Unpacking the psychological weight of weight stigma: A rejection-expectation pathway

Social anxiety and weight interact with body salience to affect experiences of social exclusion

BACKGROUND

Individuals at a higher weight experience greater victimization and exclusion by peers, and limited research suggests that the salience of one's body image may increase negative emotional reactions to social rejection. Additionally, social exclusion is related to higher levels of social anxiety (SA). We examined how body salience interacts with SA and weight to predict anxiety, self-esteem, and negative affect following social rejection.

METHODS

Participants were undergraduate women (N = 186). We explored the interactive effects of SA, body mass index (BMI), and body salience (i.e., face versus body photo condition) on emotional response to exclusion in a social ostracism paradigm, Cyberball. BMI and self-reported SA were collected at baseline. One week later, participants played Cyberball and reported state affect, anxiety, and self-esteem before and after the game.

RESULTS

The 3-way interaction of BMI, SA, and photo condition did not significantly predict post-exclusion state measures. Photo condition moderated the relationship between SA and post-exclusion anxiety and between BMI and post-exclusion anxiety.

CONCLUSIONS

Those with higher SA were particularly anxious following exclusion if their bodies were visible to others. Additionally, those with lower BMI experienced greater anxiety after exclusion when their body was visible than those with higher BMI.

Higher-weight social identity as a risk and protective factor in the negative health consequences of weight stigma: a systematic review

BACKGROUND

Weight stigma causes significant physical and psychological harm to its targets.

OBJECTIVE

This review aims to determine when identifying as a member of the higher-weight group exacerbates versus mitigates the adverse effects of weight stigma.

METHODS

Searches were conducted on 10 January, 2025, using PsycInfo, Medline, Scopus, Web of Science, Embase, and CINAHL. Evidence was synthesised in terms of exacerbating versus protective effects of higher-weight social identity (as moderator/mediator) in the relationship between weight stigma and 18 distinct health outcomes. This review is registered on PROSPERO (ID: CRD42023415639).

RESULTS

Fourteen studies met the inclusion criteria. Studies employing weight status measures to assess higher-weight social identity identified actual and self-perceived higher-weight as risk factors for anticipated rejection, dietary control challenges, increased physiological stress and greater functional disability following stigmatisation. Conversely, studies measuring individual connection with the higher-weight group revealed that stronger identification had protective effects on self-esteem and distress, but only for specific individuals (e.g., those with low internalised weight bias).

LIMITATIONS

Grey literature and unpublished studies were not reviewed.

CONCLUSIONS

Initial evidence suggests that higher-weight social identity functions as both risk and protective factor in the relationship between weight stigma and well-being.

IMPLICATIONS

Future research should explore the emotional and evaluative components of higher-weight social identity to enhance understanding of how and when group membership influences the adverse effects of weight stigma. This knowledge can inform targeted interventions designed to improve the well-being of higher-weight individuals.

Bracing for impact: An intensive longitudinal investigation of weight stigma, vigilant coping, and maladaptive eating

OBJECTIVE

Interpersonal weight stigma (being teased, treated unfairly, or discriminated against for body weight) increases one's stress and negatively impacts their well-being. Weight stigma consistently increases maladaptive eating behaviors, such as eating to cope, binge eating, and restrictive dieting. Previously published cross-sectional models suggest that vigilant coping (being on the lookout for future discrimination) is one way in which weight stigma may impact maladaptive eating behaviors, especially as internalized weight stigma (self-stigma) increases. This study aimed to analyze these relationships longitudinally using ecological momentary assessments.

METHODS

Female, higher weight college students (MBMI = 32.7, SDBMI = 6.09) from a large public midwestern university (N = 130) completed 3 surveys per day for 7 days, reporting their vigilant coping, eating to cope, restrictive dieting, and binge eating. Data was collected from January 2023-February 2024. We examined the relationship between baseline experienced and internalized weight stigma and day-to-day vigilant coping. Additionally, we examined vigilant coping earlier in the day as a predictor of eating later in the day.

RESULTS

Experienced and internalized weight stigma did not interact to predict day-to-day vigilant coping, but they both independently predicted vigilant coping. Vigilant coping earlier in the day predicted restrictive dieting later in the day but did not predict emotional or binge eating. There were no significant conditional indirect effects.

CONCLUSIONS

This study establishes vigilant coping as a longitudinal predictor of restrictive dieting, but further research is required to understand other health behaviors and outcomes related to vigilant coping.

The determinants of help-seeking behaviors among cancer patients in online health communities: Evidence from China

OBJECTIVE

Although online health communities offer a new approach to patient interaction, the help-seeking behaviors of cancer patients within these platforms remain unexplored. This study aims to identify the determinants influencing online help-seeking behaviors among cancer patients.

METHOD

Based on motivation theory, we proposed six hypotheses and developed a research model. Data were collected from 1100 cancer patients who sought help in a leading Chinese online cancer community in March, June, and September 2023. We used the fixed-effect negative binomial model to test research hypotheses.

RESULTS

The findings indicated that the time since diagnosis (β = -0.127, P < 0.001) was negatively associated with online help-seeking behaviors among cancer patients. In contrast, social support (β = 0.002, P = 0.003) and disease stigma (β = 0.170, P < 0.001) positively influenced their help-seeking behaviors in online health communities. Furthermore, while male and female cancer patients showed decreased help-seeking behaviors as time since diagnosis increased, the decline was less pronounced for females (β = 0.040, P < 0.001). The positive impact of disease stigma on help-seeking behaviors is stronger for female patients than male patients (β = 0.098, P < 0.001).

CONCLUSION

This research broadens the understanding of how cancer patients seek help in digital environments and enhances theoretical insights into these behaviors.

Women's Relationships With Healthcare and Providers: The Role of Weight Stigma in Healthcare and Weight Bias Internalization

BACKGROUND

Weight stigma (devaluation due to body weight) in healthcare is common and influences one's engagement in healthcare, health behaviors, and relationship with providers. Positive patient-provider relationships (PPR) are important for one's healthcare engagement and long-term health.

PURPOSE

To date, no research has yet investigated whether weight bias internalization (self-stigma due to weight; WBI) moderates the effect of weight stigma on the PPR. We predict that weight stigma in healthcare is negatively associated with (i) trust in physicians, (ii) physician empathy, (iii) autonomy and competence when interacting with physicians, and (iv) perceived physician expertise. We also predict that those with high levels of WBI would have the strongest relationship between experiences of weight stigma and PPR outcomes.

METHODS

We recruited women (N = 1,114) to complete a survey about weight stigma in healthcare, WBI and the previously cited PPR outcomes.

RESULTS

Weight stigma in healthcare and WBI were associated with each of the PPR outcomes when controlling for age, BMI, education, income, race, and ethnicity. The only exception was that WBI was not associated with trust in physicians. The hypothesis that WBI would moderate the effect of weight stigma in healthcare on PPR outcomes was generally not supported.

CONCLUSIONS

Overall, this research highlights how weight stigma in healthcare as well as one's own internalization negatively impact PPRs, especially how autonomous and competent one feels with their provider which are essential for one to take an active role in their health and healthcare.

The Impact of Weight Bias and Stigma on the 24 h Dietary Recall Process in Adults with Overweight and Obesity: A Pilot Study

People with overweight and obesity tend to both underreport dietary energy intake and experience weight stigma. This exploratory pilot study aimed to determine the relationship between weight bias and weight stigma and energy intake reporting accuracy. Thirty-nine weight-stable adults with BMI ≥ 25 completed three 24 h dietary recalls; indirect calorimetry to measure resting metabolic rate; a survey measuring weight stigma, psychosocial constructs, and physical activity; and a semi-structured qualitative interview. Multiple linear regression was used to determine if weight bias internalization, weight bias toward others, and experiences of weight stigma were predictive of the accuracy of energy reporting. A thematic analysis was conducted for the qualitative interviews. Weight stigma was reported by 64.1% of the sample. Weight stigma constructs did not predict the accuracy of energy intake reporting. People with obesity underreported by a mean of 477 kcals (p = 0.02). People classified as overweight overreported by a mean of 144 kcals, but this was not significant (p = 0.18). Participants reported a desire to report accurate data despite concerns about reporting socially undesirable foods. Future research should quantify the impact of weight stigma on energy reporting in 24 h recalls using a larger, more diverse sample size and objective measures like doubly labeled water for validation.

Exposure to written content eliciting weight stigmatization: Neural responses in appetitive and food reward regions

OBJECTIVE

Neural activity in food reward- and appetite-related regions was examined in response to high-calorie (HC), low-calorie, and non-food pictures after exposure to written weight stigma (WS) content. Relationships with eating behavior (by Three-Factor Eating Questionnaire [TFEQ]), blood glucose, and subjective appetite were also explored.

METHODS

Adults with overweight and obesity were randomized to read either a WS (n = 20) or control (n = 20) article and subsequently underwent brain scans while they rated pleasantness of food pictures. Fasting glucose, TFEQ, stigma experiences, and appetite were measured before reading the article, appetite after reading, and glucose and appetite again after the scan.

RESULTS

A priori region of interest analyses revealed significant group differences in activation to HC > low-calorie food cues in the caudate and thalamus whereas exploratory whole-brain analyses suggested significant differences in regions including left insula, left thalamus, left inferior temporal gyrus, right lingual gyrus, and bilateral middle occipital gyrus and superior parietal lobule (p < 0.005 uncorrected, k ≥ 200 m3 ). No significant relationships were observed between the pattern of activation and TFEQ, glucose, or subjective appetite in the WS group.

CONCLUSIONS

Exposure to WS was associated with increased responsiveness to HC food content in the dorsal striatum and thalamus in individuals with overweight and obesity.

Implications of Socio-Cultural Pressure for a Thin Body Image on Avoidance of Social Interaction and on Corrective, Compensatory or Compulsive Shopping Behaviour

This paper aims to discuss the implications of body talk and socio-cultural pressure for the internalisation of a thin body image in purchase decisions, shopping habits and other outcomes of body dissatisfaction, in particular the proneness to avoid human/social interaction in retail contexts and proneness to engage in corrective, compensatory or compulsive shopping behaviour. This paper conducted an online questionnaire that measured the following constructs: body mass index; Socio-cultural Attitudes Towards Appearance Scale-4 (SATAQ-4), Body Appreciation Scale (BAS-2), Acceptance of Cosmetic Surgery Scale (ACSS), Compulsive Buying Follow-up Scale (CBFS), proneness to avoid social interaction in retail contexts, and the intention to purchase a list of products and services as a compensation for body dissatisfaction. A structural equations model supported the hypotheses proposing the influence of BAS-2 and SATAQ-4 (the internalisation of thin/athletic body and the social comparison induced by family, peers and media) upon the outcomes of social-interaction avoidance, ACSS and CBFS. Nevertheless, BAS-2 only influences social-interaction avoidance. This paper provides several recommendations to brand managers highlighting the social responsibility role of brand advertising in enhancing positive body appreciation, mitigating the psychological damage caused by socio-cultural pressure and preventing the stigmatisation bias against obese people.

Identity and weight-related beliefs among Black, Black/White biracial, East Asian, Hispanic/Latino, Native American, South Asian, and White U.S. Americans

In the current study we move away from bias-focused, White-centric research to examine relationships between gender, race/ethnicity, and weight-related attitudes, identity, and beliefs among Black, Black/White Biracial, East Asian, Hispanic/Latino, Native American, South Asian, and White U.S. Americans who self-identify as higher weight. The results showed that: (1) women identify as fat more than men do, (2) fat identity, operationalized as feelings of similarity to fat people (self-stereotyping) and importance of weight to one's sense of self (identity centrality) are relatively similar across races and ethnicities, and (3) fat identity and weight-related beliefs are related to positivity toward fat people across the racial/ethnic groups sampled in this study.

Attitudes Towards Appearance and Body-Related Stigma Among Young Women With Obesity and Psoriasis

The goal of this study was to investigate the role of the subjective assessment of one's body image in the relationship between objective indices of appearance and perceived stigma in young women affected by obesity and psoriasis. These are chronic diseases that decrease one's physical attractiveness and are associated with stigmas related to body defects. A total of 188 women in early adulthood took part in the study (M = 25.58; SD = 2.90), including obese women (n = 54), women suffering from psoriasis (n = 57), and a control group (n = 77). The participants completed the Multidimensional Body-Self Relations Questionnaire, Perceived Stigmatisation Questionnaire, and a socio-demographic questionnaire. Anthropometric data were gathered using a body composition analyzer. Objective parameters of body shape were calculated (WHR and ICO). Subjective assessment of one's body and attitudes towards one's body were found to influence perceived stigma, independently of the condition causing the stigma and of the objective appearance of the participant. This study did not support the existence of a relationship between parameters regarding body shape and sense of stigma, even when subjective body assessment acted as a moderator. At the same time, body mass was a strong predictor of levels of perceived stigma. Women affected with obesity perceived a higher level of stigma than the other groups. The severity of psoriasis did not impact the perceived stigma. Moreover, women with psoriasis assessed their health-as a part of the assessment of their bodies-the highest, which may explain the lower perceived stigma in this group.

Exploring the association between parental anti-fat attitudes and restrictive feeding practices in a British and Irish sample

Parental restriction of food intake has been associated with heightened eating disorder psychopathology in some longitudinal research. Yet, relatively little is known about the determinants of restrictive feeding practices. This cross-sectional study explored the association between parents' anti-fat attitudes and their use of restrictive feeding practices in a mixed British (41.10% England, 39.90% Scotland, 4.20% Other) and Irish (14.80%) sample. Parents and caregivers (N = 472; 94.10% female; 70.90% university level education) of children between the ages of 4-8 (48.20% female; 91.10% rated as "normal weight" by their parents) completed self-report questionnaires assessing their anti-fat attitudes (dislike, fear, and blame subscales), use of restrictive feeding practices (for weight control, health purposes, and covert restriction), and how influential their child's body-weight and -shape is for their perception of themselves as parents. Overall, our hypothesis that parental anti-fat attitudes would be significantly associated with restrictive feeding practices was supported. Anti-fat attitudes related to disliking higher body-weight people and blaming parents for their child's weight were significant predictors of all forms of restrictive feeding (all ps < .05). However, anti-fat attitudes related to fearing being a higher body-weight were not significant predictors of restrictive feeding for the purposes of health nor for covert restriction (ps > .05). Additionally, our hypothesis that the associations between anti-fat attitudes and restrictive feeding practices would be stronger for parents for whom their child's body-weight and -shape more strongly influenced how they judged themselves as parents was not supported (the interaction term was not significant in two out of three analyses). Future research is needed to investigate these associations across time and in samples of higher body-weight children.

"Better If They Laugh with Me than at Me": The Role of Humor in Coping with Obesity-Related Stigma in Women

This study investigated the role of perceived stigmatization in the relationship between humor styles and coping with stress among young women suffering from stigma due to obesity. In the 21st century, obesity is an increasing global health issue with many physical and mental consequences for obese women. As a chronic stigmatizing disease, it requires that the affected individuals cope with social consequences; women with obesity are more prone to such consequences than men. Humor fosters the breaking of stereotypes and alleviating the consequences of stigmatization. A total of 127 young adult women (age M = 25.74, SD = 2.73) participated in the study (n = 54 with overfat and n = 73 with healthy fat). Participants filled out the Humor Styles Questionnaire, Perceived Stigmatization Questionnaire, and the Brief COPE Scale. Anthropometric data were gathered using a body composition analyzer. Results indicate that, when perceiving hostile behaviors toward themselves and using humor as a coping strategy, women with overfat select maladaptive styles of humor (i.e., self-defeating and aggressive styles). Women with overfat were also more likely to use humor as a coping strategy in difficult situations. Furthermore, none of the participants were satisfied with their body mass. At the same time, among women without obesity, a lack of compliments was not treated as a problem, even if they had high body fat.

Weight stigma and health – Repercussions on the health of adolescents and adults: integrative review of the literature

ABSTRACT Objective To conduct an integrative review in order to understand the repercussions of the social stigma of overweight on the health of adults and adolescents. Methods The international protocol for systematic review and meta-analysis studies PRISMA was adopted to guide the writing of this review. The databases used were PubMed, Psycinfo, SciELO, Medline, Lilacs and Pepsic, considering studies published in the period from 2000 to 2020. Sixty-seven (67) articles were analyzed, and 4 categories emerged: repercussions on physical well-being; repercussions on social well-being; repercussions on mental well-being; and mixed category (physical and psychological impact). Results In the vast majority of studies analyzed, weight stigma had a negative impact on the different spheres that make up the health construct, that is, the physical, social and mental spheres. Conclusions The consequences of weight stigma are a source of intense suffering, with an impact that reduces the quality of life of individuals who experience stigmatization, involving physical, emotional and social aspects.

The role of executive functioning deficits in the association between substance-use-related stigma and substance use problems among trauma-exposed individuals

Background: Previous research has linked the internalization of shame and negative stereotypes associated with substance use to increased severity of substance use problems (i.e., negative consequences associated with alcohol and drug use, including occupational or relational difficulties and illegal behavior). However, little work has examined how other aspects of substance-use-related stigma (e.g., encounters with and anticipation of discrimination) might be related to the severity of substance use problems. Further, the psychological mechanisms through which stigma drives substance use problems remain poorly understood. Addressing these key limitations, the current study examined the role of executive functioning (EF) deficits in the relation between substance-use-related stigma and severity of substance use problems. Methods: In fall 2019, adults exposed to trauma who use substances were recruited via Amazon's Mechanical Turk (N = 320, 46.9% women) and completed self-report measures of substance-use-related stigma, EF deficits, and substance use problems. Results: Substance-use-related stigma was positively associated with EF deficits, which in turn related to substance use problems. Substance-use-related stigma was also indirectly associated with substance use problems through EF deficits, suggesting that EF deficits accounted for the significant association between substance-use-related stigma and substance use problems. Conclusions: These findings provide initial support for the role of EF deficits as a mechanism through which stigma drives substance use problems among individuals exposed to trauma. Results underscore the potential utility of addressing stigma coping and EF deficits in interventions aimed at preventing and treating substance use disorders.

Reminders of a Stigmatized Status Might Help Smokers Quit

As members of a devalued group, it is not surprising that smokers experience stigmatization and discrimination. But it is not clear if smokers react to these experiences by moving toward or away from their group membership and identity as smokers. Guided by the identity threat model of stigma (Major and O'Brien, 2005) we examined the process of stigmatization and its emotional, cognitive, attitudinal, and behavioral consequences. We experimentally examined how reading a stigmatizing newspaper article or a control article (Experiment 1) and recalling one's experience with smoking discrimination or a control prompt (Experiment 2) affected smokers' responses. We also examined the role of cultural contexts (U.S. vs. Denmark; only in Experiment 1) and smoking identity. In Experiment 1, we used a community sample of smokers from the U.S. (N = 111) and Denmark (N = 111). We found that reading the stigmatizing article (compared to the control) caused more rejection sensitivity (U.S. participants only) and more intentions to quit smoking (both U.S. and Danish participants) for smokers low in smoking identity. In Experiment 2, we used an online sample of 194 U.S. smokers and found that recalling instances of mistreatment made smokers more stressed, rejection sensitive, and interested in smoking cessation, when smokers appraised the stigma cue as threatening. Thus, we generally found that identity threat moved smokers toward leaving their stigmatized group (e.g., quitting smoking) rather than away from it. Our studies highlight the importance of understanding psychological process by which smokers distance themselves from their spoiled identity.

The role of psychological attribution in responses to weight stigma

Objective

Weight discrimination is associated with numerous negative health consequences. Little is known about early‐stage psychological mechanisms that explain variability in responses to weight discrimination among people with obesity. This study tested the hypothesis that attributing negative social evaluation to one's weight would be associated with stigma‐related stress responses (eg, reduced cognitive functioning and self‐esteem, increased negative affect and cortisol), especially among people who had experienced frequent weight discrimination in the past.

Methods

Adults (N = 109) with obesity were randomly assigned to receive a mildly positive (control) versus negative social evaluation. The extent to which participants attributed the negative evaluation to their physical appearance was assessed, along with negative affect, social and appearance self‐esteem, cognitive functioning and salivary cortisol.

Results

Participants who had experienced frequent weight discrimination in the past were more likely to attribute the negative evaluation to their appearance. Participants who attributed the negative evaluation to their appearance in turn experienced elevated negative affect, lower appearance self‐esteem and worse cognitive functioning.

Conclusions

This study is among the first to identify attribution as an early‐stage process underlying responses to weight stigma. Attribution may be a key psychological factor conferring risk for or protection from the negative effects of weight stigma.

Weight discrimination, anticipated weight stigma, and disordered eating

Weight discrimination is a well-established risk factor for disordered eating cognitions and behaviors. However, little is known about what may account for this association. Recent research suggests that anticipated weight stigma may explain the relationship between weight discrimination and non-eating disorder related health outcomes; the present study seeks to replicate this premise and extend it to the disordered eating realm. In a non-clinical sample of adults in the United States (N = 297) we test the hypothesis that weight discrimination has an indirect association with eating disorder symptomatology through anticipated stigma. At a single timepoint, participants recruited from the online data collection platform SocialSci completed self-report, online surveys of weight discrimination in day-to-day life, anticipated weight stigma, eating disorder symptoms, and demographic information. As hypothesized, weight discrimination was indirectly associated with greater disordered eating symptoms via its association with anticipated weight stigma. This pattern of results held when controlling for gender, body mass index, and self-perceived weight status. These findings suggest that anticipated stigma is relevant in the association between weight discrimination and greater disordered eating. This premise deserves additional attention using methodological approaches that can facilitate stronger causal claims. We discuss the potential for this line of research to inform clinical interventions.

Does a Common Ingroup Identity Reduce Weight Bias? Only When Weight Discrimination Is Salient

Compared to many other forms of social bias, weight bias is pervasive, socially accepted, and difficult to attenuate. According to the common ingroup identity model, strategies that expand group inclusiveness may promote more positive intergroup attitudes and behaviors, particularly when people are aware of unjust treatment of others included within their shared identity. Considering that most people are not aware of the social justice issue of weight discrimination, we hypothesized that a common ingroup identity would be effective in reducing weight bias primarily when unfair weight-based treatment was made salient (i.e., that fat people experience discrimination in employment). Participants were randomly assigned to conditions following a 3 (discrimination salience: weight discrimination, height discrimination, control) × 2 (group identity: common ingroup, control) design and completed an evaluative measure of weight bias. Results revealed a significant interaction, showing that when weight discrimination was salient, participants in the common ingroup identity condition reported less weight bias than participants in the group identity control condition. When a common ingroup identity was emphasized, weight bias was lower when weight discrimination was salient compared to when height discrimination was salient and the control condition in which nothing about discrimination was mentioned. These results were not moderated by participant weight. This study demonstrates that a common ingroup identity can be effective in reducing weight bias if a cue is provided that fat people experience disparate and unjust outcomes in employment. Given the serious consequences of weight bias for health and well-being, and the relative ease of implementing this prejudice-reduction intervention, the common ingroup identity model has potential application for reducing weight bias in a range of real-world settings. However, these findings should be considered preliminary until they are replicated in well-powered and pre-registered future research.

Impacto das Consequências Psicossociais do Estigma do Peso no Tratamento da Obesidade: uma Revisão Integrativa da Literatura

Resumo Trata-se de uma revisão integrativa da literatura, cujo objetivo foi investigar as consequências psicossociais do estigma do peso em adultos e sua influência no tratamento da obesidade. A busca envolveu as bases de dados PubMed, Web of Science e PsycINFO e incluiu artigos em inglês e português publicados nos últimos cinco anos. Foram selecionados quinze artigos, analisados a partir da definição de dois subtemas: “A relação entre estigma, psicopatologias e transtornos do comportamento alimentar” e “A estigmatização entre os profissionais de saúde”. Os resultados apontam para o grande impacto do estigma do peso na saúde psicossocial da pessoa com obesidade e para as atitudes estigmatizantes dos profissionais de saúde no cuidado terapêutico. Observa-se um enfoque patológico do enfrentamento da obesidade com estratégias de cunho comportamental que minimizam a compreensão da problemática. Atualmente, o tratamento da obesidade promovido pelo modelo biomédico não abrange as demandas de caráter psicossocial, o que torna necessário a educação permanente para capacitação dos profissionais de saúde e a implementação de protocolos de intervenção específicos a este grupo populacional. A contribuição de profissionais de diversas áreas, e em especial, daqueles de saúde mental, é essencial em atenção às diferentes particularidades do tratamento, devendo ser baseada em uma perspectiva integral e humanizada, e inserida nos diferentes contextos psicossociais. Devido à perversidade do estigma do peso e suas graves consequências, futuros estudos são necessários para investigação desse problema e das atitudes dos profissionais da saúde, familiares, mídia e da população em geral em relação à pessoa com obesidade.

Reactions to ideal body shapes

Difficult-to-attain beauty standards that are promulgated by the media could contribute to body dissatisfaction, but their potential impact upon body image remains unclear. The present study examined reactions to thin-ideal and muscular-ideal images, and examined the effects of ideal image exposure on preferred body shape and time spent deliberating about ideal shape. In a 2 × 2 experimental design, 200 Internet users completed the Kessler psychological distress scale (K10) and were randomly assigned to view idealistic body images or houses (and rated them on semantic differential dimensions). Females viewed thin ideal images and males viewed muscular ideal images, while the control groups viewed images of houses. Between group measures analysis of variance revealed women reacted negatively to thinspirational images. Women were more driven for thinness and idealized a thinner shape for the female body than men. Psychologically distressed participants had a stronger drive for thinness and greater body dissatisfaction compared to low-distress participants. In addition, although beauty ideal imagery had no significant impact on males, females spent more time in choosing ideal body figure. Viewing thin bodies for females created a trend toward desiring a slimmer figure, as well as increased preoccupation with size as they spent more time deliberating over a photorealistic figure rating scale. Therefore, exposure to thinspiration promotes dissatisfaction with self and leads women to dwell more upon their body image.

Interpersonal difficulties in obesity: A systematic review and meta-analysis to inform a rejection sensitivity-based model

Obesity is associated with difficulties due to stigma and loneliness. These impact negatively on individuals' quality of life and behaviour change efforts. Increased sensitivity to others' negative feedback might play a role in the maintenance of these difficulties and could be addressed in psychological interventions. We conducted a systematic review of interpersonal difficulties in individuals with obesity, across the lifespan. We investigated early interpersonal adversity (i.e. frequency of teasing/bullying), perceived interpersonal stress and quality of social life, based on a rejection sensitivity model. The databases PubMed, Web of Knowledge and AGRIS, Embase, Medline and PsychINFO were searched for published peer-reviewed journal articles (1980-June 2018). Thirty-two studies met inclusion criteria. Results from the meta-analyses (n = 16 studies) indicated that overweight/obese individuals reported more frequent experiences of teasing/bullying, greater interpersonal stress and poorer quality of social life than healthy weight individuals. Findings in the systematic review aligned to this evidence. Psychological interventions targeting increased sensitivity to negative interpersonal feedback could improve interpersonal functioning and, in turn, eating behaviours in individuals with obesity.

DOES IT HELP SMOKERS IF WE STIGMATIZE THEM? A TEST OF THE STIGMA-INDUCED IDENTITY THREAT MODEL AMONG U.S. AND DANISH SMOKERS

Research shows that smokers feel stigmatized, but does stigmatizing smokers do more harm than good? The model of stigma-induced identity threat was used to experimentally examine how U.S. and Danish smokers respond to stigma-relevant cues. Heavy smokers (112 Americans, 112 Danes) smoked a cigarette while giving a speech that was either video (stigma-visible condition) or audio recorded (stigma-concealed condition). Smokers high in self-concept reacted to the stigma-visible (as opposed to the stigma-concealed) condition with greater physiological reactivity (b = -2.80, p = .05), cognitive depletion (U.S. smokers, b = -0.06, p = .11), self-exempting beliefs (b = 0.32, p < .001), and less interest in stopping smoking (b = 0.28, p = .02). Thus, stigmatization led smokers toward emotional, cognitive, and attitudinal reactions that might make them less likely to quit. Future research should examine when smokers respond to stigmatization by quitting rather than with resistance or indifference.

Weight Stigma and Hypothalamic-Pituitary-Adrenocortical Axis Reactivity in Individuals Who Are Overweight

BACKGROUND

Stigmatized people exhibit blunted cortisol responses to many stressors.

PURPOSE

To examine the cortisol responses of individuals who are overweight to a stigma-related stressor involving interviewing for a weight-discriminatory company.

METHODS

We recruited 170 men and women (mean age = 35.01) from towns located within about a 30-min drive of the study center. Weight was assessed using body mass index (BMI) and self-perceptions about being overweight. Participants were exposed to a laboratory stressor, modeled after the Trier Social Stress Test. In the stigmatizing condition, participants gave a supposedly videotaped speech about what makes them a good candidate for a job at a company that was described as having a weight-discriminatory health insurance benefit. Participants in the nonstigmatizing condition made a supposedly audiotaped speech for a company whose health insurance benefit was not described. Cortisol reactivity was then assessed.

RESULTS

Participants who rated themselves as overweight or who were overweight according to their BMI evidenced a blunted cortisol response in the weight-stigmatizing condition, whereas lean participants in the weight-stigmatizing condition showed the rise in cortisol levels that typically occurs following the Trier Social Stress Test.

CONCLUSIONS

People who experience the chronic stress of being stigmatized due to their weight show blunted cortisol responses just as other chronically stressed people do.

The psychological and physiological effects of interacting with an anti-fat peer

This experiment tested whether interacting with a peer who holds explicitly anti-fat attitudes leads to cognitive performance deficits and poorer psychological and cardiovascular outcomes among higher body weight women by increasing anticipated rejection. One hundred and forty six higher body weight women were randomly assigned to interact in a non-romantic context with a same-sex peer who endorsed explicit anti-fat or unbiased attitudes. All women showed greater heart rate reactivity and anger when interacting with an anti-fat peer. The heavier women were, and the more they thought they were overweight, the more they anticipated rejection when interacting with an anti-fat peer. This anticipated rejection was in turn associated with poorer cognitive performance, lower state self-esteem, and increased negative emotions, rumination, compensatory efforts, and thoughts related to anxiety and evaluation. These effects were not observed among women in our sample categorized as slightly "overweight" or who perceived themselves as only slightly overweight.

The psychosocial experience of feeling overweight promotes increased snack food consumption in women but not men

Self-identification of being overweight has been associated with overeating and weight gain in observational studies, irrespective of whether the individual in question is objectively overweight. The aims of the present studies were to examine whether experimentally manipulating the psychosocial experience of feeling overweight impacted on snack food consumption and to identify mechanisms explaining this effect. In Study 1, to manipulate the psychosocial experience of feeling overweight, 120 women wore an obese body suit or control clothing in public or private settings, before consuming snack foods. Wearing the obese body suit resulted in an increase in snack food consumption and this effect was not moderated by whether participants wore the obese body suit in public or in private. In Study 2, we aimed to replicate the effect of the obese body suit on snack food consumption and also examined whether the effect of the body suit on eating behaviour was moderated by participant sex (n = 150; 80 women). Women who wore the obese body suit ate significantly more than women who wore the control clothing, but this effect was not observed in men. Across both studies we examined a number of potential mechanisms that could explain the effect that wearing the obese body suit had on snack food consumption, but did not find supporting evidence. The psychosocial experience of feeling overweight may lead to increased snack food consumption in women, but the psychological mechanism explaining this effect is unclear.

Weight Labeling and Disordered Eating Among Adolescent Girls: Longitudinal Evidence From the National Heart, Lung, and Blood Institute Growth and Health Study

PURPOSE

Weight stigma is implicated in disordered eating, but much of this research focuses on forms of stigma such as weight-based teasing.

METHODS

In a large cohort of adolescent girls (N = 2,036), we tested the hypothesis that being labeled as "too fat" by others predicts subsequent greater disordered eating cognitions and behaviors.

RESULTS

Compared with girls who did not report weight labeling, girls who were labeled at age 14 showed an increase in unhealthy weight control behaviors and disordered eating cognitions over the subsequent 5 years. These effects were independent of objective body mass index, race, parental income and education, and initial levels of disordered eating.

CONCLUSIONS

Exploratory analyses suggest that weight labeling from family members is more strongly associated with disordered eating than labeling from nonfamily members. This study highlights how the long-term consequences of weight stigma can potentially begin when one is labeled as "too fat."

Weight Perception, Weight Stigma Concerns, and Overeating

OBJECTIVE

Perceiving one's own weight status as being overweight is a likely motivation for weight loss. However, self-perceived overweight status has also been found to be associated with overeating and weight gain. This study examined whether weight stigma concerns explain why individuals who perceive their weight status as overweight are at increased risk of overeating.

METHODS

We conducted two survey studies of United States adults (N = 1,236) in which we assessed whether weight stigma concerns explain the cross-sectional relationship between perceived overweight and overeating tendencies.

RESULTS

Across two studies, the cross-sectional relationship between perceived overweight and overeating tendencies was in part explained by weight stigma concerns. Participants who perceived their weight as "overweight" reported greater weight stigma concerns than participants who perceived their weight as "about right," and this explained 23.3% (Study 1) to 58.6% (Study 2) of the variance in the relationship between perceived overweight and overeating tendencies.

CONCLUSIONS

Weight stigma concerns may explain why perceiving one's own weight status as overweight is associated with an increased tendency to overeat.

Fundamentals for an Osteopathic Obesity Designed Study: The Effects of Education on Osteopathic Medical Students' Attitudes Regarding Obesity

Context

Obesity is a major health concern in the United States, and its prevalence continues to rise. Although it is a common health issue, many people, including health care professionals, are biased against people with obesity.

Objective

To determine whether a comprehensive obesity curriculum presented to students in medical school can positively influence their attitudes toward obesity.

Methods

The study was designed around a comprehensive educational obesity curriculum at Touro University College of Osteopathic Medicine-CA, involving the classes of 2013 through 2018. A survey to assess student attitudes toward obesity was distributed to first-year students before the curriculum, directly after completion, and each year after until graduation (graduating classes of 2015 through 2018). Second- and third-year medical students in 2011 (graduating classes of 2014 and 2013), who did not complete the curriculum, were given an examination to establish baseline values and served as the control group. The obesity curriculum consisted of lectures delivered during the first and second year of medical school and case study simulations during the third year. Knowledge gained from the curriculum was assessed with a multiple-choice examination, and bias was assessed using the Fat Phobia Scale.

Results

A total of 718 first- through fourth-year students were included. Students who completed the first year of the obesity curriculum (n=528) showed significantly greater medical knowledge regarding obesity-related epidemiology, pathogenesis, biochemistry, pathophysiology, and metabolic factors; nutrition, diet, physical activity, self-control, and behavior modification; pharmacologic and nonpharmacologic interventions; and associated chronic disorders, based on their multiple-choice examination scores compared with the control group. The examination scores indicated significant increases in medical knowledge compared with the precurriculum cohort after the curriculum (OMS I students: 130 [72.4%]; 133 [92.6%]; 133 [91.1%]; 132 [89.0%]; vs control: 105 [47.2%]; 134 [52.6%], respectively [P<.01]). In all 4 years observed, there was a significant reduction in bias among first-year medical students after obesity curriculum (before: 3.65, 3.76, 3.57, 3.61, and after: 3.47, 3.38, 3.34, 3.37, respectively) (P<.05). The reduction in bias was also significantly sustained throughout the fourth year.

Conclusion

A comprehensive obesity curriculum throughout medical school resulted in an improvement in students' attitudes toward and knowledge of obesity.

The Cardiometabolic Burden of Self-Perceived Obesity: A Multilevel Analysis of a Nationally Representative Sample of Korean Adults

Emerging evidence has shown that self-perception of overweight/obese status is associated with unfavorable cardiometabolic outcomes, above and beyond actual body weight. Given the lack of research among Asian populations, we examined the association between weight perception and metabolic syndrome (MetS) and cardiometabolic risks among Koreans. Data from the 2010–2015 Korea National Health and Nutrition Examination Survey, including women (N = 12,181) and men (N = 9,448) aged 19–65 years, were analyzed. Weight status perception was measured by participants’ self-evaluation of their body size (“very/slightly obese,” “normal,” and “very/slightly thin”). Overall, 23.2% of women and 28.7% of men had MetS. Our cross-sectional multilevel logistic analyses showed a significant positive association between self-perceived obesity (vs. perceived normal weight) and MetS, independent of BMI and sociodemographic/behavioral/medical conditions, with a stronger association detected among men (OR = 1.38, p < 0.05) than women (OR = 1.22, p < 0.05), confirmed by a statistically significant interaction. Additionally, perceived obesity was associated with high blood pressure (OR = 1.27, p < 0.05) and high triglycerides (OR = 1.38, p < 0.05) among men and low high-density lipoprotein cholesterol (OR = 1.15, p < 0.05) among women. While further prospective research is needed, our findings suggest that perception of being obese may be an unfavorable indicator of cardiometabolic health among Koreans regardless of actual body weight.

Parasympathetic cardio-regulation during social interactions in individuals with obesity-The influence of negative body image

Individuals with obesity in Western societies often face weight-related stigmatization and social exclusion. Recurrent exposure to prejudice and negative social feedback alters one's behavior in future social interactions. In this study, we aimed to investigate autonomic nervous system and affective responses to social interactions in individuals with obesity. Women and men with (n = 56) and without (n = 56) obesity participated in episodes of social inclusion and social exclusion using a virtual ball-tossing game. During the experiment, heart rate was measured and parasympathetic activity (overall high-frequency power and event-related cardiac slowing) was analyzed. Our results show that in novel social interactions, women with obesity, relative to the other groups, exhibited the strongest increase in parasympathetic activity. Furthermore, parasympathetic activity was related to a more negative body image in individuals with obesity, but not in lean individuals. Additionally, women with obesity reported a stronger decrease in mood after social exclusion than did the other participants. Our results demonstrate influences of objective and subjective bodily characteristics on parasympathetic cardio-regulation during social interactions. In particular, they show behavioral and physiological alterations during social interactions in women with obesity.

Does Knowing Hurt? Perceiving Oneself as Overweight Predicts Future Physical Health and Well-Being

Identifying oneself as being overweight may be associated with adverse health outcomes, yet prospective tests of this possibility are lacking. Over 7 years, we examined associations between perceptions of being overweight and subsequent health in a sample of 3,582 U.S. adults. Perceiving oneself as being overweight predicted longitudinal declines in subjective health ( d = -0.22, p < .001), increases in depressive symptoms ( d = 0.09, p < .05), and raised levels of physiological dysregulation ( d = 0.24, p < .001), as gauged by clinical indicators of cardiovascular, inflammatory, and metabolic functioning. These associations remained after controlling for a range of potential confounders and were observed irrespective of whether perceptions of being overweight were accurate or inaccurate. This research highlights the possibility that identifying oneself as overweight may act independently of body mass index to contribute to unhealthy profiles of physiological functioning and impaired health over time. These findings underscore the importance of evaluating whether weight-feedback interventions may have unforeseen adverse consequences.

The bogus taste test: Validity as a measure of laboratory food intake

Because overconsumption of food contributes to ill health, understanding what affects how much people eat is of importance. The ‘bogus’ taste test is a measure widely used in eating behaviour research to identify factors that may have a causal effect on food intake. However, there has been no examination of the validity of the bogus taste test as a measure of food intake. We conducted a participant level analysis of 31 published laboratory studies that used the taste test to measure food intake. We assessed whether the taste test was sensitive to experimental manipulations hypothesized to increase or decrease food intake. We examined construct validity by testing whether participant sex, hunger and liking of taste test food were associated with the amount of food consumed in the taste test. In addition, we also examined whether BMI (body mass index), trait measures of dietary restraint and over-eating in response to palatable food cues were associated with food consumption. Results indicated that the taste test was sensitive to experimental manipulations hypothesized to increase or decrease food intake. Factors that were reliably associated with increased consumption during the taste test were being male, have a higher baseline hunger, liking of the taste test food and a greater tendency to overeat in response to palatable food cues, whereas trait dietary restraint and BMI were not. These results indicate that the bogus taste test is likely to be a valid measure of food intake and can be used to identify factors that have a causal effect on food intake.