4-year PhD Studentship: Internalized weight stigma: using general population data to understand causes and consequences in young adulthood

Obesity is common, affecting 28% of adults and 16% of children in England(1) but it is also highly stigmatized. Weight-related discrimination is widely observed in workplace(2), educational, and medical(3) settings, and appears to damage health in diverse ways. Experiencing weight stigma is associated with worse mental health(4) and worse quality of life(5). Ironically, weight stigma may contribute to obesity(6), by negatively affecting eating patterns(7) and acting as barrier to physical activity(8,9). ‘Internalized’ weight stigma - when people start to believe that negative obesity-related stereotypes apply to themselves(10) - may have especially negative health effects. Among higher-weight individuals, it is linked to disordered eating(11), but it also predicts disordered eating and drive for thinness among normal-weight and underweight individuals(12), making it relevant to mental health across the body weight range. There is widespread concern that public health initiatives aiming to reduce obesity may have contributed to weight stigma(13), especially during the COVID-19 lockdowns(14), which saw an unprecedented increase in referrals to eating disorder services(15). However, we know little about when and how weight stigma is internalized, because research has been based on small, non-representative samples, which tell us little about this process or its health consequences in the wider population.

Aims and Objectives

Aim: Using general population survey data, to identify risk and resilience factors which predict young people’s internalization of weight stigma, and explore consequences for their mental health, physical health, and social functioning. Objectives are to:

1. Describe life-course predictors of internalized weight stigma at age 31, including sociodemographic factors (e.g., gender, education, income), mental health (e.g., depressive symptoms, eating disorders), lifetime trajectories of BMI, social media use.
2. Identify intergenerational predictors, including family socioeconomic background, parent’s weight, and mother’s weight-related attitudes.
3. Explore consequences of internalized weight stigma at 31, including for BMI, mental health, relationships, and employment.

Methodology

This project will use brand new data: the Modified Weight Bias Internalization Scale (WBIS-M)(16), the first validated measure of Internalized Weight Stigma included in a general population birth cohort study. It will be completed by participants of the Avon Longitudinal Study of Parents and Children (ALSPAC) at age 31, in 2022. It asks participants of all body sizes to rate their agreement with 11 statements like “I hate myself for my weight” and “Because of my weight, I feel that I am just as competent as anyone” (reverse coded); summed responses give an overall score. Data on sequalae of internalized weight stigma will come from questionnaires at age 32 and 34. This could include body weight, depressive symptoms, overall self-rated health, and social outcomes around relationships and employment.

The student will learn methods including multivariable regression and growth curve modelling, using these to explore associations of lifetime and intergenerational factors with WBIS-M score, and will learn multiple imputation to maximise statistical power and reduce bias. They will also have the possibility to work with genetic data, for instance exploring associations of internalized weight stigma with genetic liability for eating disorders.

Keywords

Obesity, stigma, body image, eating disorder,s mental health, body mass index, epidemiology, lifecourse, intergenerational, resilience

How to apply for this project

This project will be based in Bristol Medical School - Population Health Sciences in the Faculty of Health Sciences at the University of Bristol.

Please visit the Faculty of Health Sciences website for details of how to apply