Internalized Societal Attitudes Moderate the Impact of Weight Stigma on Avoidance of Exercise

“Participants also completed the Current Thoughts Scale (31), a 20-item measure that assesses state self-esteem across three domains (social, performance, and appearance).”

“Although several studies exist that document cross-sectional associations between weight and weight stigma (e.g., Drury, Louis, & Alegria Drury, 2002; Puhl & Brownell, 2006; Vartanian & Novak, 2011), this does not speak to the positive feedback nature of the model.”

“tive body image [121–124], low self-esteem [121, 122], and”

“Such bias can have severe psychological consequences, including increased vulnerability to depression [5,6] and lower self-esteem [5,7], selfacceptance [3], and life satisfaction [8].”

“…weight stigma predicts an increased motivation to avoid exercising, particularly in public settings (Vartanian & Shaprow, 2008), and this effect is most pronounced among individuals who have internalized negative weight-related attitudes and societal beauty norms (Vartanian & Novak, 2011).”

“For example, Vartanian and Novak (2011) and Vartanian (2015) found that scores on the Stigmatizing Situations Inventory were positively correlated with scores on the bulimia subscale of the EDI.”

“Paired samples t-tests revealed that all groups except for the Overweight/Stigma group experienced decreased negative affect following the video, though only the change observed in the Overweight/Neutral group reached significance (t(16) = 2.”

“Research examining psychological (including behavioral) consequences of weight stigma include symptoms of depression and anxiety (16,17), suicidal thoughts and behaviors (26), desire for thinness, body dissatisfaction, bulimic symptoms, and poor self-esteem (27).”

“In a study of 111 US adults who considered themselves overweight, both reported experiences of weight stigma and own internalized anti-fat attitudes predicted avoidance of exercise (most especially at gyms), and less strenuous exercise (Vartanian and Novak, 2011).”

“Some studies have pointed to WBI as a mechanism through which experienced weight stigma exacerbates adverse health behaviors (23), potentially through low self-esteem and basing one’s self-evaluation on body weight (24,25).”

“The negative physiological and psychological implications of patients experiencing weight bias are widespread and can increase the risk of engaging in unhealthy behaviours, including increased food consumption (44,45) and decreased physical activity (45,46), patient non-adherence, delay in seeking health care or its a…”

“Perceived weight discrimination is also associated with exercise avoidance motivation (Vartanian & Novak, 2011) and weight gain over a 4-year period (Sutin & Terracciano, 2013).”

“Due to previously nonsignificant associations between weight stigma experiences and exercise behavior (Vartanian and Novak, 2011; Vartanian and Shaprow, 2008), and evidence that other forms of self-stigma affect aspects of motivation such as self-efficacy (Corrigan et al., 2009), we hypothesized…”

“In addition, exposure to weight stigma may promote unhealthy eating behaviors such as binge eating, increased caloric consumption, and reluctance to diet (5Y7), while also attenuating physical activity and motivation to exercise (8,9), all of which impair weight loss efforts and promote obesity.”

“Additionally, individuals with high WBI exhibit diminished self-efficacy to exercise due to endorsing negative stereotypes, such as laziness (6,23), and thus are more likely to avoid physical activity (21).”

“Others have shown that weight stigma is positively correlated with increased exercise avoidance, but has no direct link to self-reported exercise [14, 47].”

“For example, independent of BMI, research implicates weight stigma in decreased exercise motivation (13,14), decreased subjective health (15), increased disease burden (15), increased caloric consumption (16,17), increased disordered eating (18), and increased blood pressure (19,20).”

“…Puhl & Brownell, 2006; Puhl et al., 2007) and physical health (e.g., exercise avoidance, disordered eating; Annis, Cash, & Hrabosky, 2004; Benas & Gibb, 2008; Haines, Neumark-Sztainer, Eisenberg, & Hannan, 2006; Neumark-Sztainer et al., 2007; Vartanian & Novak, 2010; Vartanian & Shaprow, 2008).”

“Vartanian and Novak (2011) found that personal endorsement of societal attitudes toward obesity exacerbated the negative motivational effects of obesity stigma.”

“There is a growing literature indicating that weight-stigma experiences are associated with a range of negative psychological outcomes (Friedman et al., 2005; Puhl & Brownell, 2006; Vartanian & Novak, 2011; Vartanian & Shaprow, 2008).”

“, exercise avoidance (32), binge eating behavior (30)), such that the negative effects of stigma are stronger for individuals who are high in internalized weight bias.”

“Research utilising retrospective measures has found that weight-based stigma experiences are reported to occur in overweight and obese samples on average ‘once in a life-time’, with mean values ranging in frequency from ‘never’ to ‘once per month’ (Myers and Rosen, 1999; Vartanian and Novak, 2011; Vartanian and Shapro…”

“…individuals with greater internalized weight 100 stigma report lower engagement in physical activity (Carels et al., 2009; Pearl et al., 2014; 101 Vartanian & Novak, 2011), higher caloric intake during weight loss programs (Carels et al., 102 2009; Schvey, Puhl, & Brownell, 2011), and greater…”

“Individuals who perceive discrimination based on their weight, for example, tend to overeat to cope with the stress and also avoid physical activity (14).”

“Among these, researchers have identified depression [12], increased binge-eating behaviour [11], anxiety [44], and stress [9], as well as decreased motivation to engage in physical activity [10].”

“, 2008) and even among individuals not classified as overweight/obese (Latner et al., 2012; Vartanian and Novak, 2011).”

“In one study (Vartanian & Novak, 2011) of more than 100 adults, 97% reported that they had experienced weight-related stigma, and 48% said that they experienced it at least once per week.”

“Studies of weightstigmatizing experiences Seven studies included at least one subscale or adaptation of the Stigmatizing Situations Inventory (SSI) (13,19,21,28,35,43,44), four included the Everyday Discrimination Scale (EDS; in full or an abbreviated version) (3638,41), and six included a set of three yes/ no items a…”

“Sample 1 [4] included 111 adults from the USA who were overweight or obese (76% women, 71% Caucasians, mean age=34.”

“…that stigma experiences are associated with decreased motivation to engage in health behaviors, the majority of these studies are limited by their reliance on cross-sectional designs involving retrospective self-reports of stigma experiences and of health behaviors (e.g., Vartanian & Novak, 2011).”

“, 2007), and avoidance of exercise (Vartanian and Novak, 2011).”

“Individuals with negative/poor body image are more likely to avoid participation in positive health behaviors (Vartanian and Novak, 2011), experience mood disorders (Jackson et al.”

“Previous studies that have examined associations between weight stigma and actual exercise behaviour have produced mixed results.(7) 8 11 13 Our finding linking weight discrimination with reduced physical activity contrasts with one previous study in particular that observed increased levels of physical activity among…”

“For example, one study found that the relationship between experiences with weight- based discrimination and a reduced desire to avoid exercising in public was particularly pronounced among individuals who internalized weight bias (Vartanian & Novak, 2011).”

“Later evidence noted that this effect was 83 moderated by the participants’ own anti-fat attitudes and internalization of the thin ideal 84 (Vartanian & Novak, 2011).”

“Further, Vartanian and Novak (2011) argued that internalization of societal messages about weight was strongly related to exercise avoidance.”

“…bias internalization, or the holding of negative beliefs about oneself based on weight-based stereotypes, has been found to be associated with psychological distress, disordered eating (O’Brien et al., 2016), lower self-esteem (Pearl & Puhl, 2016), and exercise avoidance (Vartanian & Novak, 2011).”

“Previous research in this area had found a relationship between weight stigma and exercise avoidance [16,41]; however, no work has assessed the potential psychosocial factors underpinning the relationship between weight stigma and enjoyment or tendency to avoid physical activity and sport.”

“Exposure to weight stigma is also associated with binge eating (Durso et al., 2012) and exercise avoidance (Vartanian & Novak, 2011; Vartanian & Shaprow, 2008)—behaviors that are 1University of California, Santa Barbara, USA 2The University of Queensland, St Lucia, Australia 3Miami University,…”

“Experience of weight stigma has been linked to avoidance of exercise and reduced exercise intentions in higher-weight adults (Schvey et al. 2016; Vartanian and Novak 2011; Vartanian, Pinkus, and Smyth 2016; Vartanian and Shaprow 2008) and children (for a review, see Salvy et al. 2012), as well as…”

“As discussed earlier, weight-based stigmatizing experiences have a profound effect on body image dissatisfaction and PA avoidance behaviors.(20) These findings reinforce that body image dissatisfaction, at least partially in response to social discrimination, may adversely impact adoption and maintenance of PA.”

“E u r op e P M C F und e r s A u t ho r M a nu s c r i p t s problematic eating, 41-44 refusal to diet, 7,45 and avoidance of physical activity, 46,47 and may even lead to weight gain.”

“…risk of engaging in unhealthy eating behaviors and avoidance of physical activity (Ashmore, Friedman, Reichmann, & Musante, 2008; Carels et al., 2009; Puhl & Heuer, 2009; Puhl et al., 2007; Vartanian & Novak, 2010; Vartanian & Shaprow, 2008), both of which can reinforce weight gain and obesity.”

“…has been associated with a range of behaviors, including medication adherence (Rao et al., 2007; Rintamaki et al., 2006), motivation to exercise (Vartanian & Novak, 2011; Vartanian & Shaprow, 2008), academic performance (Brown & Lee, 2005), financial decisions (Gladstone et al., 2021) and…”

“…include unhealthy dietary behaviors and psychological difficulties such as body dissatisfaction, depression, low self-esteem, and drive for thinness (Ashmore, Friedman, Reichmann, & Musante, 2008; Brochu & Dovidio, 2014; Haines, Neumark-Sztainer, Eisenberg, & Hannan, 2006; Vartanian & Novak, 2011).”

“…with overweight/obesity actually results in poorer weight loss outcomes, greater rates of maladaptive eating, decreased motivation to exercise, and poor self-efficacy for dietary control and exercise (Haines et al. 2006; Puhl and Brownell 2006; Vartanian and Novak 2011; Wott and Carels 2010).”

“Stated another way, there are people who are “fit and fat,” and that is better than being “unfit and thin,” at least in terms of health and longevity (Wei et al., 1999).”

“Such stigma 687 surrounding exercise during the period has been similarly reported in overweight 688 individuals (Vartanian & Novak, 2011), people with mobility impairments (Mulligan et 689 al., 2017), and the LGBTQ+ community (Herrick & Duncan, 2018) undertaking 690 physical activity.”

“…stereotypes led to significantly diminished exercise and dietary health intentions (Seacat & Mickelson, 2009), and the combination of IWB and the experience of external stigmatisation were associated with increased avoidance of exercise in an overweight adult sample (Vartanian & Novak, 2011).”

“…domains, including an individual’s reduction of positive health behaviors such as going to the doctor, exercising, and eating a well-balanced diet (Vartanian & Novak, 2011); and an increase in negative health outcomes and maladaptive health behaviors, including an increase in mood disorders…”