Distressed or not distressed? A mixed methods examination of reactions to weight stigma and implications for emotional wellbeing and internalized weight bias
Abstract
People react to, and are affected by, stigmatizing experiences in different ways. The current study examined different reactions to weight stigma to identify who may be vulnerable to lasting distress from these experiences. Using a mixed methods approach, this study compared qualitative descriptions of reactions to experiences of weight stigma in conjunction with quantitative measures of weight bias internalization (WBI) and other health indices. Data were collected from September 2017 to August 2018. Participants were U.S. adults enrolled in a commercial weight management program (n = 425, 96% female) who reported previous experiences of weight stigma (on quantitative measures), and who also qualitatively described feeling either no longer distressed (n = 178) or still distressed (n = 247) by those experiences. Qualitative analyses revealed that participants who were no longer distressed engaged in self-acceptance, were not concerned about other's evaluations of them, and prioritized health rather than appearance. Those who were still distressed from previous weight stigma experiences considered their body weight, and being stigmatized for it, as playing a prominent role in shaping their self-perception, they blamed themselves for experiencing the consequences of weight stigma, and ruminated on their memories of stigmatizing experiences. Hierarchical regressions demonstrated that participants who were still distressed reported greater WBI, greater perceived stress, and poorer mental health than participants who were no longer distressed. When adding WBI to the model predicting perceived stress, differences between participants who were no longer distressed versus still distressed attenuated and became statistically insignificant, suggesting that these qualitative reaction patterns to stigma may be related to participants' level of WBI. Given that some people may experience longer term distress from weight stigma than others, this study can inform interventions aimed to prevent or mitigate the negative consequences associated with being stigmatized.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
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 people will experience longer term distress from weight stigma than others.
“It has also been shown that some people will experience longer term distress from weight stigma than others [209].”
From Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications (2020) · cites this paper as [209]
Cites
Stigma; Notes On The Management Of Spoiled Identity
Defleur, M., & Goffman, E. (1964) · Social Forces · doi:10.2307/2575995 · Cited by 23,025 · see citing works
WARE, J. E., KOSINSKI, M., & KELLER, S. D. (1996) · Medical Care · doi:10.1097/00005650-199603000-00003 · Cited by 17,392 · see citing works
(2017) · Cited by 16,036 · see citing works
Stigma: Notes on the Management of Spoiled Identity
(1969) · Postgraduate Medical Journal · doi:10.1136/pgmj.45.527.642 · Cited by 14,251 · see citing works
Link, B. G., & Phelan, J. C. (2001) · Annual Review of Sociology · doi:10.1146/annurev.soc.27.1.363 · Cited by 8,848 · see citing works
(1988) · Cited by 4,111 · see citing works
The Stigma of Obesity: A Review and Update
Puhl, R. M., & Heuer, C. A. (2009) · Obesity · doi:10.1038/oby.2008.636 · Cited by 3,323 · see citing works
Redefine statistical significance
Benjamin, D. J., Berger, J. O., Johannesson, M., Nosek, B. A., Wagenmakers, E.-J., Berk, R., Bollen, K. A., Brembs, B., Brown, L., Camerer, C., et al. (2017) · Nature Human Behaviour · doi:10.1038/s41562-017-0189-z · Cited by 2,772 · see citing works
Grabe, S., Ward, L. M., & Hyde, J. S. (2008) · Psychological Bulletin · doi:10.1037/0033-2909.134.3.460 · Cited by 2,053 · cited 1× · see citing works
“In the United States, sociocultural values of thinness and ideals of physical attractiveness are commonly perpetuated in the mass media (Grabe et al., 2008), contributing to considerable societal stigma towards individuals whose body size deviates from these expectations of thinness.”
BackgroundThe social psychology of health
(1989) · Choice Reviews Online · doi:10.5860/choice.26-5686 · Cited by 1,797 · see citing works
Body image across the adult life span: stability and change
Tiggemann, M. (2003) · Body Image · doi:10.1016/s1740-1445(03)00002-0 · Cited by 948 · see citing works
Quinn, D. M., & Chaudoir, S. R. (2009) · Journal of Personality and Social Psychology · doi:10.1037/a0015815 · Cited by 934 · see citing works
Gender differences in language use: An analysis of 14,000 text samples
Newman, M. L., Groom, C. J., Handelman, L. D., & Pennebaker, J. W. (2008) · Discourse Processes · doi:10.1080/01638530802073712 · Cited by 788 · see citing works
Understanding Self‐directed Stigma: Development of the Weight Bias Internalization Scale
Durso, L. E., & Latner, J. (2008) · Obesity · doi:10.1038/oby.2008.448 · Cited by 709 · see citing works
Weight bias internalization and health: a systematic review
Pearl, R. L., & Puhl, R. M. (2018) · Obesity Reviews · doi:10.1111/obr.12701 · Cited by 642 · see citing works
Self-citationHealth Consequences of Weight Stigma: Implications for Obesity Prevention and Treatment
Puhl, R. M., & Suh, Y. (2015) · Current Obesity Reports · doi:10.1007/s13679-015-0153-z · Cited by 582 · see citing works
Wu, Y., & Berry, D. C. (2018) · Journal of Advanced Nursing · doi:10.1111/jan.13511 · Cited by 536 · see citing works
Pearl, R., & Puhl, R. (2014) · Body image · doi:10.1016/j.bodyim.2013.09.005 · Cited by 417 · see citing works
Weight stigmatization and bias reduction: perspectives of overweight and obese adults
Puhl, R. M., Moss-Racusin, C. A., Schwartz, M. B., & Kd, B. (2007) · Health Education Research · doi:10.1093/her/cym052 · Cited by 389 · see citing works
Obesity and discrimination – a systematic review and meta‐analysis of observational studies
Spahlholz, J., Baer, N., König, H., Riedel-Heller, S., & Luck-Sikorski, C. (2016) · Obesity Reviews · doi:10.1111/obr.12343 · Cited by 379 · see citing works
Weight-Based Victimization Toward Overweight Adolescents: Observations and Reactions of Peers
Puhl, R. M., Luedicke, J., & Heuer, C. A. (2011) · Journal of School Health · doi:10.1111/j.1746-1561.2011.00646.x · Cited by 359 · see citing works
Intersectionality: An Understudied Framework for Addressing Weight Stigma
Himmelstein, M. S., Puhl, R. M., & Quinn, D. M. (2017) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2017.04.003 · Cited by 311 · see citing works
A multinational examination of weight bias: predictors of anti-fat attitudes across four countries
Puhl, R. M., Latner, J. D., O’Brien, K., Luedicke, J., Daníelsdóttir, S., & Forhan, M. A. (2015) · International Journal of Obesity · doi:10.1038/ijo.2015.32 · Cited by 304 · see citing works
O'Brien, K. S., Latner, J., Puhl, R., Vartanian, L., Giles, C., Griva, K., & Carter, A. (2016) · Appetite · doi:10.1016/j.appet.2016.02.032 · Cited by 295 · see citing works
Internalizing Weight Stigma: Prevalence and Sociodemographic Considerations in US Adults
Puhl, R. M., Himmelstein, M. S., & Quinn, D. M. (2017) · Obesity · doi:10.1002/oby.22029 · Cited by 269 · see citing works
Puhl, R. M., Wall, M. M., Chen, C., Austin, S. B., Eisenberg, M. E., & Neumark‐Sztainer, D. (2017) · Preventive Medicine · doi:10.1016/j.ypmed.2017.04.023 · Cited by 265 · see citing works
Lewis, S. C., Thomas, S. L., Blood, R. W., Castle, D. J., Hyde, J., & Komesaroff, P. A. (2011) · Social Science & Medicine · doi:10.1016/j.socscimed.2011.08.021 · Cited by 242 · see citing works
Thomas, S. L., Hyde, J., Karunaratne, A. S., Herbert, D., & Komesaroff, P. A. (2008) · Health Expectations · doi:10.1111/j.1369-7625.2008.00490.x · Cited by 238 · see citing works
Ahern, A. L., Wheeler, G. M., Aveyard, P., Boyland, E. J., Halford, J. C. G., Mander, A. P., Woolston, J., Thomson, A. M., Tsiountsioura, M., Cole, D., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(17)30647-5 · Cited by 218 · see citing works
Perceptions of intersectional stigma among diverse women living with HIV in the United States
Rice, W. S., Logie, C. H., Nápoles, T. M., Walcott, M. M., Batchelder, A., Kempf, M.-C., Wingood, G. M., Konkle‐Parker, D. J., Turan, B., Wilson, T. E., et al. (2018) · Social Science & Medicine · doi:10.1016/j.socscimed.2018.05.001 · Cited by 193 · see citing works
Patients who feel judged about their weight have lower trust in their primary care providers
Gudzune, K., Bennett, W. L., Cooper, L., & Bleich, S. (2014) · Patient Education and Counseling · doi:10.1016/j.pec.2014.06.019 · Cited by 122 · see citing works
Hayward, L. E., Vartanian, L., & Pinkus, R. T. (2018) · Obesity · doi:10.1002/oby.22126 · Cited by 114 · see citing works
The Role of Stigma in Weight Loss Maintenance Among U.S. Adults
Puhl, R. M., Quinn, D. M., Weisz, B. M., & Suh, Y. J. (2017) · Annals of Behavioral Medicine · doi:10.1007/s12160-017-9898-9 · Cited by 92 · see citing works
Self-citationWeight stigma and health: The mediating role of coping responses.
Himmelstein, M. S., Puhl, R. M., & Quinn, D. M. (2017) · Health Psychology · doi:10.1037/hea0000575 · Cited by 87 · see citing works
O'Neil, P. M., Miller‐Kovach, K., Tuerk, P. W., Becker, L. E., Wadden, T. A., Fujioka, K., Hollander, P. L., Kushner, R. F., Garvey, W. T., Rubino, D., et al. (2016) · Obesity · doi:10.1002/oby.21616 · Cited by 84 · see citing works
Lee, M. S., & Dedrick, R. (2016) · Body image · doi:10.1016/j.bodyim.2016.01.008 · Cited by 78 · see citing works
Wang, S. B., Lydecker, J. A., & Grilo, C. M. (2017) · European Eating Disorders Review · doi:10.1002/erv.2499 · Cited by 73 · see citing works
Weight bias internalization in a commercial weight management sample: prevalence and correlates
Pearl, R. L., Himmelstein, M. S., Puhl, R. M., Wadden, T. A., Wojtanowski, A. C., & Foster, G. D. (2019) · Obesity Science & Practice · doi:10.1002/osp4.354 · Cited by 62 · see citing works
Fettich, K. C., & Chen, E. Y. (2012) · Obesity · doi:10.1038/oby.2012.12 · Cited by 52 · see citing works
Marrero, D. G., Palmer, K. N. B., Phillips, E. O., Miller‐Kovach, K., Foster, G. D., & Saha, C. (2016) · American Journal of Public Health · doi:10.2105/ajph.2015.303035 · Cited by 48 · see citing works
Sociocultural and Familial Factors Associated with Weight Bias Internalization
Pearl, R. L., Wadden, T. A., Tronieri, J. S., Chao, A. M., Alamuddin, N., Bakizada, Z. M., Pinkasavage, E., & Berkowitz, R. I. (2018) · Obesity Facts · doi:10.1159/000488534 · Cited by 41 · see citing works
Examining experiences of weight-related oppression in a bariatric sample: A qualitative exploration.
Davis, H. A., & Bowman, S. L. (2015) · Translational Issues in Psychological Science · doi:10.1037/tps0000036 · Cited by 8 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Obesity and psychological distress
Steptoe, A., & Frank, P. (2023) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2022.0225 · Cited by 164 · see citing works
Wiss, D. A., Avena, N., & Gold, M. (2020) · Nutrients · doi:10.3390/nu12113521 · Cited by 66 · see citing works
Frederick, D. A., Gordon, A. R., Cook‐Cottone, C. P., Brady, J. P., Reynolds, T. A., Alley, J. C., Garcia, J. R., Brown, T. A., Compte, E. J., Convertino, A. D., et al. (2022) · Body Image · doi:10.1016/j.bodyim.2022.01.010 · Cited by 39 · see citing works
Examining weight bias before and/or after bariatric surgery: A systematic review
Bennett, B. L., Lawson, J., Funaro, M., & Ivezaj, V. (2022) · Obesity Reviews · doi:10.1111/obr.13500 · Cited by 25 · see citing works
Jones, R. A., Mueller, J., Sharp, S. J., Vincent, A., Duschinsky, R., Griffin, S. J., & Ahern, A. L. (2021) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-021-01216-6 · Cited by 26 · see citing works
Jackson, S. E., Brown, J., Llewellyn, C. H., Mytton, O. T., & Shahab, L. (2026) · BMC Medicine · doi:10.1186/s12916-025-04528-7 · Cited by 29 · see citing works
“Do you find it normal to be so fat?” Weight stigma in obese gym users
Argüelles, D., Samaniego, V. P., & López-Cañada, E. (2021) · International Review for the Sociology of Sport · doi:10.1177/10126902211056867 · Cited by 24 · see citing works
Why people follow a gluten-free diet? An application of health behaviour models
Xhakollari, V., Canavari, M., & Osman, M. (2021) · Appetite · doi:10.1016/j.appet.2021.105136 · Cited by 20 · see citing works
A primer with purpose: Research implications of the objectification of weight in the workplace
Lemmon, G., Jensen, J. M., & Kuljanin, G. (2021) · Journal of Occupational and Organizational Psychology · doi:10.1111/joop.12378 · Cited by 21 · see citing works
Eating Disorders In weight-related Therapy (EDIT) Collaboration: rationale and study design
Lister, N. B., Baur, L. A., Paxton, S. J., Garnett, S. P., Ahern, A. L., Wilfley, D. E., Maguire, S., Sainsbury, A., Steinbeck, K. S., Braet, C., et al. (2023) · Nutrition Research Reviews · doi:10.1017/s0954422423000045 · Cited by 18 · see citing works
Jones, R. A. P., Christiansen, P., Maloney, N. G., Duckworth, J. J., Hugh‐Jones, S., Ahern, A. L., Richards, R., Brown, A. C., Flint, S. W., Robinson, E., et al. (2022) · International Journal of Obesity · doi:10.1038/s41366-022-01220-1 · Cited by 15 · see citing works
Parental Reasons for Engaging in or Avoiding Weight Talk With Children
Pudney, E. V., Puhl, R. M., Halgunseth, L. C., & Schwartz, M. B. (2022) · Childhood Obesity · doi:10.1089/chi.2022.0173 · Cited by 15 · see citing works
Best practices for weight at work research
Lemmon, G., Jensen, J. M., & Kuljanin, G. (2023) · Industrial and Organizational Psychology · doi:10.1017/iop.2023.50 · Cited by 13 · see citing works
Hawkins, L. K., Burns, L., Swancutt, D. R., Moghadam, S., Pinkney, J. H., Tarrant, M., & The PROGROUP Programme Team (2024) · Obesity Reviews · doi:10.1111/obr.13798 · Cited by 13 · see citing works
LaFata, E. M., Bach, C., Berkowitz, R. I., Latner, J. D., & Pearl, R. L. (2021) · Stigma and Health · doi:10.1037/sah0000341 · Cited by 13 · see citing works
Intersecting Expectations when Expecting: Pregnancy-Related Weight Stigma in Women of Colour
Deol, S., Ferdinands, A. R., Hill, B., Rodriguez, A. C. I., Nutter, S., Salas, X. R., & Nagpal, T. S. (2024) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-024-01619-0 · Cited by 12 · see citing works
Experiences of Size Inclusive Physical Activity Settings Among Women With Larger Bodies
Myre, M., Glenn, N. M., & Berry, T. R. (2022) · Research Quarterly for Exercise and Sport · doi:10.1080/02701367.2021.1983515 · Cited by 9 · see citing works
Wetzel, K. E., & Himmelstein, M. S. (2024) · Annals of Behavioral Medicine · doi:10.1093/abm/kaae044 · Cited by 8 · see citing works
A mixed‐method exploratory study of weight‐based mistreatment at work
Lemmon, G., Jensen, J. M., Kuljanin, G., & Chu‐Jacoby, R. (2024) · Journal of Occupational and Organizational Psychology · doi:10.1111/joop.12550 · Cited by 7 · see citing works
Standen, E. C., Rothman, A. J., & Mann, T. L. (2024) · Social Science & Medicine · doi:10.1016/j.socscimed.2024.116784 · Cited by 7 · see citing works
Wetzel, K. E., Himmelstein, M. S., & Ciesla, J. A. (2025) · Social Science & Medicine · doi:10.1016/j.socscimed.2025.117904 · Cited by 7 · see citing works
Weight bias among dietitians: does the weight status of the patients change the dietary approaches?
Cebioğlu, İ. K., Bi̇lgi̇n, G. D., Bakır, B. O., & Koyuncu, A. G. (2022) · Revista de Nutrição · doi:10.1590/1678-9865202235e210214 · Cited by 6 · see citing works
Zahra-Zeitoun, Y., Elran‐Barak, R., Salameh-Dakwar, R., Froylich, D., Sroka, G., ASSALIA, A., & Latzer, Y. (2024) · Israel Journal of Health Policy Research · doi:10.1186/s13584-023-00587-4 · Cited by 5 · see citing works
20-55 Yaş Arası Kadınların Beden Algılarının Değerlendirilmesi
Ergün, C., Koç, B. M., & KALEOĞLU, S. (2022) · İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi · doi:10.38079/igusabder.1196777 · Cited by 5 · see citing works
Aladel, A., Dakhakhni, B., Almuhtadi, Y., Alsheweir, A., & Aljammaz, S. A. (2023) · Healthcare · doi:10.3390/healthcare11121754 · Cited by 5 · see citing works
Jackson, S. E., Brown, J., Llewellyn, C. H., Mytton, O. T., & Shahab, L. (2025) · medRxiv · doi:10.1101/2025.06.06.25329114 · Cited by 5 · see citing works
Stovall, T., Mitchell, N. A., Smith, F. S., & Jones, R. E. (2021) · Appetite · doi:10.1016/j.appet.2021.105429 · Cited by 4 · see citing works
Peng, J., Tan, X., Ning, N., Wiley, J. A., Hua, N., Zeng, Y., & Sun, M. (2025) · International Journal of Nursing Studies Advances · doi:10.1016/j.ijnsa.2025.100306 · Cited by 3 · see citing works
Pearl, R. L., Groshon, L. C., Hernandez, M., Bach, C., LaFata, E. M., Fitterman-Harris, H. F., Leget, D. L., Sheynblyum, M., & Wadden, T. A. (2025) · Clinical Obesity · doi:10.1111/cob.70005 · Cited by 3 · see citing works
Täuber, S., Flint, S. W., & Gausel, N. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.598109 · Cited by 1 · see citing works
Psihogios, A., Baggio, A., & Clouthier, S. N. (2021) · CAND Journal · doi:10.54434/candj.16
Junqueira, A. C. P., Marques, M., Pagnano, M. C. L., Bonacasata, J. P., da Cunha, M. C. F., & Laus, M. F. (2024) · Trends in Psychology · doi:10.1007/s43076-024-00384-1
Validation of the Nurse Practitioner Knowledge and Attitudes of Patient Obesity Scale: A pilot study
Willenbrock, D., & Rose, S. (2024) · Journal of the American Association of Nurse Practitioners · doi:10.1097/jxx.0000000000001097
Elran‐Barak, R., & Sagi‐Dain, L. (2026) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2026.06.007
An exploratory study of the correlates of weight-based mistreatment at work
Lemmon, G., Jensen, J. M., Kuljanin, G., & Reddy, M. S. (2026) · PLoS ONE · doi:10.1371/journal.pone.0342144
Squires, N. D., Clifford, D., Asantewaa, S. M., Garrison, S., & Galli, N. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1953974
- Authors
- Pudney, E. V., Himmelstein, M. S., Puhl, R. M., & Foster, G. D.
- Affiliations
- University of Connecticut (US)
- WW International, Inc. (United States) (US)
- Corresponding author
- Pudney, Ellen V.
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2020-03
- Volume
- 249
- Pages
- 112854
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W3006530395
- Cited by
- 37
- References
- 42
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 8 · 2023: 4 · 2022: 7 · 2021: 7 · 2020: 2
- FWCI
- 7.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- University of Connecticut
- Topics
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- weight stigma, weight bias internalization, emotional distress, self-acceptance, perceived stress, mental health, weight management interventions, body image, rumination
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
