The role of weight stigma in quality of life among people with larger body sizes

Abstract Background Overweight/obesity is associated with negative health outcomes that may be caused by experienced weight stigma and its internalisation. Although some previous studies identified a negative effect of weight stigma on mental quality of life (MCS), its role in physical quality of life (PCS) is inconclusive and it is often assumed to be outweighed by anthropometric factors. Therefore, we aimed to assess the role of experienced weight stigma and self-stigmatization in PCS and MCS controlling for sociodemographic and clinical variables. Methods A total of 189 participants with overweight and obesity (52.9% female; mean age 48.8±14.5 years; BMI 32.6±6.5 kg/m2; waist-to-height ratio (WHtR) 0.6±0.1) completed the Experienced Weight Stigma Questionnaire, and Self-devaluation and Fear of Enacted Stigma subscales of the Weight Self-Stigma Questionnaire. Quality of life (QoL) was assessed using the SF-36. Multiple linear regression analyses were used to analyse the data. Results A total of 41% of participants experienced weight stigmatization. We found an association between older age (β=-0.35; p < 0.001), WHtR (β=-0.19; p < 0.05) and PCS. No role of age or central obesity was identified in MCS. Experienced weight stigma was found to play a role in MCS (β = 0.34; p < 0.001) and PCS (β = 0.31; p < 0.001), however, this association was no longer significant when self-devaluation was added to the regression models for PCS (β = 0.24; p < 0.05) and MCS (β = 0.30; p < 0.01). No role of fear of enacted stigma in QoL was found. The final models showed an explained variance of 32.4% in PCS and 20.7% in MCS. Conclusions Experienced weight stigma and internalized self-devaluation negatively affect PCS/MCS and seem to be more significant contributors to diminished QoL than body size. Interventions targeting experienced stigma and weight-related self-stigmatization may mitigate the negative impact of weight stigma on physical and mental QoL. Grant: APVV-22-0587 and VAIA 09I01-03-V04-00101. Key messages • Weight stigma seems to be a more significant contributor to reduced QoL than obesity per se. • The negative effect of weight stigma on QoL should be considered in effective public health interventions.