A systematic review of weight stigma and disordered eating cognitions and behaviors

Weight stigma is the discrimination towards people based on their body weight and size. While weight stigma may occur across most weight categories, weight stigma is most prevalent among people who are of higher weight. 

Weight stigma has serious adverse impacts on the lives, health and treatment seeking of people with higher weight. Weight stigma is pervasive, with people with higher weight experiencing stigma from health professionals, educators, employers, the media, and even friends and family.

Research demonstrates that some forms of weight stigma may even be equally or more prevalent than other forms of discrimination such as sexism, racism, homophobia, and religious intolerance [1, 2].

Healthcare is a setting in which weight stigma is particularly pervasive. Health professionals, as humans who are part of society and because of their socialisation as health professionals, are likely to hold both implicit and explicit bias towards people with higher weight.

As a result of weight stigma and discrimination, people with higher weight are more likely to:

• avoid seeking and engaging in medical care, leading to delays in diagnosis and treatment
• engage in disordered eating, contributing to the onset of eating disorders and increasing disordered eating in people experiencing eating disorders
• experience higher levels of body dissatisfaction
• experience higher levels of psychological distress, including stress, anxiety, depression, feelings of worthlessness and loneliness, and suicidal ideation
• experience poorer quality of life
• face discrimination in healthcare, affecting the quality of care they receive, leading to poorer health outcomes and increasing risk of mortality
• face discrimination in employment and education
• avoid physical activity and leisure pursuits

Why is this research important?  

Disordered eating is pervasive and prevalence is increasing. It is crucial to identify potentially modifiable risk factors for disordered eating to reduce its prevalence.

Weight stigma has been associated with disordered eating behaviours and cognitions, and thus identified as a potential modifiable risk factor. This systematic review aimed to explore this relationship, examining three dimensions of weight stigma - experienced, anticipated and internalised. 

What did the research find?

• There is a clear link between weight stigma and disordered eating cognitions and behaviours (e.g., body image, binge eating, weight and shape concerns, drive for thinness, dietary restriction, bulimia symptoms) 
• All three dimensions of weight stigma (experienced, anticipated, internalised) were associated with disordered eating outcomes
• Weight stigma was identified as a predictor of disordered eating among both clinical and nonclinical samples across adolescence and adulthood

What are the implications of this research?

• Weight stigma could be a meaningful target for prevention and treatment contexts
• Assessing and addressing anticipated and internalised weight stigma in clinical settings could impact on treatment planning and outcomes
• Educating health professionals about weight stigma could help to reduce the prevalence of weight stigma in health settings
• Public health initiatives to reduce weight stigma could reduce the incidence and severity of disordered eating across the population

The National Eating Disorders Strategy 2023-2033 calls for weight stigma to be challenged and reduced, working towards elimination (Prevention Standard 1). Implementation of the relevant Actions will help to reduce the prevalence and impact of weight stigma in Australia.

Abstract/Summary:  

Weight stigma is persistent across contexts and is associated with disordered eating cognitions and behaviors. This systematic review aimed to examine the existing literature that has explored the relationship between weight stigma and disordered eating cognitions and behaviors. We specifically examined three dimensions of weight stigma – experienced, anticipated, and internalized – and adopted an inclusive conceptualization of outcomes related to disordered eating (including constructs such as binge eating, body dissatisfaction, and other cognitions and behaviors such as dietary restraint, unhealthy weight control behaviors, and drive for thinness). We searched PubMed, Embase, CINAHL, Web of Science, Sociological Abstracts, and PsycINFO for English language, peer-reviewed articles and dissertations with quantitative methodology published through October 2023. The search resulted in 242 articles meeting inclusion criteria.

A narrative review found a consistent relationship between greater weight stigma and more disordered eating cognitions and behaviors. Methodological and theoretical limitations are discussed, as are critical avenues for future research and potential clinical implications stemming from this body of research. Given the widespread nature and impact of weight stigma on disordered eating, it is imperative that we intervene to address weight stigma at all levels, from the structural to the intrapersonal.

Link:  

Access the study from ScienceDirect.  

Citation:  

Levinson, JA, Kinkel-Ram, S, Myers, B., & Hunger, JM. A systematic review of weight stigma and disordered eating cognitions and behaviors. Body Image. 2024;48:1-38.  

References:   

Further information

• Weight Stigma webpage and factsheet

• Management of eating disorders for people with higher weight: clinical practice guideline