This research article, authored by Timkova, Mikula, and Nagyova (2025), delves into the complex interplay between weight stigma, social support, and psychosocial distress—specifically depression, anxiety, and loneliness—among individuals categorized as overweight or obese. The authors highlight that while obesity is a significant public health issue, with rates continuously rising due to genetic, biopsychosocial, and obesogenic environmental factors, efforts to address it often rely on weight-centric paradigms that inadvertently contribute to stigmatization. Such paradigms frequently assume that body weight is easily controllable, leading to perceptions of a larger body size as a personal moral failure and associating individuals with obesity with negative stereotypes like being lazy, weak, or unmotivated. This stigmatization, rather than obesity itself, is increasingly recognized as a key driver of psychosocial distress.
The authors underscore that larger body size is not only linked to physical comorbidities but also significantly impacts psychosocial distress, social isolation, and feelings of rejection, often as a direct result of stigmatization. Weight stigma, defined as negative weight-related attitudes, beliefs, and overt discrimination, is prevalent across individual, interpersonal, institutional, and societal levels and is often perceived as socially acceptable. Despite this, it has been shown to have no motivating effects on weight loss and may even diminish weight control efforts or trigger obesogenic processes.
Crucially, experiences of stigma can become internalized, leading individuals with high body weight to blame themselves for their size. This internalized weight stigma has been linked to even stronger adverse health consequences, including higher depression, anxiety, and loneliness, compared to externally experienced stigma. Existing research has largely focused on the direct relationship between weight and health, leaving a gap in understanding how experienced and internalized weight stigma affect physiological, psychological, and social outcomes, and importantly, the role of protective factors like social support. Previous reviews on the buffering effect of social support against weight stigma have been inconclusive, pointing to a need for further research in this area.
To address these gaps, the study employed a cross-sectional design involving 189 adults with overweight or obesity (52.9% female; mean age 48.8 ± 14.5 years; mean BMI 32.6 ± 6.5 kg/m2). Participants were recruited from outpatient clinics across Slovakia by general practitioners, with no exclusion based on comorbidities, focusing instead on BMI and waist-to-height ratio (WHtR) criteria.
Data collection involved self-report questionnaires and physical measurements. The following measures were utilized:
- Psychosocial Distress:
- Depression: Assessed using the 9-item Patient Health Questionnaire (PHQ-9).
- Anxiety: Measured by the 7-item General Anxiety Disorder Questionnaire (GAD-7).
- Loneliness: Evaluated with the revised 20-item UCLA Loneliness Scale.
- Weight Stigma:
- Experienced Weight Stigma (EWS): A 3-item questionnaire assessing teasing, unfair treatment, and discrimination due to weight.
- Weight Self-Stigma (WSSQ): A 12-item measure with subscales for self-devaluation and fear of enacted stigma.
- Social Support Systems:
- Social Support: Measured by the 3-item Oslo Social Support Scale (OSSS-3), assessing confidants, sense of concern, and accessibility of practical help.
- Family Function: Assessed using the Family APGAR Scale, covering adaptation, partnership, growth, affection, and resolve within the family.
- Sociodemographic and Clinical Variables: Age, sex, education, household income, place of residence, relationship status, height, weight, and waist circumference (to calculate BMI and WHtR).
Statistical analyses included descriptive statistics, correlation analyses, and multiple linear regression to assess the explained variance of psychosocial distress, with variables entered in a hierarchical order (sociodemographics, clinical variables, experienced stigma, self-stigma, social support systems).
Key Findings
The study revealed several significant findings:
- Prevalence of Stigma: A substantial portion of participants reported experiencing weight-related teasing (40.4%), unfair treatment (18.0%), and discrimination (14.1%), with 41.0% reporting at least one such event. These figures are consistent with previous research in Western countries.
- Demographic Associations with Stigma: Younger age and female sex were significantly associated with experiencing weight stigma. Anxiety was also found to be higher in females, potentially due to greater societal pressure to be thin and more common experiences of stigmatization.
- Limited Role of Obesity Indicators on Distress: In the multivariate regression analyses, no significant association was found between BMI/WHtR and depression, anxiety, or loneliness, with only a small correlation between BMI and depression in initial analyses. This challenges weight-centric paradigms by suggesting that psychological distress is more likely caused by weight stigmatization rather than by overweight/obesity itself.
- Impact of Weight Stigma and Self-Stigmatization:
- Both experienced weight stigma and weight self-stigmatization were strongly associated with higher psychosocial distress.
- However, the associations between experienced weight stigma and psychosocial distress (anxiety, depression, loneliness) weakened or became insignificant when weight self-stigmatization was added to the regression models.
- Weight self-stigmatization emerged as a more significant contributor to depression, anxiety, and especially loneliness, indicating that internalizing negative weight-related beliefs has a more profound impact on mental well-being than external experiences alone.
- Crucial Role of Social Support:
- Poor social support was strongly associated with depression, anxiety, and loneliness.
- Importantly, when variables related to the social support system (Oslo Social Support Scale and Family APGAR Scale) were added to the regression models, the negative impacts of weight stigma on psychological well-being and sense of belonging were weakened or became insignificant.
- Specifically, the association between weight stigma and anxiety was no longer significant when family function and social support were included. Family function and social support were also significantly associated with loneliness and appeared to diminish the negative role of self-stigmatization in the sense of belonging.
The findings suggest that the high prevalence of psychosocial distress, including loneliness (50.0% of participants) and mild to severe depressive symptomatology (52.0%), in people with overweight and obesity may be largely attributable to the experience and internalization of weight stigma. The study’s results challenge the prevailing weight-centric paradigms, advocating for a shift in focus from body size alone to the profound psychological impact of weight stigmatization.
The buffering effect of social support systems is an encouraging finding. It indicates that fostering strong social relationships and improving family function can significantly mitigate the adverse psychological outcomes associated with weight stigma and self-stigmatization. This highlights the importance of interventions that not only address internalized stigma but also build robust social networks, which are vital for both physical and emotional health. The study also suggests that the family environment might be a significant source of weight bias, as both experienced stigma and self-stigmatization were linked to higher family dysfunction.
The cross-sectional nature of the study means that causal relationships cannot be definitively established. Other limitations include missing data for some variables, a sample predominantly of white ethnicity, and the inability to identify specific sources of weight stigma (e.g., family, media, healthcare) or their long-term effects. Future research should aim for longitudinal designs, larger and more diverse samples, and investigate the different sources of weight stigma and their cumulative impact over time.
The authors conclude that experienced weight stigma and particularly self-stigmatization negatively affect mental health and sense of belonging, independent of body weight measurements. The research provides strong evidence that adequate social support systems can significantly diminish psychosocial distress caused by weight stigma. Therefore, interventions that target weight-related self-stigmatization and strengthen social relationships are crucial for mitigating the negative impact of weight stigma on psychosocial well-being, fostering a more empathetic and health-focused approach to weight management.
Reference: Timkova, V., Mikula, P., & Nagyova, I. (2025). Psychosocial distress in people with overweight and obesity: the role of weight stigma and social support. Frontiers in Psychology, 15, 1474844. https://doi.org/10.3389/fpsyg.2024.1474844
