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

Abstract

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

Effective strategies in ending weight stigma in healthcare

“…Internalized weight bias (IWB) encompasses self‐blame and self‐devaluation that results from endorsing negative social messages around weight and applying them to the self 3 . IWB is believed to explain the relationship between acutely experienced or indirectly perceived weight stigma and maladaptive eating behaviors 41–43 as well as body shame and dissatisfaction, exercise and healthcare behaviors, bodily pain and parental weight talk 44 . Stigma may lead to efforts of escaping discrimination through weight‐loss attempts, 45 and thus, some have argued that it may have a positive role in motivating individuals to engage in health behaviors.…”

“…3 IWB is believed to explain the relationship between acutely experienced or indirectly perceived weight stigma and maladaptive eating behaviors [41][42][43] as well as body shame and dissatisfaction, exercise and healthcare behaviors, bodily pain and parental weight talk. 44 Stigma may lead to efforts of escaping discrimination through weight-loss attempts, 45 and thus, some have argued that it may have a positive role in motivating individuals to engage in health behaviors. However, stigmatization creates a dual and countervailing effect of increasing motivation to engage in unhealthy weight-control behaviors, while simultaneously decreasing the perceived capacity to control weight, 46 and is consistently linked to adverse health behaviors and decreased long-term health.…”

Mental and Body Health: The Association between Psychological Factors, Overweight, and Blood Pressure in Young Adults

“…Longitudinal studies have suggested that obesity may be both a cause and a consequence of mental distress, creating a vicious circle [ 15 , 16 ]. On the one hand, obesity-related stigmatization may result in high mental distress [ 20 , 21 , 22 ]; on the other hand, inappropriate eating behaviors (e.g., emotional eating) may lead to obesity in individuals with poor mental health and maladaptive coping strategies [ 23 ]. Moreover, the effect of antipsychotic medication for the treatment of psychiatric disorders (e.g., schizophrenia [ 24 ]) is a risk factor for severe weight gain.…”

The mediation effect of perceived weight stigma in association between weight status and eating disturbances among university students: is there any gender difference?

“…However, weight-related self-stigma is distinct from the two other types of weight stigma, PWS and experienced stigma. Furthermore, perceived and experienced weight stigma could be categorized as ‘public stigma,’ a broad term for stigma [ 7 ]. Following the findings from a systematic review and meta-analysis [ 5 , 7 ], we used PWS to indicate both perceived and experienced weight stigma in the present study.…”