Demographic, socioeconomic and life-course risk factors for internalized weight stigma in adulthood: evidence from an English birth cohort study.

Background

Obesity is highly stigmatized, with negative obesity-related stereotypes widespread across society. Internalized weight stigma (IWS) is linked to negative outcomes including poor mental health and disordered eating. Previous evidence examining population groups at higher risk of experiencing IWS comes from small, nonrepresentative samples. Here, we re-assess previously reported associations of IWS with demographic, socioeconomic, and wider social factors in a large general population birth cohort study for the first time.

Methods

In the Avon Longitudinal Study of Parents and Children (ALSPAC), we explored differences in IWS at age 31 years by sex, ethnicity, socioeconomic factors, sexual orientation, and family and wider social influences, using confounder-adjusted multivariable regression.

Findings

In models adjusted for potential confounders and BMI in childhood, adolescence, and adulthood (N = 4060), IWS was higher for females (standardized beta: 0.56, 95% CI: 0.50, 0.61), sexual minorities (0.17 S.D. higher, 95% CI: 0.09, 0.24), and less socioeconomically advantaged individuals (e.g., 0.16 S.D. higher (95% CI: 0.08, 0.24) for participants whose mothers had minimum or no qualifications, compared to a university degree). The social environment during adolescence and young adulthood was important: IWS was higher for people who at age 13 years felt pressure to lose weight from family (by 0.13 S.D., 95% CI: 0.03, 0.23), and the media (by 0.17, 95% CI: 0.10, 0.25), or had experienced bullying (e.g., 0.25 S.D., 95% CI: 0.17, 0.33 for bullying at age 23 years).

Interpretation

Internalized weight stigma differs substantially between demographic groups. Risk is elevated for females, sexual minorities, and socioeconomically disadvantaged adults, and this is not explained by differences in BMI. Pressure to lose weight from family and the media in adolescence may have long-lasting effects on IWS.

Funding

The ESRC, MRC, NIHR, and Wellcome Trust.

Informations de copyright

© 2024 The Author(s).

Déclaration de conflit d'intérêts

AMH, AAK, and ERR have no interests to declare. HB declares an NIHR Advanced Fellowship (NIHR302271) and support for attending meetings from the NIHR via the Bristol Biomedical Research Centre and is an elected member of the Faculty of Eating Disorders, RCPsych. LDH declares research grants unrelated to this work from the ESRC and British Heart Foundation. KC reports lecture fees from Ethicon and Apollo Endosurgery, consultation fees from Eli Lilly, Patient Advisory Board membership for Boehringer Ingelheim, and trusteeship for ASO. SWF declares researcher led grants from the National Institute for Health Research, the Office of Health Improvement and Disparities, Doncaster Council, the West Yorkshire Combined Authority, and Novo Nordisk; and support for attending academic conferences from Johnson & Johnson, Novo Nordisk, Devon NHS Integrated Care Service, the UK Parliament, and Safefood.