Weight Stigma, Body Trust, and Suicide Ideation Among Adolescents: A Longitudinal Study

Suicide is the fourth leading cause of death, with rates rising during adolescence. In the United States, suicide deaths rose among 15-24-year-olds and more than doubled among 10-14-year-olds from 2008 to 2018, with one in six reporting suicidal ideation (SI) annually. Weight stigma (WS), both experienced and internalized, is a significant suicide risk factor. WS fosters shame, self-doubt, and reduced body trust, or feeling unsafe in one's body-all of which are linked to SI. This study tested whether body trust mediated the relation between WS and SI among Iranian adolescents. Participants (N = 1243) completed online measures at three timepoints (baseline, 1-month, 3 months). Cross-lagged panel models were tested in MPlus to examine relations between constructs. Higher internalized WS predicted lower body trust at 1-month follow-up, but body trust at 1-month follow-up did not significantly predict SI at 3-month follow-up. Experienced WS and SI demonstrated reciprocal relations such that experienced WS and SI at baseline predicted one another at 1-month follow-up. Higher body trust at baseline predicted lower experienced WS, Internalized WS, and SI at 3-month follow-up, as well as lower internalized WS at 1-month follow-up. WS was not indirectly associated with SI through low body trust. These findings show independent links between WS, body trust, and SI, underscoring the need for targeted interventions. Clinicians should assess and address these factors in adolescents at risk. Approaches that challenge weight-biased beliefs and build body trust, such as mindfulness or acceptance-based strategies, may reduce distress.