Exploring weight bias internalization in pregnancy

Abstract

Background Recent research has shown that pregnant individuals experience weight stigma throughout gestation, including negative comments and judgement associated with gestational weight gain (GWG). Weight bias internalization (WBI) is often a result of exposure to weight stigma and is detrimental to biopsychological health outcomes. The purpose of this study was to explore WBI in pregnancy and compare scores based on maternal weight-related factors including pre-pregnancy body mass index (BMI), obesity diagnosis and excessive GWG. Methods Pregnant individuals in Canada and USA completed a modified version of the Adult Weight Bias Internalization Scale. Self-reported pre-pregnancy height and weight were collected to calculate and classify pre-pregnancy BMI. Current weight was also reported to calculate GWG, which was then classified as excessive or not based on Institute of Medicine (2009) guidelines. Participants indicated if they were diagnosed with obesity by a healthcare provider. Inferential analyses were performed comparing WBI scores according to pre-pregnancy BMI, excessive GWG, and obesity diagnosis. Significance was accepted as p < 0.05 and effect sizes accompanied all analyses. Result 336 pregnant individuals completed the survey, with an average WBI score of 3.9 ± 1.2. WBI was higher among those who had a pre-pregnancy BMI of obese than normal weight (p = 0.04, η2 = 0.03), diagnosed with obesity than not diagnosed (p < 0.001, Cohen’s d = 1.3), and gained excessively versus not (p < 0.001, Cohen’s d = 1.2). Conclusions Pregnant individuals who have a higher BMI, obesity and gain excessively may experience WBI. Given that weight stigma frequently occurs in pregnancy, effective person-oriented strategies are needed to mitigate stigma and prevent and care for WBI.

Biological and behavioral pathways from prenatal depression to offspring cardiometabolic risk: Testing the developmental origins of health and disease hypothesis.

“…Living in a larger body in an environment with growing weight stigma may have its own implications for maternal and offspring cardiometabolic health, in addition to documented associations between experiencing weight stigma and poorer mental health (Incollingo Rodriguez & Nagpal, 2021). For example, pregnant individuals with higher body mass index (BMI) prepregnancy or who gain excessive weight across pregnancy are more likely to have higher weight bias internalization compared to those with lower BMI or weight gain (Nagpal et al, 2022). Weight bias internalization has been associated with poorer adult mental health (Pearl & Puhl, 2018) and greater adult cardiometabolic risk (Pearl et al, 2017), which may be a psychosocial pathway by which higher weight may lead to poorer health outcomes for pregnant individuals and their offspring.…”

Current trends and future directions in internalized weight stigma research: a scoping review and synthesis of the literature

“…The WSSQ is a 12-item measure also designed for use with higher-weight participants across two factors: self-devaluation and fear of enacted stigma [ 16 ]. Both scales have since been translated into several languages, including Traditional Chinese (Taiwan) [ 18 ], Spanish [ 19 ], and Japanese [ 20 ], as well as adapted for use with adolescents [ 21 ], children [ 22 ], and pregnant participants [ 23 ].…”

The Challenge of Weight Stigma for Women in the Preconception Period: Workshop Recommendations for Action from the 5th European Conference on Preconception Health and Care

“…This becomes particularly important for women with chronic conditions who subsequently experience delays in diagnosis and treatment because they are foremost told to lose weight [25,26]. Women are also susceptible to internalised weight bias which may manifest as self-blame if they are struggling to conceive or if they have experienced pregnancy loss [27,28].…”