Weighed Down by Stigma: How Weight‐Based Social Identity Threat Contributes to Weight Gain and Poor Health

“Allostatic load is assumed to be a common biological pathway leading from stress to multiple health outcomes often linked to obesity, including cardiovascular disease, diabetes, strokes, ulcers, decreased immune functioning, and cancers (McEwen, 1998).”

“Although temporary weight loss may be achieved through such efforts, long term maintenance of weight loss is difficult if not impossible to achieve (Mann et al., 2007; Tomiyama, Alhstrom, & Mann, 2013).”

“According to the weight-based social identity threat model (Hunger et al., 2015), when individuals regularly perceived weight stigma and believe that others view them as overweight, they will endorse negative weight-based stereotypes and internalize the belief that obese people are socially…”

“…in weight has been linked to several negative psychological outcomes and unhealthy eating behaviors (e.g. Araiza and Wellman, 2017; Groesz et al., 2012; Himmelstein et al., 2015; Hunger et al., 2015; Wellman et al., 2018), which have deleterious consequences for psychological and physical health.”

“Managing the stress caused by weight stigma is an effortful and taxing endeavor that exhausts executive resources, as individuals try to suppress negative emotions or compensate for negative stereotypes by expending extra energy to make positive impressions (Hunger et al., 2015).”

“…& Murphy, 2017; Diekman et al., 2002; Shelton & Richeson, 2005), decreased working memory (e.g., Beilock et al., 2007), poorer well-being (e.g., Hunger et al., 2015), and greater anxiety and physiological arousal when interacting with outgroup members (Finchilescu, 2010; Sawyer et al., 2012).”

“Consistent with discrimination as one mechanism through which individuals with a high relative BMI are subjected to social sanctions, Janssen et al. (Janssen & Fahr, 2014) found that deviations from the median BMI of one’s peer group are associated with reduced wages, independent of deviations from “an optimal BMI in…”

“The prevalence, pervasive nature and impact of societal stigma (including expectations, judgement and bullying) around weight [41, 42] may in part account for the expectation that these attacks would be more harmful and serious.”

“Sociocultural body image and weight stigma theories (e.g. Hunger et al., 2015; Petrie and Greenleaf, 2012) suggest that continued exposure to body and weight pressure from sociocultural sources (including interpersonal interactions) can lead to internalization of these unrealistic ideals and…”

“The negative association between anticipated weight stigma and participants ’ mental well-being can be understood through the social identity threat model as high awareness and expectation of discriminatory treatment based on an identity status typically excluded from power and privilege (55).”

“Higher weight individuals are more likely to experience weight stigma, which in turn can lead to increased weight gain through several pathways (e.g., Hunger et al., 2015; Tomiyama, 2014).”

“A scoping review by Dieterich and Demirci [68] identified that weight stigma impacted the delivery of weight related communication in obstetric settings.”

“…does not need to objectively belong to a stigmatized group to experience the negative consequences of stigma, but merely perceiving oneself as having a stigmatized identity may be sufficient—especially in the case of weight stigma (Haynes et al., 2019; Hunger et al., 2015; Schmitt et al., 2014).”

“Although discomfort and avoidance of healthcare settings may arise from many sources, social identity threat theory may posit that they originate from the body stigma people expect to experience in the healthcare domain [9].”

“Providers may aim to motivate patients toward weight loss by voicing negative beliefs about weight, yet this approach often increases the likelihood of both poorer physical and mental health [55, 56].”

“Hunger et al. (2015) suggest that disturbance in self-regulatory resources and individuals’ efforts to avoid weight stigma are related to problematic health behaviors.”

“Though previous studies have investigated barriers and facilitators to successful weight management [15–19], it is important to stress that migrants do not constitute a homogenous group [7, 20].”

“Medicalized “ concern ” is implicated in weight-related stigma, exacerbating negative mental health and physiological outcomes (Hunger et al., 2015) that are not necessarily neutralized or fi ltered out by the Fatosphere.”

“healthcare professionals [8, 11], social media [12, 13], and public health policy makers [14] not to exacerbate weight bias.”

“As discussed, studies have found that stigmatizing obesity can result in a high degree of psychological stress (54) which in turn promote unwanted coping responses by eating more food and refusing to lose weight and consequently, could lead to more weight gain (55, 56).”

“Anticipated classism was assessed using an item modeled from Hunger and colleagues [19].”

“…serve as a motivator for behavior change and weight loss, empirical evidence points to its negative implications on individuals’ physical and mental health (e.g., Hunger et al., 2015; Puhl & Suh, 2015), with a stronger association found with increasing body mass index (BMI) (Emmer et al., 2020).”

“Weight-based social identity threat is caused by situational cues that people are devalued due to their weight and triggers negative responses linked to both acute and chronic health conditions (Hunger et al., 2015).”

“…intergroup relations suggests that fat people experience identity threat or concern about how they will be treated on the basis of their fatness (see also Hunger, Major, Blodorn, et al. 2015), in contexts where thinness and thin people are prevalent (Oswald and Adams 2024; Oswald et al. 2022).”

“Observational studies provide some indication that stigma is associated with unfavorable diet-related behaviors, including breakfast skipping, greater consumption of fast food and sugar-sweetened beverages, and irregular meal patterns [17,18].”

“Anticipated stigma is linked with disordered eating among people with visible stigmatized identities (i.e., weight)(Himmelstein et al., 2015; Hunger et al., 2015, 2020); and having a CSI is associated with disordered eating (Feldman & Meyer, 2007; Laws & Golding, 1996; Lindeman & Stark, 2001;…”

“The emergent weight-based discrimination can then create highly consequential inequities as well as negative effects on health and well-being (Hunger et al., 2015, 2020; Mason et al., 2021; Sutin et al., 2015; Vartanian et al., 2018), especially among women, who are judged more harshly for having…”

“Awareness of cultural negative stereotypes surrounding certain sports disciplines, such as being overweight, makes individuals vulnerable to social identity threats triggered by concerns about potential devaluation, discrimination, rejection, or negative stereotyping (Hunger et al., 2015).”

“Social support is an important resource for promoting both general health and weight management [16].”

“Individuals facing weight stigma may attempt to escape stigma (Hunger et al., 2015) by negating, or distancing themselves from, their body size, which may lead to engagement in self-blaming (i.e., negative self-talk) or self-changing (i.e., weight loss attempts) efforts.”

“The majority of the research also focused on the prevalence of weight stigma among women and less attention was given to the male population (Hunger et al., 2015; Salvia et al., 2023).”

“3,17 18-20 The impact of weight bias is not limited to patients.”

“Future interventions should prioritize the elimination of weight-based discrimination, as theory and evidence suggest internalized weight bias tends to be responsive to the external influence of discriminatory experiences rather than the reverse (Hunger et al., 2015).”

“[7] In South Africa (SA), there are many different stigmas associated with body shape.”

“…there are also studies that have made useful explorations in this regard, such as the currently more widely accepted theory of social identity threat to explain the negative effects of weight stigma (Hunger et al., 2015), which will need to be supplemented and verified with data in the future.”

“…depression (Lam et al., 2024; Vetter et al., 2011), as well as physical health issues, including high blood pressure and cardio-vascular disease (Hunger et al., 2015), increased respiratory illnesses, reduced vitality (McLoughlin et al., 2024), and declined physical functioning (Hermsen et al.,…”

“According to the weight-based social identity threat model (Hunger et al., 2015), perceiving oneself as belonging to a socially devalued weight group may heighten concerns about social judgment, rejection, and appearance-based evaluation.”

“The relationship between stress and obesity is bidirectional; chronic stress has been associated with the development of obesity, whereas obesity may also increase stress levels, thereby creating a vicious cycle [87 –90].”

“Such stereotypes can lead to differential treatment and evaluations of overweight individuals; this includes mistreatment (Hunger et al. 2015), marginalization (Scaraboto and Fischer 2013), social rejection (Blodorn et al. 2016), and, as the current studies investigate, possibly gift giving.”

“These findings provide empirical support for the COBWEB model (Tomiyama, 2014) and the Weight-Based Social Identity Threat Model (e.g. Hunger et al., 2015), which both centre stress as the causal mechanism underlying the impacts of weight stigma on health.”

“Systematic reviews provided that both enacted and internalized WS are invariably connected to impaired psychological health, lower self-esteem, and decreased quality of life, even when adjusting for BMI (Hunger et al., 2015; Levinson et al., 2024).”

“…biological, environmental, and socioeconomic factors, mainstream media continues to portray high weight myopically because of individual shortcomings such as poor self-discipline, unhealthy lifestyle choices, and moral shortcomings (Hunger et al., 2015; Murro et al., 2022; Ravussin & Ryan, 2018).”

“…theory suggests that those who have experienced discrimination in the past or are aware of societal stigma against their social group may anticipate mistreatment in future interactions and use disengagement (e.g., avoidance) strategies to manage stress (Hunger et al., 2015; Major & Schmader, 2017).”

“…distress from anticipated and self-directed weight stigma, which promotes excess energy intake and future gain of actual weight through increasing emotional eating, disrupting cognitive resources involved in regulating eating, or undermining self-efficacy to manage healthier diets [2, 6, 11–14].”

“(Emmer et al., 2020; Hunger et al., 2015; Major et al., 2017; Muennig, 2008; Puhl et al., 2020; Zhu et al., 2022).”

“They are also at risk of stigmatization and social isolation due to their condition [8, 9].”

“…et al., 2013; Orpana et al., 2010; Tylka et al., 2014), and the growing recognition of weight stigma as a driver of negative health outcomes (Hunger et al., 2015), dominant medical discourses still largely hold that adiposity is unequivocally the cause of worse health outcomes among…”

“…disso, estudos mostram que o nutricionista acaba sendo pouco incluído no contexto das academias e a sua atuação é substituída por informações compartilhadas entre os praticantes, por amigos e por orientações fornecidas pelos instrutores (Karkle, 2015; Nascimento et al., 2013; Silva et al., 2010).”

“Weight-influenced stigma is stressful (Tomiyama 2014) and often internalized, and this results in adverse health outcomes (Hunger et al., 2015; Pearl et al., 2020).”