Sex, Race, and the Adverse Effects of Social Stigma vs. Other Quality of Life Factors Among Primary Care Patients with Moderate to Severe Obesity
Open accessAbstract
Background Patients with obesity face widespread social bias, but the importance of this social stigma to patients relative to other quality of life (QOL) factors is unclear.Objective Our aim was to examine the importance of obesity-related social stigma relative to other QOL factors on reducing patients' overall well-being.Design We used a cross-sectional telephone interview.Setting The study was conducted at four diverse primary care practices in Greater Boston.Participants Three hundred and thirty-seven primary care patients aged 18-65 years and with a body mass index (BMI) of 35 kg/m(2) or higher participated in the study.Main measures Patients' health utility (preference-based QOL measure) was determined via responses to a series of standard gamble scenarios assessing willingness to risk death to lose various amounts of weight or to achieve perfect health. We used the Impact of Weight on Quality of Life-lite instrument to assess QOL domains specific to obesity (physical function, self-esteem, sexual life, public distress or social stigma, and work), and we examined variation in utility explained by these domains.Key results Depending on patients' race/ethnicity, mean health utilities ranged from 0.92 to 0.99 among men and from 0.89 to 0.93 among women. After adjustment for race, BMI, and education, none of the QOL domains explained much of the variation in utility among men, except for work function among Hispanic men. In contrast, social stigma was the leading QOL contributor to utility for Caucasian women (explaining 6 % of the marginal variation beyond demographics and BMI). In contrast, sexual function was the most important contributor among African American women (3 % marginal variation), and work life was most important among Hispanic women (> 20 % in variation). Lower scores in one domain did not always translate into lower well-being. Moreover, QOL summary scores often explained less of the variation than some individual domains.Conclusion Obesity-related social stigma had disproportionate adverse effects on Caucasian women patients' well-being, whereas weight-related impairment in work function was particularly important among Hispanic patients and impaired sexual function was important to diminished well-being among African American women although its impact appeared modest.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Some researchers found no association between obesity and aspects of PPWB (positive affect, happiness, self-esteem).
“Still some researchers found no association between obesity and aspects of PPWB (positive affect, happiness, self‐esteem). 44 , 50 , 61”
From Positive psychological well-being in women with obesity: A scoping review of qualitative and quantitative primary research (2022) · cites this paper as [44]
The Introduction (page unavailable) says patients with obesity often report lower quality of life in domains including self-esteem—the opposite of the attributed finding for that domain. The Results examine differences among patients with moderate to severe obesity, not an absence of association between obesity and positive affect or happiness. (LLM, conf=0.83)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
(1998) · PsycEXTRA Dataset · doi:10.1037/e565682010-001 · Cited by 9,452 · see citing works
Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. Adults
Calle, E. E., Rodriguez, C., Walker-Thurmond, K., & Thun, M. J. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa021423 · Cited by 7,696 · see citing works
Prevalence and Trends in Obesity Among US Adults, 1999-2008
Flegal, K. M. (2010) · JAMA · doi:10.1001/jama.2009.2014 · Cited by 7,580 · see citing works
(1998) · PubMed · Cited by 2,737 · see citing works
Bias, Discrimination, and Obesity
Puhl, R. M., & Brownell, K. D. (2001) · Obesity Research · doi:10.1038/oby.2001.108 · Cited by 2,119 · see citing works
Obesity Stigma: Important Considerations for Public Health
Puhl, R. M., & Heuer, C. A. (2010) · American Journal of Public Health · doi:10.2105/ajph.2009.159491 · Cited by 1,949 · see citing works
The Role of Cost-effectiveness Analysis in Health and Medicine
Russell, L. B. (1996) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1996.03540140060028 · Cited by 1,167 · see citing works
Patel, K. V., Guralnik, J. M., Dansie, E. J., & Turk, D. C. (2013) · Pain · doi:10.1016/j.pain.2013.07.029 · Cited by 738 · see citing works
Development of a brief measure to assess quality of life in obesity
Kolotkin, R. L., Crosby, R. D., Kosloski, K. D., & Williams, G. R. (2001) · Obesity Research · doi:10.1038/oby.2001.13 · Cited by 641 · see citing works
Panel on cost-effectiveness in health and medicine.
Gold, M. (1996) · PubMed · Cited by 491 · see citing works
Assessing Impact of Weight on Quality of Life
Kolotkin, R. L., Head, S. B., Hamilton, M., & Tse, C. J. (1995) · Obesity Research · doi:10.1002/j.1550-8528.1995.tb00120.x · Cited by 333 · see citing works
Comparing the SF-12 and SF-36 health status questionnaires in patients with and without obesity
Wee, C. C., Davis, R. B., & Hamel, M. B. (2008) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-6-11 · Cited by 155 · see citing works
Self-citationDifferential effects of BMI on diabetes risk among black and white Americans.
Resnick, H. E., Valsania, P., Halter, J. B., & Lin, X. (1998) · Diabetes Care · doi:10.2337/diacare.21.11.1828 · Cited by 147 · see citing works
Gender, Race, and Obesity‐Related Quality of Life at Extreme Levels of Obesity
White, M. A., O'Neil, P. M., Kolotkin, R. L., & Byrne, T. K. (2004) · Obesity Research · doi:10.1038/oby.2004.116 · Cited by 127 · see citing works
Wee, C. C., Huskey, K. W., Bolcic‐Jankovic, D., Colten, M. E., Davis, R. B., & Hamel, M. (2013) · Journal of General Internal Medicine · doi:10.1007/s11606-013-2603-1 · Cited by 110 · see citing works
Self-citationImpact of Age on Associations Between Weight and Mortality
Stevens, J. (2009) · Nutrition Reviews · doi:10.1111/j.1753-4887.2000.tb01847.x · Cited by 97 · see citing works
Assessment of Quality of Life in Obese Individuals
Wadden, T. A., & Phelan, S. (2002) · Obesity Research · doi:10.1038/oby.2002.190 · Cited by 97 · see citing works
Understanding Patients' Value of Weight Loss and Expectations for Bariatric Surgery
Wee, C. C., Jones, D. B., Davis, R. B., Bourland, A. C., & Hamel, M. (2006) · Obesity Surgery · doi:10.1381/096089206776327260 · Cited by 94 · see citing works
Self-citationWee, C. C., Davis, R. B., Huskey, K. W., Jones, D. B., & Hamel, M. B. (2013) · Journal of General Internal Medicine · doi:10.1007/s11606-012-2188-0 · Cited by 71 · see citing works
Self-citationAssessing the value of weight loss among primary care patients
Wee, C. C., Hamel, M. B., Davis, R. B., & Phillips, R. S. (2004) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2004.40063.x · Cited by 41 · see citing works
Self-citationTHE STANDARD OF LIVING IN THE UNITED STATES
Slesnick, D. T. (1991) · Review of Income and Wealth · doi:10.1111/j.1475-4991.1991.tb00379.x · Cited by 37 · see citing works
The Standard of Living in the United States
Dodge, J. R. (1890) · Science · doi:10.1126/science.ns-16.396.131 · Cited by 1 · see citing works
Flagged first, then by citations
1 of the 23 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Weight stigma as a psychosocial contributor to obesity.
Puhl, R. M., Himmelstein, M. S., & Pearl, R. L. (2020) · American Psychologist · doi:10.1037/amp0000538 · Cited by 452 · see citing works
Ding, C., Chan, Z., & Magkos, F. (2016) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000317 · Cited by 161 · see citing works
Funk, L. M., Jolles, S., Fischer, L. E., & Voils, C. I. (2015) · JAMA Surgery · doi:10.1001/jamasurg.2015.1250 · Cited by 150 · see citing works
Funk, L. M., Jolles, S. A., Greenberg, C. C., Schwarze, M. L., Safdar, N., McVay, M. A., Whittle, J., Maciejewski, M. L., & Voils, C. I. (2015) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2015.11.028 · Cited by 95 · see citing works
Psychological Impact of Severe Obesity
Collins, J., Meng, C., & Eng, A. (2016) · Current Obesity Reports · doi:10.1007/s13679-016-0229-4 · Cited by 57 · see citing works
Sex disparity in laparoscopic bariatric surgery outcomes: a matched-pair cohort analysis
Mousapour, P., Tasdighi, E., Khalaj, A., Mahdavi, M., Valizadeh, M., Taheri, H., Hosseinpanah, F., & Barzin, M. (2021) · Scientific Reports · doi:10.1038/s41598-021-92254-4 · Cited by 54 · see citing works
Gustafson, C. R., Kent, R., & Prate, M. R. (2018) · PLoS ONE · doi:10.1371/journal.pone.0207792 · Cited by 44 · see citing works
Milner, A. N., George, B. J., & Allison, D. B. (2016) · PLoS ONE · doi:10.1371/journal.pone.0147158 · Cited by 42 · see citing works
Gender disparities in weight loss surgery
Aly, S., Hachey, K. J., & Pernar, L. I. M. (2020) · Mini-invasive Surgery · doi:10.20517/2574-1225.2019.57 · Cited by 37 · see citing works
Gómez-Pérez, D., Ortíz, M. S., & Sáiz, J. L. (2017) · Revista médica de Chile · doi:10.4067/s0034-98872017000901160 · Cited by 34 · see citing works
Gustafson, C. R., & Zeballos, E. (2019) · Appetite · doi:10.1016/j.appet.2019.104320 · Cited by 33 · see citing works
Thomas, D. M., Kyle, T. K., & Stanford, F. C. (2015) · Preventive Medicine · doi:10.1016/j.ypmed.2015.10.001 · Cited by 31 · see citing works
Lewis, K. H., Gudzune, K. A., Fischer, H. J., Yamamoto, A., & Young, D. R. (2016) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2016.06.015 · Cited by 32 · see citing works
Sasdelli, A. S., Petroni, M. L., Paoli, A. D., Collini, G., Calugi, S., Grave, R. D., & Marchesini, G. (2018) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-017-0475-9 · Cited by 29 · see citing works
Psychosocial stress factors among mental health nursing students in KSA
Alyousef, S. M. (2018) · Journal of Taibah University Medical Sciences · doi:10.1016/j.jtumed.2018.11.006 · Cited by 30 · see citing works
Grady, K. L., Fazeli, P. L., Kirklin, J. K., Pamboukian, S. V., & White‐Williams, C. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.121.021196 · Cited by 23 · see citing works
Greenberg, J. M., Smith, K. P., Kim, T. Y., Naghdechi, L., & IsHak, W. W. (2017) · Springer eBooks · doi:10.1007/978-3-319-52539-6_34 · Cited by 23 · see citing works
Setchell, J., Gard, M., Jones, L., & Watson, B. M. (2017) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2017.1328718 · Cited by 21 · see citing works
Patient Motivations and Goals for Bariatric Surgery: A Mixed Methods Study
Ahlich, E. M., Verzijl, C. L., Cunning, A., Wright, E., & Rancourt, D. (2021) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2021.05.017 · Cited by 20 · see citing works
Weight Loss After Bariatric Surgery: Do Clinical and Behavioral Factors Explain Racial Differences?
Wee, C. C., Jones, D. B., Apovian, C. M., Hess, D. T., Chiodi, S. N., Bourland, A. C., Davis, R. B., Schneider, B. E., Blackburn, G. L., Marcantonio, E. R., et al. (2017) · Obesity Surgery · doi:10.1007/s11695-017-2701-y · Cited by 18 · see citing works
Self-citationConradson, H. E., Hayden, K. A., Russell‐Mayhew, S., Raffin Bouchal, S., & King‐Shier, K. (2022) · Obesity Science & Practice · doi:10.1002/osp4.605 · Cited by 15 · see citing works
“Still some researchers found no association between obesity and aspects of PPWB (positive affect, happiness, self‐esteem).(44,50,61) Though PPWB was significantly lower for women with obesity overall, women who were in a sub‐cohort of those who reported higher economic status, employment, education, health, relationsh…”
BackgroundSiqueira, B. B., Assumpção, M. C., Barroso, S. M., Japúr, C. C., & Penaforte, F. R. D. O. (2021) · Jornal Brasileiro de Psiquiatria · doi:10.1590/0047-2085000000324 · Cited by 13 · see citing works
Sundbom, M., Franzén, S., Ottosson, J., & Svensson, J. (2020) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2019-000989 · Cited by 10 · see citing works
The effect of presenting relative calorie information on calories ordered
Gustafson, C. R., & Zeballos, E. (2020) · Appetite · doi:10.1016/j.appet.2020.104727 · Cited by 9 · see citing works
Arnott, S. M., Skancke, M., & Obias, V. (2018) · International Journal of Medical Robotics and Computer Assisted Surgery · doi:10.1002/rcs.1956 · Cited by 6 · see citing works
Obesity and Sexual Dysfunction
Katz, A. (2017) · AJN American Journal of Nursing · doi:10.1097/01.naj.0000525873.36360.5a · Cited by 5 · see citing works
Wee, C. C., Hamel, M. B., Huskey, K. W., & Davis, R. B. (2016) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2016.11.004 · Cited by 4 · see citing works
Self-citationShould This Patient Have Weight Loss Surgery?
Smetana, G. W., Jones, D. B., & Wee, C. C. (2017) · Annals of Internal Medicine · doi:10.7326/m17-0698 · Cited by 4 · see citing works
Self-citationElgart, J. F., Prestes, M., González, L., Rucci, E., Gagliardino, J. J., & for the QUALIDIAB Net study group (2017) · PLoS ONE · doi:10.1371/journal.pone.0189755 · Cited by 4 · see citing works
Factors Related to Coital Frequency of Women in Their Thirties
Lara, L. A. D. S., Lima, M. L. D. S., Romão, G. S., Ferriani, R. A., & Navarro, P. A. (2015) · Journal of Sex & Marital Therapy · doi:10.1080/0092623x.2015.1053024 · Cited by 3 · see citing works
Johnston, L. H., Jackson, K., Hilton, C. E., & Graham, Y. N. H. (2023) · Clinical Obesity · doi:10.1111/cob.12626 · Cited by 2 · see citing works
Balint, I., Pál, S., Ferencz, L. I., & Ábrám, Z. (2018) · Revista de Chimie · doi:10.37358/rc.18.11.6691 · Cited by 1 · see citing works
Kadınların İçselleştirilmiş Kilo Önyargılarının Karşılaştırılması: Evli- Bekar Örneği
TEKGÜNDÜZ, S. E., Sayar, S. E., & Apay, S. E. (2021) · Ordu Üniversitesi Hemşirelik Çalışmaları Dergisi · doi:10.38108/ouhcd.884652
Grosser, R., Pereira, X., Romero-Vélez, G., Rodríguez-Quintero, J. H., & Camacho, D. R. (2022) · Obesity Surgery · doi:10.1007/s11695-021-05832-w
Marfuah, M., Grestin Sandy, R., & Arifin, M. (2022) · Advances in Social Science, Education and Humanities Research/Advances in social science, education and humanities research · doi:10.2991/assehr.k.220203.033
Oh, S.-G., Jeong, S.-A., Ko, C. S., Min, S.-H., Gong, C. S., Lee, I., Kim, B. S., Yook, J. H., & Yoo, M. (2024) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes23028
Determinants of obesity stigma in the 21st century
Błaszczyk, D., Graczyk, M., Sarnowska, K., Dmowska, J., Michałowska, M., Urbańska, O., & Skrypnik, D. (2025) · Postępy Higieny i Medycyny Doświadczalnej · doi:10.2478/ahem-2025-0020
Arslanoğlu, B. Ş., Bayram, S., & Altıntaş, A. (2026) · Türkiye Halk Sağlığı Dergisi · doi:10.20518/tjph.1671825
- Authors
- Wee, C. C., Davis, R. B., Chiodi, S., Huskey, K. W., & Hamel, M. B.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Wee, Christina C.
- Venue
- Journal of General Internal Medicine
- Published
- 2014-10-24
- Volume
- 30
- Issue
- 2
- Pages
- 229-235
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC4314477
- OpenAlex
- W1990304218
- Cited by
- 39
- References
- 23
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 5 · 2020: 4 · 2019: 1 · 2018: 5 · 2017: 8 · 2016: 5 · 2015: 4
- FWCI
- 13.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (K24DK087932, R01DK073302)
- Topics
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- obesity, social stigma, quality of life, health utility, sex differences, racial and ethnic differences, sexual function, work function, self-esteem, primary care patients, well-being
- MeSH terms
- Adult, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Obesity, Obesity, Morbid, Primary Health Care, Quality of Life, Sexual Behavior, Racial Groups, Social Stigma
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
