Association of internalised weight stigma and physical activity of patients with diabesity in a primary care clinic in Hong Kong: a cross-sectional study.

Abstract

Internalised weight stigma (IWS) has been associated with lower physical activity (PA) levels in Western populations with diabetes, but evidence from Asian primary care settings remains limited. This study examined factors associated with PA levels, including IWS, among obese type 2 diabetic patients in Hong Kong primary care. Cross-sectional questionnaire study. A single general outpatient clinic in Hong Kong. 310 Chinese adults aged 18-69 years with type 2 diabetes and Body Mass Index ≥25 kg/m² who attended routine follow-up appointments were randomly sampled. The primary outcome was to identify factors, particularly internalised weight stigma, associated with adequate physical activity levels. PA levels were assessed using the Chinese version of the International Physical Activity Questionnaire-Long Form, with 'adequate PA' defined as achieving moderate or high PA levels. IWS was assessed with Chinese Weight Self-Stigma Questionnaire. Secondary outcomes were the proportion of participants achieving adequate PA levels, the proportion with high IWS, and the sociodemographic and clinical factors associated with high IWS. Multivariate logistic regression was used to evaluate the association between these predictors and PA levels. 18.1% of participants had inadequate PA levels and 9.4% had high IWS. In multivariate logistic regression, high IWS (adjusted OR (aOR) 0.273; 95% CI 0.114 to 0.655; p=0.004), female sex (aOR 0.480; 95% CI 0.249 to 0.926; p=0.029), polypharmacy (aOR 0.339; 95% CI 0.170 to 0.675; p=0.002) and presence of chronic pain (aOR 0.249; 95% CI 0.112 to 0.554; p=0.001) were negatively associated with adequate PA levels independently (all p<0.05). Internalised weight stigma is independently associated with lower odds of achieving adequate PA levels among obese diabetic patients in primary care. Screening for IWS and addressing psychosocial barriers may represent a useful target for future intervention studies.