Estigma de peso e saúde – Repercussões na saúde de adolescentes e adultos: revisão integrativa da literatura

Siqueira, Bruna Barbosa; Assumpção, Marina Cunha; Barroso, Sabrina Martins; Japur, Camila Cremonezi; Penaforte, Fernanda Rodrigues de Oliveira

doi:10.1590/0047-2085000000324

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Jornal Brasileiro de Psiquiatria

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Sumário

REVIEW • J. bras. psiquiatr. 70 (2) • Jan-Mar 2021 • https://doi.org/10.1590/0047-2085000000324 copiar

Estigma de peso e saúde – Repercussões na saúde de adolescentes e adultos: revisão integrativa da literatura

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo

Realizar uma revisão integrativa a fim de compreender as repercussões do estigma social do excesso de peso na saúde de adultos e adolescentes.

Métodos

O protocolo internacional de revisão sistemática e estudos de metanálise PRISMA foi adotado para guiar a redação desta revisão. As bases de dados utilizadas foram PubMed, Psycinfo, SciELO, Medline, Lilacs e Pepsic, considerando o período de 2000 a 2020. Foram analisados 67 artigos, em que emergiam 4 categorias: repercussões no bem-estar físico; repercussões no bem-estar social; repercussões no bem-estar mental; e categoria mista (impacto físico e psicológico).

Resultados

Na ampla maioria dos estudos analisados, o estigma do peso tem um impacto negativo nas diferentes esferas que compõem o constructo saúde: física, social e mental.

Conclusões

Tais consequências são fonte de intenso sofrimento, em uma abrangência tal que reduzem a qualidade de vida de indivíduos que passam por situações de estigmatização, tanto nos aspectos físicos quanto emocionais e sociais.

Estigma social; peso corporal; preconceito

Health Dimension Assessed	Ref.	Main goal	Participants/%Women/Mean Age/BMI	Method/Instruments used to assess stigma	Main results
Physical well-being
	2009, USA¹⁹	Test an expansion of the Stereotype Threat Model in the domain of exercise intentions/food health.	100 overweight women; 100% women; mean age 38 years; mean BMI 30.	Quantitative; Subjective evaluation.	Meetings with a stereotyped threat contribute to an erosion of food/exercise self-efficacy, personal health intentions and potentially healthy behaviors among overweight individuals.
	2011, USA²⁰	Examine how discrimination based on perceived weight influences identity and physical health.	3,034 participants; 51% women; mean age 46 years; mean BMI 26.	Quantitative; Set of questions on evaluations of discriminatory experiences, formulated by the authors.	The social processes of discrimination of perceived weight are responsible, at least in part, for the deleterious effects of severe obesity on health.
	2014, UK²¹	Examine the relationships between perceived weight discrimination and changes in weight, waist circumference and weight over four years in a large population sample.	2,944 participants; 58% women; mean age 63 years; mean BMI 31.	Quantitative; Instrument developed by the authors.	There was a significant association between perceived weight discrimination and weight change over four years. There was a trend towards greater weight gain (or less weight loss) in all groups.
	2014, USA²²	To investigate the effects of experiences of weight stigma and internalization of weight bias on exercise motivation, behavior and attitudes with weight bias among overweight and obese individuals.	484 women recruited; 100% women; mean age 35 years; mean BMI 32.	Quantitative; Fat Phobia Scale, Belief Scale About Obese People (BAOP) and Weight Bias Internalization Scale.	Reports of experiences of weight stigma predicted higher levels of current reported exercise behavior. The internalization of weight bias was negatively correlated with motivation and self-efficacy of exercise, and was associated with lower levels of reported exercise behavior.
	2015, USA²³	Testing whether self-reported weight discrimination is related to worse outcomes related to diabetes.	185 patients with type 2 diabetes; 65% women; 55 years; mean BMI 37.	Quantitative; Daily Discrimination Scale.	The attribution of self-reported weight discrimination was associated with a higher rate of diabetes, more emotional distress due to diabetes and fewer days of participation in diabetes self-care activities.
	2016, USA²⁴	Assess whether weight-related discrimination triggers multisystem deregulation.	932 participants; 57% women; mean age 57 years; mean BMI 29.	Quantitative; Selfreporting of cases of perceived discrimination in interpersonal relationships on a day-today basis, both in the baseline and in 10-year follow-up surveys.	Long-term weight discrimination was associated with more than twice the risk of high allostatic; experiencing weight discrimination seems to promote many of the pathological characteristics of obesity.
	2017,UK²⁵	Examine the association between the perception of weight discrimination and self-reported physical activity.	5,480 participants; 55% women; mean age 62 years; mean BMI 31.	Quantitative; Instrument developed by the authors.	Participants with experience of weight stigma were less likely to believe that weight was controllable, which could reduce the motivation to engage in exercise for weight control purposes.
	2017, USA²⁶	Examine the role of weight stigma as potential contributors to maintaining weight loss and weight recovery.	3,087 adults; 59% women; mean age 42 years; BMI of 66% > 25.	Quantitative; Modified Weight Bias Internalization Scale.	Internalized weight stigma preticted significantly worse maintenance of weith loss.
	2018, USA²⁷	Determine the mechanisms that link women’s weight status to health care prevention.	315 participants in an online survey, 100% women; mean age 56 years; mean BMI 28.	Quantitative; 10-item Stigmatizing Situation Inventory (summary from SSI; Vartanian) and 11-item weight bias internalization scale modified (WBIS-M).	This study demonstrated a direct association between the BMI and the experienced and internalized weight stigma, which ended up being associated with a greater avoidance of health care.
	2018, USA²⁸	Examine the effect of a stigmatizing social weight assessment threat on HPA reactivity (hypothalamus-pituitary-adrenocortical, which governs the secretion of cortisol, a stress hormone).	170 adults; 63% women; mean age 35 years; mean BMI 27.	Quantitative; Subjective evaluation.	For lean participants, the test induced an increase in cortisol levels, for overweight participants, the test induced attenuated cortisol responses.
	2019, USA²⁹	Determine whether the experienced stigma and/or internalized weight bias mediate BMI for the pain-related disability ratio.	309 women recruited online; 100% women; mean age 56 years; mean BMI 28.	Qualitative; Abbreviated Stigmatizing Situations Inventory (SSI-Brief).	Weight-related stigma is associated with pain symptoms in a non-clinical/community sample of women and these relationships are evident for individuals across the weight spectrum.
	2019, Ireland³⁰	Examine the relationship, over 4 years, between obesity and longitudinal increases in biological disease in the form of physiological dysregulation and test whether the physiological consequences of obesity can be, at least in part, attributable to the stress of weight discrimination.	3,609 participants; 52% women; mean age 64 years; mean BMI 28.	Quantitative; Perceived Scale of Daily Experiences with Discrimination.	Obesity is associated with increases in physiological dysregulation over 4 years. Obese participants were more likely to report having suffered discrimination based on weight, and these stigmatizing experiences predicted adverse changes in physiological dysregulation over time.
Social well-being
	2019, Chile³¹	Determine the association between stigmatization based on weight, psychological stress, cortisol, negative emotions and eating behavior.	82 university employees; 100% women; mean age 45 years; BMI of 55% > 25.	Quantitative; Positive Affect and Negative Affect Schedule (PANAS).	Perceived stress was associated with greater food consumption, only among women belonging to the stigmatized group. Stigmatization experiences interact with the perception of stress, generating greater physiological reactivity to stress.
	2005, USA³²	Examine obesity stigma in adults by looking at the relationship between obesity stigma and adults’ preferences for sexual partners.	449 undergraduate psychology students; 61% women; mean age 19 years; mean BMI 79% < 25.	Quantitative; Instrument developed by the authors.	Men are more likely to choose sexual partners on the basis of weight than women are. Obesity stigma may specifically affect women in sexual relationships.
	2005, USA³³	Evaluate the prevalence, types, and psychological consequences of perceived discrimination reported by persons with obesity in the United States.	3,437 individuals; 49% women; mean age 47 years; mean BMI 61% > 25.	Quantitative; Instrument developed by the authors.	People with overweight and obesity are more likely, to report major discrimination, interpersonal discrimination, and work-related discrimination. However, only people with obesity (obese II/III) reported health care related discrimination, job discrimination and poorer self-acceptance levels.
	2009, UK³⁴	Examine weight-related stigma in intimate relationships.	57 heterosexual college couples; 50% women; mean age 23 years; mean BMI 24.	Quantitative; Instrument developed by the authors.	Heavier women had lower quality ratios and predicted they were less likely to remain intact.
	2013, Germany³⁵	Examine whether obese job seekers are treated or behave differently than non-obese candidates.	1,457 adults; 46% women; mean age 35 years; BMI of 55% < 25.	Quantitative; Instrument developed by the authors.	The only group that experiences negative results in the labor market are obese women.
	2016, USA³⁶	Testing whether weight stigma in individuals with higher body weight are mediated by expectations of social rejection.	162 individuals; 52% women; mean age 20 years; mean BMI 25.	Quantitative; Rosenberg’s Self-Esteem Scale.	Expectations of rejection were a major contributor to the deleterious psychological effects of the threat of weight-based social identity among overweight women.
	2016, Poland³⁷	To investigate personal and subjective experiences of obese women related to weight bias and discrimination in the workplace.	420 women; 100% women; mean age 51 years; mean BMI 36.	Qualitative; Interviews were conducted in focus groups whose central theme was stigmatization and discrimination against obese people in the workplace.	All subjects experienced significant mood disorders as a result of job discrimination.
Mental well-being
	2008, USA³⁸	Evaluate the associations between stigmatization based on weight, psychological distress and binge eating behavior.	93 individuals; 74% women; mean age 53 years; mean BMI 42.	Quantitative; Stigmatizing Situations Inventory (SSI).	A stigmatizing situation can trigger a negative mood, which, in turn, can lead to binge eating behavior designed to reduce suffering.
	2008, USA³⁹	Evaluate the psychological and behavioral correlates of recent stigmatization of weight.	94 individuals; 73% women; mean age 47 years; mean BMI 47.	Quantitative; Inventory of Stigmatizing Situations (SSI).	Recent stigmatizing experiences are associated with psychological distress as well as binge eating behavior.
	2009, USA⁴⁰	Identify relationships between perceived discrimination based on weight and multiple psychiatric disorders.	34,653 adults; 43% women; mean age 48 years; mean BMI 26.	Quantitative; Scales of Experiences with Discrimination developed by Krieger and collaborators.	Perceptions of weight discrimination can be a risk factor for multiple diagnoses of mental disorders and substance use, as well as psychiatric comorbidities.
	2009, USA⁴¹	Examine whether the experience and fear of the negative consequences of obesity are associated with relatively greater success in weight loss and maintenance.	185 members of a behavioral group treatment program for obesity; 83% women; mean age 55 years; mean BMI 27.	Quantitative; Inventory of Stigmatizing Situations (ISS).	The history of weight-based stigmatization was associated with poorer psychological functioning, however, more frequent stigmatizing experiences also predicted greater weight loss.
	2010, USA⁴²	Determine the contribution of weight stigmatization to the risk of binge eating.	99 clinic patients for weight control; 85% women; mean age 27 years; mean BMI 28.	Quantitative; Myers and Rosen’s Stigmatizing Situations Inventory.	Weight stigmatization represented a significant variation in binge eating only among students.
	2011, USA⁴³	Examine whether coping mediates the relationship between perceived weight stigma and psychological distress.	54 adults; 79% women; mean age 47 years; mean BMI 37.	Quantitative; Inventory of Stigmatizing Situations (ISS).	Greater stigmatization experiences were significantly related to greater maladaptive coping responses, which were positively related to depression.
	2011, USA⁴⁴	Analyze and elaborate the nature and impact of stigma from the point of view of obese individuals themselves.	142 participants; 100% women; mean age 44 years; mean BMI 39.	Qualitative; It was not asked specifically about the stigma of obesity, as the authors were interested in whether descriptions of the stigma would emerge “spontaneously”.	One of the most common impacts of stigmatization experiences was on emotional health and well-being and, in particular, self-worth and self-esteem.
	2011, USA⁴⁵	To determine whether exposure to a stigmatizing video influenced caloric intake, mood and blood pressure in overweight and normal weight women.	102 women; 100% women; mean age 31 years; BMI of 50% > 25.	Quantitative; Fat Phobia Scale (shortened form).	Overweight women consumed more than three times the calories of overweight women who watched an emotionally neutral video.
	2012, USA⁴⁶	Examine the relationship between discrimination and binge eating.	486 participants; 81% women; mean age > 18 years; BMI of 56% > 25.	Quantitative; Items from the National Middle Age Development Survey in the United States to measure the frequency and impact of discrimination and the scale of internalization of weight bias.	Perceived discrimination is associated with eating disorders.
	2012, USA⁴⁷	Examine whether weight-related stigma increases the likelihood of suicide.	396 individuals who sought weight loss servisse; 76% women; mean age 43 years; mean BMI 49.	Quantitative; The Stigmatizing Situations Inventory (SSI).	The rates of suicide attempts are higher than in community samples.
	2012, USA⁴⁸	To study the relationship between the different aspects of quality of life of patients who sought weight loss surgery, in particular, the impact of weight stigma on this relationship.	574 patients being evaluated for weight loss surgery; 73% women; mean age 43 years; mean BMI 46.	Quantitative; Impact of weight on quality of life (IWQOL-lite).	Weight stigma not only has an adverse effect on psychosocially obese individuals, but it can also lead some obese people to avoid the necessary health care, which ends up having direct medical implications.
	2013, USA⁴⁹	Examine the impact of weight-based provocation on aspects of psychological well-being, self-perceptions and behaviors in the physical domain, and physical fitness.	1,419 teenage students; 55% women; mean age 12 years; mean BMI 21.	Quantitative; Instrument developed by the authors.	The results support the connection between weight-based teasing and lower levels of psychological well-being as well as low self-esteem and higher levels of depression, low physical self-concept and less effective physical fitness.
	2014, USA⁵⁰	Examine the moderating role of external discrimination and weight-based self-discrimination in the relationship between BMI and health-related quality of life.	81 women; 100% women; mean age 41 years; mean BMI 43.	Quantitative; Weight-weight internalization scale and Daily discrimination scale.	The greatest internalized weight bias was associated with worse physical and mental quality of life, and more perceived discrimination experience from others was associated with worse physical quality of life. BMI alone is not sufficient to explain the variance in quality of life.
	2014, Spain⁵¹	To analyze the relationship between open and subtle discrimination and physical and psychological quality of life in patients with obesity.	111 obese outpatients; 66% women; mean age 43 years; mean BMI 38.	Quantitative; Multidimensional Perceived Discrimination Scale.	People who suffer direct and indirect forms of social discrimination report lower well-being and quality of life.
	2014, Austrália⁵²	Develop a more refined understanding of the ecologically valid experience of weight stigma in people’s daily lives.	46 community members; 52% women; mean age 28 years; mean BMI 30.	Quantitative; Inventory of Stigmatizing Situations (SSI).	Study participants reported experiences of weight stigma almost once a day, wich was associated with more negative mood.
	2014, USA⁵³	Examine the importance of social stigma related to obesity in relation to other factors of Quality of Life in reducing general well-being.	337 primary care patients with moderate to severe obesity; 68% women; mean age 46 years; mean BMI 40.	Quantitative; Public aid subscale.	Social stigma related to obesity was the most important determinant of quality of life in the adverse effect of obesity on how Caucasian women valued their health. Obesity-related sexual function impairment was the most important contributor for African American women, and the adverse impact of obesity on professional life was the most important factor for Hispanic women.
	2015, USA⁵⁴	To assess whether stigma or self-stigma is associated with factors that affect vulnerability to stress among overweight and obese medical students.	4,687 students; 50% women; mean age 23 years; BMI of 75% < 25.	Quantitative; Crandall’s Anti-Fat Attitudes Questionnaire, Fat-Thin IAT and Everyday Discrimination Scale.	Participants had worse general health and low self-esteem than students with normal weight, as well as high risk of stress, risk of professional burnout, low professionalism and empathy, lower academic performance, poor mental health, higher risk of substance abuse and suicidal ideation.
	2015, UK⁵⁵	Investigate the extent to which perceived weight discrimination mediates quality of life, life satisfaction and depressive symptoms.	5,056 participants; 55% women; mean age 67 years; mean BMI 28.	Quantitative; Instrument developed by the authors.	Individuals who reported experiences of weight discrimination had worse psychological well-being in all three domains.
	2016, USA⁵⁶	Test the relative effects of BMI and weight-based peer discrimination on increasing emotional problems.	5,128 adolescents; 52% women; mean age < 18 years; BMI of 23% > 25.	Quantitative; Four items adapted from the Teenage Distressed Discrimination Distress Index.	Young people are more dissatisfied with their bodies, as well as feeling more anxious, lonely and sick, due to the way they perceive being treated by their colleagues because of their weight.
	2016, USA⁵⁷	Examine weight stigmatization throughout life as a mediator between weight and psychological health.	299 students; 100% women; mean age 20 years; mean BMI 23.	Quantitative; Inventory of Stigmatizing Situations (SSI).	The stigma of weight throughout life significantly mediated the relationships between the variables of weight status and the psychological health variables (depressive symptoms and dissatisfaction with body image).
	2016, USA⁵⁸	Demonstrate how the stigmatizing experience associated with being overweight influences the healthy and unhealthy caloric intake of overweight people.	260 undergraduate students; 54% women; mean age 21 years; BMI of 50% > 25.	Quantitative; Subjective evaluation.	Stigmatized overweight consumers end up eating more calories, regardless of the context of consumption.
	2016, USA⁵⁹	Examine the association between weight discrimination and various eating-related behaviors.	5,129 adults; 50% women; mean age 44; BMI unavailable.	Quantitative; Perceived discrimination was measured with the version of daily experiences perceived with a discrimination scale.	Discrimination has been associated with overeating, that is, those who experience weight discrimination eat more convenience foods and eat more irregularly than those who have not experienced discrimination.
	2017, USA⁶⁰	Examine the interaction of perceived weight stigma as a predictor of food selection (inhibitory control).	84 university students; 90% women; mean age 21 years; mean BMI 32.	Quantitative; Instrument developed by the authors.	Weight stigma has implications for both cognitive function and eating behavior.
	2017, USA⁶¹	Determine the effects of weight stigma on disordered eating and physical activity.	302 students from ninth to twelfth grade; 72% women; mean age 16 years; BMI of 62% < 25.	Quantitative; Implicit Association Test (IAT).	Students who reported bullying were more likely to use avoidable coping strategies and increased strategies to cope with food consumption.
	2017, Spain⁶²	Investigate the relationship between unmasked and subtle discrimination and internalized weight stigma; and between unmasked and subtle discrimination and depression and anxiety.	170 participants; 34% women; mean age 46 years; mean BMI 42.	Quantitative; Weight Self-Stigma Questionnaire (WSSQ).	Discrimination experiences, both unmasked and subtle, are positively related to self weight stigma in people with obesity; and negative beliefs about yourself increase the chance of developing depression and anxiety problems.
	2018, UK⁶³	Examine whether concerns about weight stigma explain why individuals who perceive their weight status as being overweight are at increased risk of overeating.	1,236 participants; 56% women; mean age 37 years; mean BMI 26.	Quantitative; Perceived Everyday Experiences with Discrimination Scale and Weight Stigma Concerns Scale.	Concerns about weight stigma may explain why perceiving one’s own weight status as being overweight is associated with an increased tendency to overeat.
	2018, USA⁶⁴	Examine whether weight discrimination increases the risk of incident dementia, regardless of BMI and other risk factors involved in discrimination and dementia.	12,053 participants; 60% women; mean age 67 years; BMI of 75% > 25.	Quantitative; A measure of everyday discrimination was included in the questionnaire that participants completed in 2006 or 2008.	Weight discrimination was associated with a 40% increased risk of developing dementia in the next eight to 10 years.
	2018, Italy⁶⁵	To test whether weight stigma, through the stereotyped threat mechanism, is responsible for deficits in working memory among individuals with obesity.	137 University students and staff; 75% women; mean age 41 years; mean BMI 34.	Quantitative; Subjective evaluation.	The results revealed a negative relationship between the body mass index and working memory only under conditions of stereotyped threat.
	2018, Austrália⁶⁶	Examine whether the frequency of weight stigma experienced and internalized weight bias predicts different coping responses and whether this, in turn, predicts psychological distress.	1,391 participants; 56% women; mean age 36 years; mean BMI 35.	Quantitative; Inventory of Stigmatizing Situations (SSI).	Weight stigma predicts poor psychological well-being, through a tendency to internalize bias and to become involved in maladaptive coping in response to weight stigma.
	2018, USA⁶⁷	Examine whether and to what extent the threat of weight-based social identity occurs in non-romantic social interactions.	146 women; 100% women; mean age 19 years; mean BMI 30.	Quantitative; Crandall’s Anti-Fat Attitude Scale.	Greater anticipated rejection impaired cognitive performance, judgment of one’s appearance and social self-esteem, more negative emotions, more stressful interaction, more rumination, more reported efforts to compensate and more spontaneous thoughts related to anxiety and evaluative concern.
	2018, Netherlands⁶⁸	Testing the suggestion that the internalized weight bias predominantly reflects threats to morality.	561 participants; 52% women; mean age 47 years; mean BMI 28.	Quantitative; Modified Weight Bias Internalization Scale (WBISM).	The stigma of weight that emphasizes that overweight and obese people is immoral gives rise to fear of condemnation and will lead to preferences for responses that will allow to show quickly and visibly to others that someone is willing to improve and change behavior.
	2019, USA⁶⁹	Examine the association between weight discrimination and multiple domains of cognitive function.	2,593 adults; 60% women; mean age 75 years; mean BMI 29.	Quantitative; Everyday Experiences with Discrimination measure; Consortium to establish a registry for Alzheimer’s disease (CERAD).	Weight discrimination was associated with an about two-fold increased risk of poor performance on tasks that measured episodic memory, speed-attention, visuospatial ability, and numeric reasoning.
	2019, USA⁷⁰	Examine the experienced and internalized weight stigma and its associations with health.	1,249 men; 0% women; mean age 39 years; mean BMI 26.	Quantitative; Modified Weight Bias Internalization Scale.	The stigma of weight can contribute negatively to some health indexes in men such as: depressive symptoms, binge eating and lower self-rated health.
	2019, Germany⁷¹	Investigate the extent to which individuals with obesity suffer from loneliness and determine the role of depression and weight stigma in this context.	1,000 participants; 45% women; mean age 56 years; mean BMI 30.	Quantitative; German version of the weight bias internalization scale (WBIS) and the Lifelong Discrimination Scale of the National Midlife Development Survey in the USA (MIDUS) on self-perceived. discriminatory experiences.	Loneliness can occur more frequently in obese individuals and is related to depressive symptoms, greater self-stigma and weight discrimination.
	2019, Austrália⁷²	Test the hypothesis that the label increases weight prejudice and disgust towards people with obesity and whether the label negatively affects the mood and self-esteem of obese people.	1,187 adults; 58% women; mean age 41 years; mean BMI 26.	Quantitative; Universal Measure of Bias.	The negative image of obesity promotes prejudice and disgust towards people with obesity. In addition, worsened their mood and the state of low self-esteem.
	2019, Canadá⁷³	Explore weight bias and obesity stigma experiences of people living with obesity.	10 people living with obesity; 80% women; mean age >18 years; mean BMI 25.	Quantitative; Narrative investigation of experiences with obesity, weight bias and stigma, focusing on the personal, public and health domains.	Internalized weight bias and stigma can lead to negative conversations, feelings of shame and guilt that affect your ability to engage in health-promoting behavior. External stigmatization can reduce the participation of individuals in education, employment and in health promotion environments.
	2019, Brazil⁷⁴	Investigate the body image of overweight people and the psychosocial aspects experienced by them.	58 adults; 81% women; mean age 38 years; mean BMI 25.	Qualitative; Semi structured interview.	The look of the other had an impact on the configuration of the body image, influenced the way of thinking and feeling about oneself.
	2020, USA⁷⁵	Examined the nature of weight stigma-specific coping strategies in response to both experienced weight stigma and weight bias internalization.	11,924 adults engaged in weight management; 94% women; mean age 50 years; mean BMI 33.	Quantitative; 10-item version of the Modified Weight Bias Internalization Scale, Coping with Weight Stigma Scale and the Brief COPE inventory.	Weight bias internalization is associated with more use of coping strategies with the potential to harm health (e.g., disordered eating, substance use, self-blame), while more lifetime experiences of weight stigma appear to be associated with more attempts to cope in general.
	2020, USA⁷⁶	Examined whether anticipated weight stigma may explain the relations between weight discrimination and disordered eating.	297 participants recruited through a online data collection; 52% women; mean age 31 years; mean BMI 27.	Quantitative; Everyday Discrimination Scale.	Greater experiences with weight discrimination were indirectly associated with disordered eating behaviors and cognitions (eg: cognitions related to eating disorders) via anticipated weight stigma.
	2020, UK⁷⁷	Determine whether weight related self-stigma predicted worsening “food addiction” over time.	308 first-year psychology students; 91% women; mean age 18 years; mean BMI 21.	Quantitative; Yale Food Addiction Scale, and Weight Self-Stigma Questionnaire.	Fear of stigma but not self-devaluation was associated with worsening “food addiction” symptomatology over time.
Physical and psychological well-being
	2009, USA⁷⁸	To investigate whether weight stigma is associated with obesity-related morbidity.	87 adults; mean 44 years; BMI unavailable.	Quantitative; Instrument developed by the authors.	The stigma associated with obesity plays a role as a determinant of self-rated health, however, it may not be an important explanatory variable in the association of BMI-hypertension.
	2012, USA⁷⁹	Investigate whether overweight individuals experience threats of social identity in situations that trigger concerns about weight stigma.	99 individuals; 100% women; mean age 18 years; mean BMI 27.	Quantitative; Subjective evaluation.	Women who believed that their weight would be visible to the evaluators, the higher the BMI, the greater their reactivity to stress and the more cognitively impoverished.
	2015, USA⁸⁰	Investigate whether BMI and self-reported psychological health and physical health are mediated by past discrimination experiences and stigma concerns.	171 individuals; 60% women; mean age 34 years; mean BMI 25.	Quantitative; Instrument developed by the authors.	Perceived discrimination harms psychological and physical health, raising concerns about future stigmatization.
	2016, USA⁸¹	Examine the relationship between the perception of weight discrimination and change in health markers in approximately 10 years.	2,994 participants; 51% women; mean age 55 years; mean BMI 30.	Quantitative; Instrument developed by the authors.	The results indicate that weight discrimination is associated with worse physical and mental health over time.
	2018, USA⁸²	Identify how “overweight” endurance athletes experience stigma and how it affects their mental and physical health, as well as their participation in endurance sports.	6 adults; 83% women; mean age 42 years; mean BMI 25.	Qualitative; Semi structured interview.	The perceived stigma was what led most of the athletes to train indoors, however, after the initial discomfort of moving to public environments, none of the participants indicated that they had participated less in the chosen sport because of the perceived stigma.
	2020, USA⁸³	Assessed whether prepandemic experiences of weight stigma predicted maladaptive eating behaviors, physical activity, stress, and depressive symptoms during the spring and early summer months of the COVID-19 outbreak in the USA.	584 participants in a longitudinal study; 64% women; mean age 24 years; mean BMI 28.	Quantitative; Questionnaire on Eating and Weight Patterns-Revised, Motivations to Eat Scale, Godin Leisure Time Exercise Questionnaire.	Prepandemic experiences of weight stigma predicted higher levels of stress, depressive symptoms, eating to cope with stress, and an increased likelihood of binge eating among young adults during the COVID-19 pandemic.
	2020, Brazil⁸⁴	Understand the experience of discrimination perceived by overweight women.	11 participants; 100% women; mean age 40 years; mean BMI unavailable.	Qualitative; Instrument developed by the authors.	The stigma brought serious psychosocial repercussions, such as behavior and attitudes of social isolation, deprivation of conjugal intimacy, withdrawal from work, concealment of the body and physical illness.
	2020, Brazil⁸⁵	Investigate, qualitatively, fat Brazilian women’s perceptions of their own bodies and their experiences with weightrelated discriminations, and how these experiences affect their well-being.	39 individuals; 100% women; mean age 34 years; mean BMI 34.	Qualitative; semi-structured interview developed by the authors.	Having a larger body was related to physical (e.g., body pains, unwillingness to perform activities) and psychological (e.g., low self-esteem, less social engagement) consequences. Furthermore, the participants voiced negative attitudes towards themselves and a hateful relationship with their own bodies.

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