Childhood obesity associated with higher risk of severe weight stigma in adulthood

Adults who developed severe obesity before the age of 18 are nearly three times more likely than those who developed the condition later to be subjected to severe experienced weight stigma (EWS), a study led by UT Southwestern Medical Center researchers shows. EWS is marked by negative or discriminatory acts or ideologies related to a person's body weight or size. With growing rates of childhood obesity, an increasing population may be struggling with EWS, which has its own negative health consequences.

"Experienced weight stigma is definitely not about hurt feelings. It's a real public health issue that impacts mental health, physical health, and access to care. Recognising and addressing weight stigma needs to be part of routine obesity care," said Dr Jaime Almandoz, Associate Professor of Internal Medicine in the Division of Endocrinology at UT Southwestern. Dr Almandoz co-led the study with first author, Dr Deepali K Ernest, a doctoral researcher at UT Health Science Center at Houston.

About forty-two percent of US adults aged 20 and older live with obesity. As with other stigmatizing diseases, Almandoz explained, people with obesity are often assumed to be responsible for their condition since it is thought to be within their control.

Although more than 40% of US adults of all sizes report EWS at some point in their lives, it disproportionately affects individuals with obesity. EWS has been linked to a variety of adverse outcomes, including psychological distress, strained social relationships, challenges in professional development, low self-esteem, substance use, suicidality, maladaptive health behaviours and greater weight gain.

The number of children with obesity in the US continues to grow, with about one in five adolescents currently living with this condition. However, how the age of obesity onset might affect EWS has been unclear.

To answer this question, Drs. Almandoz and Ernest and their colleagues collected data from 686 adults receiving care between 2021 and 2023 in UT Southwestern's Weight Wellness Program, where Almandoz serves as Medical Director. After receiving an invitation to participate in the study, these volunteers filled out a questionnaire covering demographics, body measurements, and other topics, including how often specific stigmatizing situations happened to them.

The participants had a mean age of about 56 and were mostly non-Hispanic white women. Nearly all had obesity at the time they were surveyed, with nearly 62% having severe obesity, defined as a body mass index (BMI) greater than or equal to 40. About 23% of these volunteers reported meeting the criteria for obesity by age 18, with 6.3% meeting the criteria for severe obesity at that age.

Researchers found that severe obesity before age 18 was linked to greater likelihood and severity of negative experiences such as being treated disrespectfully or being socially rejected, compared with those who did not have severe obesity or those who developed obesity as an adult.

"Early onset of obesity can have lasting psychological and social consequences," Almandoz said.

The most common stigmatising situations reported by these volunteers were a doctor recommending a diet even when the primary reason for their medical visit was something other than weight loss, and people assuming they overeat or binge eat because of their weight. EWS should be addressed in the health care setting to change the attitudes of caregivers toward individuals with obesity and reduce patient-experienced weight stigma.

Given the exceedingly common experience of EWS for individuals with obesity and the strong association between EWS and negative health effects, doctors should screen for this condition as a regular part of obesity care, Almandoz added. Taking a full weight history, including the age of obesity onset, could help doctors identify patients who would benefit from EWS interventions and support, he added.

The findings were reported in the paper, ‘The association of age of onset of obesity with experienced weight stigma in adulthood’, published in the International Journal of Obesity. To access this paper, please click here