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Experienced weight stigma and its biopsychosocial correlates : The role of internalised weight stigma
Bidstrup, Hugh
Bidstrup, Hugh
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Abstract
Weight stigma is defined as social devaluation directed toward individuals because of their body-weight. Existing theoretical models have suggested that internalised weight stigma (i.e., the application of negative stereotypes about weight to the self) explains the well-established relationship between weight stigma experiences and adverse psychosocial health correlates. The first aim of this thesis was to review, test, and replicate the proposed effects of internalised weight stigma in the literature (Studies 1-3). The second aim of this thesis was to move beyond cross- sectional research to understand the temporal relationship between weight stigma and biopsychosocial health correlates (Studies 4 and 5).
The first study in this thesis was a systematic review (n = 17), which found that internalised weight stigma mediated the relationship between experienced weight stigma and several biopsychosocial correlates, including disordered eating, body image disturbances, self-esteem, and psychological distress. Studies 2 and 3 replicated these observed effects in bariatric surgery candidates (n = 217; Study 2) and in a community-based sample (n = 418; Study 3). In both samples, I found that internalised weight stigma mediated the relationship between experienced weight stigma and several psychosocial (but not physical) health correlates, including disordered eating, symptoms of depression and anxiety, self-esteem, and body image disturbances. Study 3’s second aim after replication was to characterise the protective nature of awareness, engagement, and endorsement (AEE) of non-diet approaches to health. Hypotheses were partially supported, such that non-diet AEE was related to external measures of weight stigma, but not internal measures. There were few consistent relationships between non-diet AEE and psychosocial health correlates. Though mixed, our findings suggest non-diet approaches remain an important factor to consider in future research.
To address the second aim of this thesis, I also reviewed the literature that used real-time data collection methods (i.e., Ecological Momentary Assessment [EMA] methods) to analyse temporal relationships between weight stigma and health outcomes (Study 4). The findings from this review (n = 12) indicated that EMA results corroborate those in cross-sectional studies, and that weight stigma precedes negative health outcomes – including negative affect, body image disturbances, psychological distress, exercise avoidance, and disordered eating. This review also found several limitations in existing literature, including a lack of consistency in methods used and research questions posed. Study 5 aimed to address this by creating a coherent research agenda through establishing a data-sharing consortium. Specifically, in Study 5, I used survey methods and conference workshops to collect quantitative and qualitative data about clinical, lived experience, and research experts’ views of the direction of future EMA weight stigma research and research priorities. Healthcare avoidance, disordered eating, body image disturbances, and psychological distress, respectively, were rated as the most important outcomes of weight stigma that research should prioritise.
Taken together, the findings from the studies in this thesis emphasise that internalised weight stigma is an important construct for understanding the relationship between experiences of weight stigma and adverse health correlates. This research also suggests that EMA methods provide a unique opportunity to address the limitations of existing research. The proposed data-sharing consortium may be an important component of future research for understanding and effectively addressing weight stigma’s consequences.
Keywords
weight stigma, weight-based discrimination, weight bias, non-diet approaches to health, Ecological Momentary Assessment, internalised weight stigma
Date
2025-11-20
Type
Thesis
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Book
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Page Range
1-180
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ACU Department
National School of Behavioural and Health Sciences
Faculty of Health Sciences
Faculty of Health Sciences
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Open Access Status
Open access
License
CC BY 4.0 (Creative Commons Attribution 4.0 International)
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This work © 2025 by High Bidstrup is licensed under Creative Commons Attribution 4.0 International (http://creativecommons.org/licenses/by/4.0/).
This work includes third-party copyright material used with permission. Refer to the copyright statement or Creative Commons License provided by each third-party copyright holder.