Weight stigma among diverse ethnic groups with obesity in the U.S.: the USA-OBESTIGMA study.

Abstract

The evidence on weight-related stigmatization among U.S. Hispanic (HISP), non-Hispanic White (NHW), and non-Hispanic Black (NHB) adults with obesity is limited. We compare levels of prejudices, stigma, and internalization of negative bias across diverse minority groups using validated surveys. Observational study conducted at two academic centers, including adults ( ≥ 18 years of age) with body mass index (BMI) ≥ 30 kg/m². We assessed 1) weight-related aversion/prejudices using Anti-Fat Attitudes (AFA) survey, 2) stigmatizing experiences with the Brief Stigmatizing Situations Inventory (SSI-B), and 3) internalization of negative weight bias with the Weight Bias Internalization Scale (WBIS) survey. Among 296 participants (age 54.9 ± 13 years, 59% females, 42% HISP, 23% NHW, 35% NHB), with obesity (BMI 36.7 ± 6.2), 72% perceived themselves as having overweight and only 24% as having obesity. Among the three groups, HISP had the highest AFA score (3.6 ± 1.3 vs. 3.3 ± 1.1 vs. 2.1 ± 1.2, p < 0.001), NHW had the highest SSI-B (1.2 ± 1.1 vs. 2.0 ± 1.4 vs. 1.2 ± 1.4, p < 0.001), and NHB had the lowest WBIS (2.7 ± 1.2 vs. 3.0 ± 1.3 vs. 2.3 ± 1.2, p < 0.001) score. Among an ethnically diverse U.S. cohort of adults with obesity, most participants perceive themselves as having overweight and not obesity. HISP exhibited greater aversion and prejudices towards people with obesity, NHW reported more stigmatizing situations and NHB the lowest internalization of negative bias. These findings should be incorporated when developing or implementing culturally appropriate educational or interventional programs for people with obesity.