Weight stigma: Cross-sectional and longitudinal associations with disordered eating and weight-related health behaviors in an ethnically/racially and socioeconomically diverse sample of adolescents and young adults

Abstract

This dissertation used a health equity lens to examine whether experiencing weight teasing is associated with disordered eating behaviors (DEBs), health behaviors, and weight status in an ethnically/racially and socioeconomically diverse sample of youth. It also investigated whether positive family/parenting factors are protective for DEBs in youth who experience weight stigma. 1,534 Project EAT 2010-2018 participants were surveyed as adolescents (Mage=14.4 years) and eight years later. Participants were asked about weight-stigmatizing experiences (e.g., weight teasing). Outcomes included DEBs (e.g., unhealthy weight control behaviors, chronic dieting, binge eating), health behaviors (e.g., physical activity, sleep duration, nutrition habits), and weight status. Regression models were adjusted for sociodemographic characteristics and weight status. Interaction terms and stratified models assessed whether family/parenting factors buffered DEB risk in adolescents who experienced weight stigma. Experiencing weight teasing was significantly associated with higher prevalence of DEBs and high weight status, cross-sectionally during both adolescence and young adulthood, and longitudinally. Effects of weight teasing were similar across ethnic/racial and socioeconomic subgroups. Black Indigenous, and People of Color (BIPOC) and youth from low socioeconomic backgrounds had higher prevalence of weight teasing, DEBs, and high weight, when compared to their respective counterparts. There was evidence that positive family/parenting factors operate as effect modifiers in cross-sectional relationships between weight stigma and DEBs, although these factors were primarily protective for adolescents who did not experience weight stigma. Findings provide evidence that weight teasing is a risk factor for DEBs and high weight status, and that BIPOC youth and youth from low socioeconomic backgrounds are disproportionately affected by weight teasing, DEBs, and high weight status, suggesting weight-stigmatizing experiences may create barriers to health, especially for youth who are already underserved. Positive family/parenting factors did not entirely offset the effects of weight stigma on DEBs, which may reflect the strength of weight stigma as a risk factor for DEBs. Published guidelines provide recommendations for how to decrease weight stigma experienced by youth. Future research should build upon these guidelines and include qualitative, solutions-oriented methods aimed at understanding how families, healthcare providers, and policymakers can decrease weight stigma and its effects on diverse populations of youth.