Weight stigma exposure, self-perceived weight and weight bias internalisation across preconception, pregnancy and postpartum

Weight bias internalisation (WBI) during preconception, pregnancy and postpartum undermines maternal health, yet factors promoting internalisation remain poorly understood. This cross-sectional study examined associations between WBI and weight stigma exposure, self-perceived weight and BMI among 511 women aged 18-45 years across reproductive stages in Western (Australia, UK, US) and non-Western (Singapore, Philippines) countries. Greater stigma exposure was consistently associated with higher WBI across all reproductive stages and countries. Higher self-perceived weight was associated with greater WBI during preconception and postpartum, but not during pregnancy. Self-perceived weight did not moderate the stigma-WBI relationship, and BMI was not independently related to WBI. Exploratory analyses revealed women in non-Western countries reported greater stigma exposure despite similar WBI levels. Findings suggest WBI is more strongly associated with stigmatisation and weight perceptions than BMI, challenging BMI-centric risk models and highlighting the need for multi-level strategies that reduce weight stigma while strengthening women's resilience to internalisation.