the relationship between
experienced weight stigma and appearance evaluation [26] and weight dissatisfaction [27,
56]. That is, being stigmatized by others because of one’s weight is associated with higher
levels of internalized weight stigma, which in turn is linked with poorer body image. Many
of the measures of body image used in these studies were assessed as part of an evaluation
of eating-disordered cognitions and behaviours, and, unsurprisingly, internalized weight
stigma also mediates the relationship between experienced weight stigma and problem
eating, in slimmer as well as in higher-weight samples [59, 60].
It is worth noting that the majority of these studies have used the Weight Bias
Internalization Scale (WBIS), which comprises 11 items relating to negative global self-
judgments due to weight status, appearance of the higher-weight body, and how the
individual thinks they appear to others [48], and therefore this strong relationship is not
unexpected. Nevertheless, an alternative, and increasingly popular measure of internalized
weight stigma, the Weight Self-Stigma Questionnaire (WSSQ) [16], distinguishes between
self-devaluation and fear of being stigmatized by others, and doesn’t focus on the
appearance of the body. A recent comparative study of internalized weight stigma
measures found no association between the WSSQ Self-Devaluation subscale and body
image in a weight-loss surgery sample, but did find a moderate association between the
WSSQ Fear of Stigma subscale and appearance evaluation; in contrast, the WBIS was
significantly correlated with appearance evaluation and with appearance orientation how
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focused the individual is on their appearance [55]. However, a psychometric evaluation of
the WSSQ in a sample of higher-weight French-Canadian adolescents reported high
correlation between physical appearance evaluation and both subscales of the WSSQ [57].
Further studies are needed to more clearly elucidate the relationship between internalized
weight stigma and body image, and to clarify whether alternative conceptualizations of
weight-related self-stigma differentially predict body image in clinical and non-clinical
populations.
28.6.2 Longitudinal studies
Prospective longitudinal studies in community samples of adults rarely consider body
image as an outcome measure, although body image may be an outcome of interest in
studies conducted in eating disorder or weight-loss treatment-seeking populations.
However, specific measures of internalized weight stigma have only recently been
developed, and have therefore not been included in existing long-term prospective or
cohort studies.
To our knowledge, only one study has so far tracked both internalized weight stigma
and body image over time. In a pre-post design, 14-week behavioral weight-loss
intervention, change in internalized weight stigma between baseline and the end of the
intervention was significantly associated with improvements in general appearance
evaluation [61]. It is worth noting that changes in BMI were small, and the reductions in
internalized weight stigma and body image were not due to changes in actual body size.
28.6.3 Experimental studies
Few studies have utilized experimental designs to identify any causative role of
internalized weight stigma in psychological outcomes, although a few have explored its
role in eating behavior. To our knowledge, only one study has included a measure of body
image as an outcome variable. In an online study, 260 higher-weight participants read
about a female employee denied a promotion to a sales position because of her weight [42].
They were then randomized to either an “Experienced” stigma condition, where they read
about the employee’s outrage and were asked to write about a similar experience of their
own when they had been treated unfairly because of their weight, or to an “Internalized”
stigma condition, where they read how the employee blamed herself and felt worthless,
and again asked to write about a similar experience of their own. Compared with the
Experienced stigma condition, those in the Internalized stigma condition reported more
negative affect, less positive affect, and lower self-esteem following the intervention. In
the Experienced stigma condition, women reported significantly more body dissatisfaction
than did men. They also reported slightly more body dissatisfaction than men in the
Internalized stigma condition, but this was not statistically significant. Surprisingly, while
12
men reported greater body dissatisfaction in the Internalized condition than in Experienced
stigma condition, there were no differences in the effect on body dissatisfaction between
Experienced and Internalized stigma for women. The authors hypothesized that
internalized weight stigma may be so ingrained in most higher-weight women that it may
have been less responsive to the manipulation than was the case in the male participants
[42]. While findings from several cross-sectional studies have suggested that internalized
weight stigma may be a more important driver of negative health outcomes than
experienced weight stigma, this study provided the first confirmatory experimental
evidence. Further research is needed to replicate and clarify these findings.
28.6.4 Intervention studies
A small number of studies that specifically target internalized weight stigma have now
been conducted, and have demonstrated significant improvements in quality of life,
psychological outcomes, and problematic eating behaviors in the experimental group
compared with a control [6264]. However, only one of these included body image as an
outcome measure [64]. In a small pilot trial of “Accept Yourself!” an 11-week
manualized self-acceptance program created using a Health At Every Size® and
Acceptance Commitment Therapy framework [65], 21 higher-weight women with major
depressive disorder saw marked improvements in internalized weight stigma and body
image flexibility, as well as in depressive symptoms and quality of life, at the end of the
program, and these were maintained at 3-month follow-up; no changes in weight occurred
among the participants [64].
Other studies have targeted internalized weight stigma as part of a broader intervention.
For example, one randomized controlled trial of two different behavioral weight-loss
approaches compared a typical program with one that included psychoeducation around
weight stigma, both experienced and internalized, media literacy, and body acceptance
[66]. Both programs included information about nutrition and exercise, and weight-loss
maintenance. The extent to which weight stigma can be successfully targeted within a
weight-loss treatment context is debatable, and indeed both programs produced similar
reductions in internalized weight stigma and small improvements in body satisfaction. It
is reasonable to assume that individuals who stigmatize themselves because of their
weight, will report lower self-stigma on achieving weight loss; however, it is likely that
subsequent increases in internalized weight stigma will be observed when weight is
regained, unless underlying negative attitudes toward weight are also altered. Interestingly,
the participants in the traditional weight-loss group continued to assign negative
stereotypes to both themselves and to higher-weight others after the intervention, whereas
those receiving the program with the stigma-reduction component saw large reductions in
negative stereotypes, both toward themselves and to higher-weight individuals in general
[66], suggesting that the program may have been effective in changing attitudes, despite
the weight-loss setting. Nevertheless, it would be interesting to see whether these changes
would be maintained in the face of weight regain.
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Similar findings were reported from another comparative trial of two “healthy living”
programs a traditional weight-loss intervention and a weight-neutral program [67, 68].
The weight-neutral program promoted health behaviors for intrinsic reasons, such as
personal enjoyment and wellbeing, with no focus on weight-loss as a goal. Although the
weight-neutral program emphasized size acceptance and an appreciation of natural body
size diversity, the program did not specifically target internalized weight stigma.
Nevertheless, while the weight-loss program resulted in significant weight-loss after the
6-month trial period and no weight loss was observed in the weight-neutral group, both
programs produced a similar reduction in internalized weight stigma post-study.
Reductions in weight and shape concerns also decreased in both groups, although the effect
was larger in the weight-neutral group. However, at 24-month follow-up, weight regain
was apparent in the weight-loss group, as was a rebound in internalized weight-stigma
scores, whereas improvements were maintained in the weight-neutral group. Likewise, a
significant interaction effect of internalized weight stigma and time on weight concerns
was observed in the weight-neutral but not the weight-loss group, and a marginal effect
was observed for shape concerns [67, 68]. Thus, it seems likely that improvements in
internalized weight stigma and body image that occur as a result of weight loss are due, at
least in part, to changes in weight rather than changes in views about weight, and benefits
may be contingent upon weight-loss maintenance, and therefore somewhat tenuous.
Interventions are clearly needed that result in reduced internalized weight stigma
independent of weight loss. Earlier studies of weight-neutral interventions, while not
measuring internalized weight stigma per se, do suggest that improvements in body image
measures (or other psychosocial, eating-related, or physical activity outcomes) resulting
from such programs are not generally matched or maintained in weight-loss comparison
groups [6972].
28.7 Ethnic and cultural differences
Although early cross-cultural studies suggested differences in anti-fat attitudes between
countries [73], negative attitudes toward higher-weight bodies are becoming the norm
worldwide, even in countries where fat was previously admired [74], and experienced
weight stigma is now prevalent in both developed and developing countries [75, 76] (see
also Chapter 31 of the present book). The majority of studies of internalized weight stigma
have been conducted in the US, although a small but growing number of studies have
recently emerged from countries in Europe [25, 7779] and the Middle East [8082].
In a recent study of 379 higher-weight adults from 16 different countries, frequency of
experienced weight stigma did not differ by geographical region after controlling for BMI;
however, the relationship between experienced weight stigma and appearance evaluation,
controlling for BMI, was much stronger among participants from Oceania, than among
those from the UK, North America, and Europe [26]. The reasons for this difference are
unclear, and future cross-cultural studies are needed to identify other sociocultural factors
that moderate these relationships. Some differences in levels of internalized weight stigma
14
were also apparent. Approximately two-thirds of participants from the UK and Oceania
reported at least some degree of internalized weight stigma, compared with only around
40% of participants from the US and Europe. Interestingly, regional averages were
inversely proportion to regional mean BMI, such that participants with the highest mean
BMI by region had the lowest levels of internalized weight stigma, and vice versa, possibly
due to a norming effect whereby higher-weight bodies are less obviously deviant from
regional norms. However, the relationship between internalized weight stigma and body
image was the same across all regions [26].
Looking at patterns of experienced weight stigma by ethnicity and race, baseline data
from the Project EAT cohort indicated similar rates of weight-related teasing experiences
among higher-weight adolescents, independent of race or ethnicity, although there was
some variation in source of teasing, i.e., family or peers, and White girls tended to express
more distress as a result of weight-related teasing than did girls from other racial or ethnic
groups [83]. Cross-sectional data from a subsequent wave of Project Eat, comprising a
racially and socioeconomically diverse sample of nearly 3000 middle- and high-school
students, found that ever having been harassed or teased because of weight was
independently associated with significantly lower body dissatisfaction in both boys and
girls, as well as self-esteem, and, in girls only, depressive symptoms [84]. After controlling
for weight-based harassment, no effects on body image were observed for having
experienced sexual harassment or harassment due to race or socioeconomic status,
underscoring the distinctive negative impact of this form of weight stigma for young
people.
Most studies of internalized weight stigma that have explored race/ethnicity as a
potential covariate have reported no difference between groups [26, 85, 86]. There is some
evidence from US samples that internalized weight stigma may be lower in African-
American participants than in non-Hispanic White and Latino/Latina participants, but
again, the relationship between internalized weight stigma and body image appears to be
the same across ethnicities and racial groups, with African-American participants also
tending to report less body dissatisfaction than other racial/ethnic groups [87, 88].
Little is known about the processes by which weight-related teasing is associated with
body image issues and distal health outcomes across ethnic or cultural groups. A study in
100 Australian Caucasian females and 48 Hong Kong Chinese females, aged 17 to 28,
found different associations between weight-related teasing, body dissatisfaction, and
eating disturbance between the two groups [89]. Models were constructed including BMI,
ever having dieting, internalization and pressure to conform to the thin ideal, self-esteem,
and experience of weight-based teasing as predictors of body dissatisfaction, and body
dissatisfaction as a mediator between these predictors and a measure of eating disturbance
(bulimia and drive for thinness). In the full model, self-esteem was the only significant
predictor of body dissatisfaction, and body dissatisfaction and ever having dieted predicted
eating disturbance in the Australian sample. In the Hong Kong sample, body dissatisfaction
did not significantly predict eating disturbance, whereas self-esteem and weight-related
teasing experience directly predicted problematic eating [89]. However, this sample had
only a single participant with a BMI over 25, and it has yet to be established that weight-
related teasing impacts on outcomes in the same way in higher-weight individuals.
15
28.8 Future research
Although researchers have been cataloguing the prevalence and correlates of weight
stigma for over fifty years, there are still many gaps in our knowledge. Longitudinal cohort
studies are now providing evidence of the serious long-term, cumulative harms associated
with experienced weight stigma, but little is known about the long-term impacts of
internalized weight stigma. Additionally, while some studies have explored mechanisms
between weight stigma and health and behavioral outcomes, most have utilized cross-
sectional designs that preclude determination of causal pathways.
Another area that requires attention is that much of the research in the field of weight
stigma continues to be conducted in predominantly White populations. Exploring cultural
and ethnic differences in weight stigma serves not only to document the extent of the
problem within the wider social context, but also enables consideration of intersectional
effects, more accurately mirroring the lived experience of individuals in marginalized
groups. Most people do not fit neatly into a single box, based solely on their size, gender,
ethnicity, age, socioeconomic status, sexuality, or other singular identity. In reality, there
is a non-additive effect of the multiple identities that we all possess, which may overlap in
complex ways in terms of exposure to oppression and inequality [90, 91].
Additionally, much research on weight stigma is still conducted in student samples or
other predominantly “normal-weight” populations. From an ethical standpoint, this
situation serves to obliterate the voices of the marginalized group. However, there are also
scientific reasons why this practice may result in findings of uncertain validity. While
anti-fat attitudes, fear of fat, weight-related teasing, and body dissatisfaction are present
across the weight range, the experience of experienced stigma is almost certainly different
in an individual whose body weight is considered to fall outside the normative range. These
experiences occur within a pervasively hostile environment in which higher-weight people
additionally carry the burden of their recognized subordinate status in society, in a way
unlikely to be experienced by members of the privileged, i.e., normative, group [92], and
are likely to be complicated by aspects of blame and shame, again, not-experienced by
slimmer individuals. Thus, the generalizability of research conducted in lower-weight
populations to higher-weight individuals is far from proven, and any distal effects on
affective, cognitive, or behavioral outcomes may well be transmitted via different
mechanisms [93]. Research aiming to elucidate the pathways via which weight-related
discrimination impacts on such outcomes should be conducted in populations that are the
primary target of such discrimination and prejudice, or in mixed-weight populations that
allow for any moderating effects of weight status to be explored. Nevertheless, it is critical
that the roles of both experienced and internalized weight stigma as causal and complicit
forces in negative body image and eating pathology across eating disorder diagnoses not
be minimized or missed altogether among lower- and average-weight clients in eating
disorders prevention and treatment efforts.
16
28.9 Concluding remarks
The multiple injurious effects of weight stigma on higher-weight individuals are
incontrovertible. One mechanism by which these harms are effectuated is via the impact
of weight stigma on body image. While in the short term, interventions that reduce
internalized weight stigma may increase individual resilience and help to offset some of
the psychological harms associated with weight stigma, a focus on internalized weight
stigma will only get us so far. It is essential to target intrapersonal-level factors that operate
in ways to keep people vulnerable to stigma. However, these efforts, too, are ultimately
futile if socio-structural factors that contribute to systemic weight stigma are not directly
and effectively addressed. Although the scientific literature has clearly linked weight
stigma to poorer body image and its corresponding downstream effects, the same literature
essentially ignores why higher-weight bodies are stigmatized in the first place and how
weight-based oppression operates in the lives of higher-weight people [94].
In closing, weight is central to body image and eating-related pathology in myriad ways,
and body image and eating disorders scholars and practitioners are on the front lines when
it comes to modeling and communicating attitudes and behaviors around weight with
vulnerable individuals. We cannot address weight stigma or its downstream consequences
on body image and eating pathology until we become informed advocates for those clients
and communities who suffer most acutely from experienced and internalized forms of
weight stigma. It is long past time to heed the call for cultivating size diversity as a means
of challenging weight bias in community and clinical populations.
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... This self-devaluation arises from an internalization of negative stereotypes about fat 1 people; for example, the belief that being fat is a result of gluttony or laziness (Crandall & Hortman Reser, 2005). Thus, while weight stigma can affect people across the body weight spectrum, the anti-fat stereotypes that underpin weight stigma mean that it is disproportionately perpetrated towards, and internalized by, fat people (Meadows & Calogero, 2018). Longitudinal evidence indicates that increases in internalized weight bias are associated with poorer mental health among sexual minority men over time . ...
... Future studies should qualitatively examine weight stigma among people of various minority gender and sexual identities to provide comprehensive insight into how attitudes towards weight may intersect, and vary with, different identities. Finally, our results may not be generalisable outside of an Australian context -limited existing research indicates that there are cross-cultural differences in the extent to which people experience and internalize weight stigma (Meadows & Calogero, 2018); although no extant research has accounted for these findings, cultural variations in the attitudes that construct weight stigma may contribute to these differences. Future studies might consider conducting similar qualitative investigations with sexual minority men from other cultures to provide comprehensive insight into the attitudes that construct weight stigma. ...
Article
Why is weight stigma so potent among sexual minority men? We propose that sexual minority men may be more vulnerable to weight stigma because of factors not captured by existing measures – for instance, men’s perception of fatness as less masculine and/or more feminine. To investigate, we qualitatively examined how 17 sexual minority men (Mage = 28.52, SDage = 1.63, range: 18–49) described fatness in their discussions of body ideals and appearance pressures. We generated two themes: (i) Masculinity is a currency that fat men have less of and (ii) Fatness is stigmatized or fetishized. Participants described appearing masculine (i.e., lean, muscular) as particularly valuable within the gay community – opposingly, fatness was framed as unmasculine and undesirable. Fat men’s treatment was understood as rarely divorced from their body size, either being stigmatized or fetishized because of their weight. Finally, being unattracted to fat men was constructed as a personal preference that ought not be criticised. These findings suggest the value of masculinity within the gay community may exacerbate weight stigma experiences and internalization among sexual minority men. Future research should account for the anticipated effects of fatness on men’s masculinity and clarify whether sexual preferences and fetishization should be subsumed in weight stigma definitions.
... Physically, it is associated with an increased risk of several secondary diseases like diabetes, cardiovascular disorders, or cancer, and with increased mortality from infections (Stefan et al., 2021). Psychologically, individuals deal with external or internalized stigmatization that can lead to a disturbed body image (Meadows and Calogero, 2018). Noninvasive treatments of obesity often consist of a multi-method approach combining lifestyle and weight-loss interventions with cognitivebehavioral therapy (Yumuk et al., 2015). ...
... It may manifest into body image distortion, the misperception of one's body weight and dimensions that have repeatedly been reported based on underestimations (Maximova et al., 2008;Valtolina, 1998) or overestimations (Thaler et al., 2018a;Docteur et al., 2010), or body image dissatisfaction, a negative attitude towards the own body that is associated with body image avoidance (Walker et al., 2018) and a reduced body awareness (awareness for bodily signals, Mehling et al., 2011;Peat and Muehlenkamp, 2011;Todd et al., 2019a,b;Zanetti et al., 2013). While often caused by internalized weight stigma and a fear of being stigmatized by others (Meadows and Calogero, 2018), a disturbed body image interferes with efforts to stabilize body weight in the long term (Rosen, 2001). Treatments for body image disturbances mainly rely on cognitive-behavioral therapy, typically combining psychoeducation and self-monitoring tasks, mirror exposure, or video feedback (Farrell et al., 2006;Ziser et al., 2018;Griffen et al., 2018). ...
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Obesity is a serious disease that can affect both physical and psychological well-being. Due to weight stigmatization, many affected individuals suffer from body image disturbances whereby they perceive their body in a distorted way, evaluate it negatively, or neglect it. Beyond established interventions such as mirror exposure, recent advancements aim to complement body image treatments by the embodiment of visually altered virtual bodies in virtual reality (VR). We present a high-fidelity prototype of an advanced VR system that allows users to embody a rapidly generated personalized, photorealistic avatar and to realistically modulate its body weight in real-time within a carefully designed virtual environment. In a formative multi-method approach, a total of 12 participants rated the general user experience (UX) of our system during body scan and VR experience using semi-structured qualitative interviews and multiple quantitative UX measures. By using body weight modification tasks, we further compared three different interaction methods for real-time body weight modification and measured our system's impact on the body image relevant measures body awareness and body weight perception. From the feedback received, demonstrating an already solid UX of our overall system and providing constructive input for further improvement, we derived a set of design guidelines to guide future development and evaluation processes of systems supporting body image interventions.
... Weight stigma is a ubiquitous form of social stigma that primarily targets higher weight individuals in nearly every domain of daily living (Puhl & King, 2013). Experienced and internalized weight stigma have been linked to serious health consequences for higher weight individuals, including, but not limited to, disordered eating, substance use and dependence, self-harm, healthcare avoidance, and higher risk of chronic morbidity and mortality, independent of BMI and other relevant covariates (Meadows & Calogero, 2018;Tomiyama, 2014). Weight stigma is underpinned by weight-based stereotypes that cast higher weight individuals as lazy, impulsive, unhealthy, unattractive, unintelligent, and lacking in willpower and self-discipline (Puhl & Brownell, 2001). ...
... Weight stigma influences how people understand, perceive, and behave toward others based on their body size, shape, and perceived weight across multiple sectors and situations (Meadows & Calogero, 2018;Setchell et al., 2015;Tillman et al., 2007). The current study was a preliminary experimental investigation of specific weight-stigmatizing perceptions toward higher weight individuals in the context of an ED. ...
Article
The present study examined how weight status would affect lay perceptions of a White female student presenting signs of eating disorder-related distress. We recruited a mixed-gender, weight-diverse U.S. community sample through Mechanical Turk (N = 130; 49.2% female) to complete an online survey. Participants were randomly assigned to one of two conditions in which they read a personal statement section of a college application revealing eating disorder-related distress from a student who was either ‘overweight’ or ‘underweight.’ Participants evaluated the student on need for support, behavioural prescriptions for eating and exercise, and personal qualities. Although participants recognized a serious mental health concern in both conditions, they were more likely to prescribe eating disorder behaviors to the higher weight student. Findings suggest that weight stigma may bias lay perceptions of and even reinforce an eating disorder when exhibited by higher weight individuals.
... It is important to highlight that, though fitness professionals do not overtly engage in direct discrimination, their actions and beliefs may have important and pervasive effects as indirect discrimination. In this regard, quantitative research has contributed to shedding light on the relationship between discrimination and self-stigma, for instance, providing evidence on the effects of implicit anti-fat bias of fitness professionals on obese persons' psychological maladjustments (Carels et al., 2010;Robertson and Vohora, 2008), or the importance of shame-free environments as a consideration for obese persons when selecting a gym (Meadows and Calogero, 2018;Schvey et al., 2017). ...
Article
Weight stigma is a negative social process that involves discrimination against overweight and obese people. Gyms are important environments to promote exercise where weight stigma can be a hindrance for obese exercise practitioners. This critical-oriented study provides evidence-based answers to this question: How do obese users experience weight stigma in gyms? Six obese gym users (BMI >30) participated in semi-structured interviews and provided visual data for photo-elicitation. A thematic analysis enabled the grouping of their experiences around weight stigma into three forms of discrimination: 1) direct: negative comments about body weight and body size; 2) indirect: internalization of negative stereotypes on weight, ability or appearance; 3) structural: explicit or symbolic rejection related with weight-centric exercise, equipment and recommendations implicit in marketing and advertising. The results provide evidence and interpretations of different forms of discrimination and inequality that operate in gyms, and how they affect obese users’ experiences. Based on these results, we compile a list of measures to prevent weight stigma and recommendations for exercise professionals to relate with obese users.
... Transgender people face regular interpersonal and structural violence for being trans (Bauer & Scheim, 2015), and report avoiding public spaces or situations where they anticipate harassment and violence, even moving their homes in order to be safer (Scheim, Bauer, & Pyne, 2013). Higher weight people, especially women, face verbal and physical threats of violence for being fat in every setting where it has been examined: the home, workplace, school, healthcare, restaurants, and even movie theaters (Meadows & Calogero, 2018). The PSAVS would allow for more direct analysis of the safety repercussions of socio-environmental threats, and the degree to which personal safety anxiety and vigilance become a kind of phenomenological posture for members of Running Head: SEXUAL OBJECTIFICATION AND SAFETY 54! ! ...
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Objectification Theory posits that everyday encounters with sexual objectification carry a diffuse nonspecific sense of threat that engenders personal safety anxiety in women. In this article, we provide direct evidence for this tenet across 5 studies and 1,665 participants using multiple methods. Study 1 (N = 207) and Study 2 (N = 161) explored and confirmed the factor structure of the Personal Safety Anxiety and Vigilance Scale (PSAVS), a measure of personal safety anxiety, and provided evidence for the reliability and construct validity of its scores. Study 3 (N = 363) showed that personal safety anxiety is a conceptually different construct for women and men, and differentially mediated the relation between sexual objectification and restricted freedom of movement and the relation between self-objectification and restricted freedom of movement for women and men. Study 4 (N = 460) included a comprehensive test of personal safety anxiety within an expanded Objectification Theory model, which supported personal safety anxiety as a mediator of the links from sexual and self-objectification to women's restricted freedom of movement. Study 5 (N = 474) replicated these results while also adjusting for specific fears of crime and rape. Our findings offer a newly validated assessment tool for future research on safety anxiety, illuminate the real and lasting sense of threat engendered by everyday sexual objectification, and broaden understanding of the mental and physical constraints on women's lived experiences posited in Objectification Theory. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Purpose of review: Androgen abuse is more prevalent among gay and bisexual (i.e. sexual minority) men than heterosexual men. We review recent research about androgen abuse in sexual minority men and provide relevant social, cultural, and historical contexts. Recent findings: Androgen abuse among sexual minority men is shaped by the intersections of sexuality, desirability, masculinity, and race. Muscular male bodies are desired and - in erotic settings especially - prized as literal embodiments of masculinity. Racist stereotypes unjustly diminish the desirability and masculinity of sexual minority men who belong to racial minorities, especially those who are Asian or Black, and the higher rates of androgen abuse among these racial minorities may reflect a compensatory motivation for these diminishments. The historical context for sexual minority men - decades of subjugation alongside stereotypes of masculinity-compromising effeminacy - further complicate the intersections of sexuality with androgen abuse. Harm minimization efforts led by empathetic endocrinologists stand the best chance of achieving positive outcomes for sexual minority men who use androgens. Summary: More dedicated research on androgen abuse among sexual minority men is needed as this population requires thoughtfully designed research that is incorporative - at a minimum - of the complexities of sexuality, desirability, masculinity, and race.
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Despite their negative effects on the emotional, physical, and social wellbeing of students, weight stigma and anti‐fat attitudes are rarely systematically addressed in schools or within school psychology. Weight‐based oppression is regarded differently than other domains of prejudice. Therefore, implicit and explicit bias continue unimpeded, even when practitioners are attentive to other areas of social injustice. Mental health providers serving schools must acknowledge the prevalence of weight stigma and fatphobia to reduce their deleterious and oppressive effects. This conceptual paper outlines the underpinnings of weight stigma, overviews the necessity of addressing it and body image in educational settings, incorporates interdisciplinary perspectives, and proposes a justice‐oriented shift in the conceptualization of weight status within school psychological service delivery.
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There has been a surge in “quarantine15” social media posts during the self-isolation and lockdowns associated with the COVID-19 global pandemic. Given the influence of other body and weight-centered social media content (e.g., Fitspiration, Fatspiration) on body image and weight stigmatizing thoughts and attitudes, characterizing the features of quarantine15 content is an imperative first step towards understanding its impact on those who view it. Therefore, the present study is a content analysis of quarantine15 content on Instagram. A total of 668 posts were sampled using the hashtag quarantine15, and systematically analyzed for features related to positive and negative body image, as well as weight stigma. The results showed that the posts containing human figures (57.5%) showcased individuals who were perceived as lower-weight (88.8%), White (70.3%), and women (87%). Approximately one-third (34.4%) of the images containing individuals were considered objectifying. Posts also perpetuated the controllability of weight through diet (51.5%) and physical activity (27.5%), while 46.9% expressed dislike towards higher-weight bodies. Future experimental research in this area will be important for understanding both the acute and long-term effects of viewing quarantine15 content on body image, weight stigmatizing attitudes and thoughts, and internalized weight stigma.
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Research suggests that weight-related teasing is associated with body concerns and disordered eating in male and female adolescents and women. Yet, little is known about these associations for young men with diverse racial and ethnic identities. This study examined the association of weight-related teasing frequency and distress with body concerns, loss of control (LOC) eating, dietary restraint, and history of psychiatric and medical diagnoses in racially and ethnically diverse young men. Racial and ethnic identity was examined as a potential moderator. Participants (N = 1,069; 18–30 years; Mage = 24.1 ± 3.6 years) completed an online survey and reported on general demographics; weight-related teasing; body concerns; LOC eating frequency in the last 28 days; dietary restraint; and history of psychiatric and medical diagnoses. All models adjusted for BMI, income, education, and history of psychiatric diagnoses (when not the dependent variable). Both weight-related teasing frequency and distress were significantly and positively linked with all dependent variables, and these associations did not significantly vary by racial and ethnic identity. These findings suggest that, much like in prior research with adolescents and women, experiences with weight-related teasing are associated with body concerns, disordered eating, and poorer health in racially and ethnically diverse young men, regardless of body size.
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Purpose: The Weight Self-Stigma Questionnaire (WSSQ) was recently developed to assess the internalization of weight stigma among English-speaking overweight and obese adults. The objective of the present study was to develop and examine the psychometric properties of a French version of the WSSQ, as well as its applicability to adolescents. Methods: The sample comprised 156 overweight and obese adolescents (81 boys, 75 girls, M age = 16.31). The factor validity and the convergent validity of the French version of the WSSQ were examined using a confirmatory factor analysis and a structural equation model, respectively. Results: The a priori two-factor structure of the WSSQ and the composite reliability of its subscales (self-devaluation and fear of enacted stigma) were supported. Convergent validity analyses revealed that both WSSQ subscales were significantly and (a) negatively correlated with measures of self-esteem and physical appearance, and (b) positively correlated with measures of anxiety, depression, fear of negative appearance evaluation, and eating-related pathology (fear of getting fat, eating-related control, food preoccupation, vomiting-purging behaviors, and eating-related guilt subscales). However, no significant relation was found between the WSSQ subscales and body mass index. Conclusion: These results suggest that the French version of the WSSQ has acceptable psychometric properties and can be used to assess weight self-stigma among overweight and obese adolescents.
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Objective: Certain psychological and emotional factors can undermine attempts at weight management. Previously we have found that shame and self-criticism were significantly associated with disinhibition and perceived hunger in 2,236 participants of a weight management programme. This effect was fully mediated through weight-related negative affect. The present study examined the impact of self-criticism and self-reassurance on well-being and whether it was mediated by weight-related affect in the same population. Methods: Participants completed an online survey of measures of self-criticism and self-reassurance, and negative and positive affect associated with weight and well-being. Results: Path analysis suggested that self-criticism was significantly associated with decreased well-being, both directly and indirectly, mediated by increased negative and decreased positive weight-related affect. Self-reassurance had a stronger association with increased well-being by predicting lower negative and increased positive weight-related affect. All effects were significant at p < 0.001. Conclusion: Self-criticism and self-reassurance were related to well-being in participants attempting to manage their weight, both directly and through their impact on weight-related affect. The positive association between self-reassurance and well-being was stronger than the negative association between self-criticism and well-being. Supporting the development of self-reassuring competencies in weight management programmes may improve weight-related affect and well-being.
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Weight-related teasing is a widespread phenomenon in childhood, and might foster the internalization of weight bias. The goal of this study was to examine the role of weight teasing and weight bias internalization as mediators between weight status and negative psychological sequelae, such as restrained eating and emotional and conduct problems in childhood. Participants included 546 female (52%) and 501 (48%) male children aged 7-11 and their parents, who completed surveys assessing weight teasing, weight bias internalization, restrained eating behaviors, and emotional and conduct problems at two points of measurement, approximately 2?years apart. To examine the hypothesized mediation, a prospective design using structural equation modeling was applied. As expected, the experience of weight teasing and the internalization of weight bias were mediators in the relationship between weight status and psychosocial problems. This pattern was observed independently of gender or weight status. Our findings suggest that the experience of weight teasing and internalization of weight bias is more important than weight status in explaining psychological functioning among children and indicate a need for appropriate prevention and intervention approaches.
Article
Studies show that women with high BMI are less likely than thinner women to seek healthcare. We aimed to determine the mechanisms linking women's weight status to their healthcare avoidance. Women (N = 313) were surveyed from a U.S. health-panel database. We tested a theory-driven model containing multiple stigma and body-related constructs linking BMI to healthcare avoidance. The model had a good fit to the data. Higher BMI was related to greater experienced and internalized weight stigma, which were linked to greater body-related shame. Internalized weight stigma was also related to greater body-related guilt, which was associated with higher body-related shame. Body-related shame was associated with healthcare stress which ultimately contributed to healthcare avoidance. We discuss recommendations for a Weight Inclusive Approach to healthcare and the importance of enhancing education for health professionals in weight bias in order to increase appropriate use of preventive healthcare in higher weight women.
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In this article, the author reviews the ways that the microaggressions framework has been taken up with regard to weight stigma by academics and activists and offers insight into its value for conceptualizing and challenging weight stigma.
Article
Weight-based teasing is common among youth, but little is known about its long-term impact on health outcomes. We aimed to 1) identify whether weight-based teasing in adolescence predicts adverse eating and weight-related outcomes 15 years later; and 2) determine whether teasing source (peers or family) affects these outcomes. Data were collected from Project EAT-IV (Eating and Activity in Teens and Young Adults) (N = 1830), a longitudinal cohort study that followed a diverse sample of adolescents from 1999 (baseline) to 2015 (follow-up). Weight-based teasing at baseline was examined as a predictor of weight status, binge eating, dieting, eating as a coping strategy, unhealthy weight control, and body image at 15-year follow-up. After adjusting for demographic covariates and baseline body mass index (BMI), weight-based teasing in adolescence predicted higher BMI and obesity 15 years later. For women, these longitudinal associations occurred across peer and family-based teasing sources, but for men, only peer-based teasing predicted higher BMI. The same pattern emerged for adverse eating outcomes; weight-based teasing from peers and family during adolescence predicted binge eating, unhealthy weight control, eating to cope, poor body image, and recent dieting in women 15 years later. For men, teasing had fewer longitudinal associations. Taken together, this study shows that weight-based teasing in adolescence predicts obesity and adverse eating behaviors well into adulthood, with differences across gender and teasing source. Findings underscore the importance of addressing weight-based teasing in educational and health initiatives, and including the family environment as a target of anti-bullying intervention, especially for girls.
Article
Food addiction is controversial within the scientific community. However many lay people consider themselves addicted to certain foods. We assessed the prevalence and characteristics of self-perceived "food addiction" and its relationship to a diagnostic measure of "clinical food addiction" in two samples: (1) 658 university students, and (2) 614 adults from an international online crowdsourcing platform. Participants indicated whether they considered themselves to be addicted to food, and then completed the Yale Food Addiction Scale, measures of eating behavior, body image, and explicit and internalized weight stigma. Participants in the community sample additionally completed measures of impulsivity, food cravings, binge eating, and depressive symptomatology. Follow-up data were collected from a subset of 305 students (mean follow-up 280 ± 30 days). Self-perceived "food addiction" was prevalent, and was associated with elevated levels of problematic eating behavior, body image concerns, and psychopathology compared with "non-addicts", although individuals who also received a positive "diagnosis" on the Yale Food Addiction Scale experienced the most severe symptoms. A clear continuum was evident for all measures despite no differences in body mass index between the three groups. Multinomial logistic regression analyses indicated that perceived lack of self-control around food was the main factor distinguishing between those who did and did not consider themselves addicted to food, whereas severity of food cravings and depressive symptoms were the main discriminating variables between self-classifiers and those receiving a positive "diagnosis" on the Yale Food Addiction Scale. Self-perceived "food addiction" was moderately stable across time, but did not appear predictive of worsening eating pathology. Self-classification as a "food addict" may be of use in identifying individuals in need of assistance with food misuse, loss-of-control eating, and body image issues.
Article
Obesity may be considered a social stigma. In addition, people with obesity are frequently aware of stigma directed at others who have a similar weight and come to think stigmatized thoughts about themselves. Our study focused specifically on how blatant and subtle discrimination and weight self-stigma are related to depression and anxiety in people with obesity. The sample comprised 170 participants from the Clinical Nutrition Unit of the “ Hospital de Valme ” (Seville, Spain). The Weight Self-Stigma Questionnaire, the Multidimensional Perceived Discrimination Scale, and the Hospital Anxiety and Depression Scale were used. It was found that blatant and subtle discrimination and weight self-stigma were positively related to depression (.31, .38, and .45 respectively) and anxiety (.30, .36, and .49 respectively; all p s < .01). The path analysis conducted showed that there was a mediational effect of weight self-stigma between blatant (β = .36) and subtle discrimination (β = .40) and depression (β = .24) and anxiety (β = .49; all p s < .01). According to these results, it can be said that weight self-stigma was a full mediator in the model found because the relationships between the independent and the dependent variables were non-significant. Finally, results are discussed in the frame of the obesity stigma literature, and some clinical implications of the results of the study are suggested.
Article
This randomized-controlled trial aims to test the efficacy of a group intervention (Kg-Free) for women with overweight or obesity based on mindfulness, ACT and compassion approaches. The intervention aimed to reduce weight self-stigma and unhealthy eating patterns and increase quality-of-life (QoL). Seventy-three women, aged between 18 and 55 years old, with BMI ≥25 without binge-eating seeking weight loss treatment were randomly assigned to intervention or control groups. Kg-Free comprises 10 weekly group sessions plus 2 booster fortnightly sessions, of 2h30 h each. The control group maintained Treatment as Usual (TAU). Data was collected at baseline and at the end of the Kg-Free intervention. Overall, participants enrolled in Kg-Free found the intervention to be very important and helpful when dealing with their weight-related unwanted internal experiences. Moreover, when compared with TAU, the Kg-Free group revealed a significant increased health-related QoL and physical exercise and a reduction of weight self-stigma, unhealthy eating behaviors, BMI, self-criticism, weight-related experiential avoidance and psychopathological symptoms at post-treatment. Results for self-compassion showed a trend towards significance, whereas no significant between-groups differences were found for mindfulness. Taken together, evidence was found for Kg-Free efficacy in reducing weight-related negative experiences and promoting healthy behaviors, psychological functioning, and QoL.