Weight stigma is a key aspect of the lived experience of individuals with obesity, and adversely affects health. This article provides an overview of recent evidence examining links between experiences of weight stigma and weight-related behaviors and health (e.g., maladaptive eating, physical activity, stress, obesity, weight loss), including health consequences for individuals with heightened vulnerability to weight stigma (e.g., youth and people seeking bariatric surgery) and implications for clinicians working with individuals who have obesity. This literature points to weight stigma as a psychosocial contributor to obesogenic behaviors, yet the role of weight stigma in weight loss among treatment-seeking individuals has received little attention. Research priorities are identified, including the need for future studies to (a) determine the potentially predictive value of specific characteristics of weight-stigmatizing experiences for weight loss (such as the time period, interpersonal sources, and coping responses for stigma experiences), (b) identify mechanisms through which weight stigma may undermine or facilitate weight-related treatment outcomes, and (c) test strategies that can be implemented in weight management programs to reduce the negative impact of weight stigma on health behaviors. Broadly, more attention should be directed to weight stigma in the obesity field as a relevant psychosocial factor in obesity-focused prevention and treatment. Public Significance StatementThis article reviews evidence of the ways in which weight stigma may contribute to obesity in youth and adults, such as maladaptive eating behaviors, stress, and weight gain. Additionally, it highlights the importance of addressing weight stigma in clinical practice, through education and efforts to promote a supportive culture of patient care for individuals who are vulnerable to weight stigma.

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Objective: This study aimed to conduct a comprehensive assessment of the presence, severity, and sociodemographic correlates of weight bias internalization (WBI) across three distinct samples of US adults. Methods: Levels of WBI were compared in (1) a sample of adults with obesity and heightened risk of weight stigma (N 5 456), (2) an online community sample (N 5 519), and (3) a national online panel (N 5 2,529). Samples 2 and 3 comprised adults with and without obesity. Participants completed identical self-report measures, including demographic variables and weight-related factors, to determine their relationship with low, mean, and high levels of WBI. Results: At least 44% of adults across samples endorsed mean levels of WBI (as determined by sample 3). The highest levels of WBI were endorsed by approximately one in five adults in the general population samples and by 52% in the sample of adults with obesity. Individuals with the highest WBI were white, had less education and income, were currently trying to lose weight, and had higher BMIs, higher selfperceived weight, and previous experiences of weight stigma (especially teasing). Conclusions: Internalized weight bias is prevalent among women and men and across body weight categories. Findings provide a foundation to better understand characteristics of individuals who are at risk for internalizing weight bias.

Objective: Rates of weight-based stigmatization have steadily increased over the past decade. The psychological and physiological consequences of weight stigma remain understudied. Methods: This study examined the effects of experimentally manipulated weight stigma on the stressresponsive hypothalamic-pituitary-adrenal axis (HPA) in 110 female undergraduate participants (BMI: M 5 19.30, SD 5 1.55). Objective BMI and self-perceived body weight were examined as moderators of the relationship between stigma and HPA reactivity. Results: Results indicated participants' perceptions of their own body weight (but not objective BMI) moderated the effect of weight stigma on cortisol reactivity: F(1,102) 5 13.48, P < 0.001, g 2 p 5 0.12 (interaction 95% CI range [22.06 to 21.44, 21.31 to 20.99]). Specifically, participants who perceived themselves as heavy exhibited sustained cortisol elevation post-manipulation compared with individuals who did not experience the weight-related stigma. Cortisol change did not vary by condition for participants who perceived themselves as average weight. Conclusions: In the first study to examine physiological consequences of active interpersonal exposure to weight stigma, experiencing weight stigma was stressful for participants who perceived themselves as heavy, regardless of their BMI. These results are important because stress and cortisol are linked to deleterious health outcomes, stimulate eating, and contribute to abdominal adiposity.

Objective Daily events of discrimination are important factors in understanding health disparities. Vigilant coping, or protecting against anticipated discrimination by monitoring and modifying behaviour, is an understudied mechanism that may link discrimination and health outcomes. This study investigates how responding to everyday discrimination with anticipatory vigilance relates to the health of Black men and women. Methods Black adults (N = 221) from the Detroit area completed measures of discrimination, adverse life events, vigilance coping, stress, depressive symptoms and self-reported health. Results Vigilance coping strategies mediated the relationship between discrimination and stress. Multi-group path analysis revealed that stress in turn was associated with increased depression in men and women. Self-reported health consequences of stress differed between men and women. Conclusions Vigilance coping mediates the link between discrimination and stress, and stress has consequences for health outcomes resulting from discrimination. More research is needed to understand other underlying contributors to discrimination, stress and poor health outcomes as well as to create potential interventions to ameliorate health outcomes in the face of discrimination-related stress.