Weight stigma mediates the association between BMI and self-reported health.

Abstract

Objective Weight stigma is pervasive in the United States. We tested the hypothesis that stigma may be a mechanism through which obesity negatively affects self-reported health. Two studies examined whether perceived weight-based discrimination and concerns over weight stigma mediated the association between BMI and self-reported psychological health (Study 1) and physical health (Study 2). Method In two online studies, adult community members completed measures of stigma-relevant mediators (perceived weight discrimination, weight stigma concerns) and provided their height and weight. In Study 1 (N = 171) participants also completed measures of psychological health (depression, self-esteem, quality of life), whereas participants in Study 2 (N = 194) also completed a measure of self-reported physical health. Process modeling was used to simultaneously test for mediation through perceived discrimination and stigma concerns independently as well as for serial mediation through both variables. Results Across both studies, we hypothesized and found support for serial mediation such that BMI was indirectly related to poorer self-reported health through its effect on perceived discrimination and concerns about stigma. Additionally, concerns about stigma mediated the association between BMI and health independent of perceived discrimination. Conclusion Weight stigma is an important mediator of the association between BMI and self-reported health. Furthermore, results indicate that concerns about facing stigma in the future mediate the link between perceived past experiences of discrimination and psychological and physical health.

Emotional Implications of Weight Stigma Across Middle School: The Role of Weight-Based Peer Discrimination

“…Consistent with recent findings on adults (Hunger & Major, 2015), the current findings indicate that the connection between heavy weight and emotional adjustment is largely due to perceived weight discrimination. At 7 th grade, it was weight-based peer discrimination rather than concurrently assessed BMI that predicted body dissatisfaction, social anxiety, and loneliness by 8 th grade.…”

“…Weight-based peer mistreatment, in turn, is concurrently associated with lower self-esteem and elevated depression, over and above actual weight (i.e., body mass index, BMI) (Eisenberg, Neumark-Sztainer, & Story, 2003; Eisenberg, Neumark-Sztainer, Haines, & Wall, 2006). These findings are consistent with recent research on adults suggesting higher BMI is indirectly related to concurrent psychological and physical health through perceived weight discrimination (Hunger & Major, 2015; Rosenthal et al, 2015). The latest evidence on adults also suggests that weight-discrimination might be an even more potent predictor of health than other attributions for discrimination (Sutin, Stephan, & Terracciano, 2015).…”

Weighed Down by Stigma: How Weight‐Based Social Identity Threat Contributes to Weight Gain and Poor Health

“…Research from other large-scale epidemiological studies has likewise shown that experiencing weight-based mistreatment is associated with lower self-acceptance, a construct analogous to self-esteem (Carr & Friedman, 2005). Hunger and Major (2014) found that weight stigma mediated the negative relationship between BMI and psychological wellbeing (i.e., self-esteem, depression, and quality of life). Interestingly, concerns about stigma emerged as a stronger predictor of health than did perceptions of discrimination, although these two components of weight stigma were strongly correlated.…”

“…Indeed, many of the psychological effects routinely attributed to carrying excess weight – such as low self-esteem, greater depression and anxiety, and poorer quality of life – result more from the stigma faced by overweight individuals than from the weight itself (Carr, Friedman, & Jaffe, 2007; Hunger & Major, 2014). Hatzenbuehler, Keyes, and Hasin (2009) performed a comprehensive analysis of the effects of perceived weight discrimination on mental health.…”

Overweight and Obesity: Prevalence, Consequences, and Causes of a Growing Public Health Problem

“…Interestingly, low body-and self-esteem occurs less among OW/obese black girls and women, who generally report a higher quality of life (QOL) than white women. OW/obese children are more likely to be bullied by others and are less likely to participate in physical activities adding to the likelihood of obesity-related complications [24,25]. Stigma and weight discrimination may mediate some of the poor health outcomes that are related to increased BMI, but additional research is needed [26].…”