Abstract
Background: Almost one in three New Zealand women are obese, increasing from 26.5% in 2006/2007 to 31.3% in 2012/2013. Previous research has shown high levels of stigma associated with overweight and obesity, particularly among women with a body mass index (BMI) above 30kg/m2, of white ethnicity, high socioeconomic status (SES), and in both younger as well as postmenopausal age groups. Weight related stigma is defined as either enacted or self-stigma (internalised stigma) depending on the source of the negative devaluation (society or the individual). Weight stigma has been documented in a variety of settings including employment, education, health care and interpersonal relationships. Weight self-stigma may adversely affect the health of overweight and obese individuals by contributing to unhealthy lifestyle behaviours such as physical inactivity and binge eating, which may also hinder maintenance of a healthy bodyweight.
Aim: To investigate the experience of internalised weight stigma in a nationwide sample of mid-life women, and to explore whether particular demographic characteristics increase vulnerability to experiencing weight self-stigma. The present study also aims to investigate whether the experience of weight stigma is associated with adverse health-related behaviours.
Methods: In 2009, 2500 New Zealand women aged between 40-50 years were randomly selected from nationwide electoral rolls to participate in a longitudinal study examining psychological, behavioural and lifestyle factors and BMI. Weight self-stigma was assessed in the 2011 two year follow-up survey using a validated subscale from the ‘Weight Self-Stigma Questionnaire’. The association between weight self-stigma and health-related behaviours including hazardous drinking, tobacco smoking, physical activity and binge eating behaviours were assessed both at the time of stigma assessment (2011) and during the three-year follow-up (2012). Women’s Body Mass Index category at the time of reported weight self-stigma was examined as a potential moderator of the relationship between self-stigma and health behaviours.
Results: A response rate of 66% (n=1601) was achieved for the 2009 survey, with 69.4% of these respondents also completing the 2011 survey. After the inclusion criteria were met, the final analysable 2011 and 2012 samples consisted of n=1111 and n=1025 women respectively. Mean weight stigma score was 13.0 out of a possible 30, with significant differences in weight stigma scores between BMI categories (p=<0.001), ethnic groups (p=0.002) and according to living situation (p=0.006). Higher weight-self stigma scores were significantly associated with more frequent binge eating (p=<0.001), and among those women whose BMI fell in the obese range, with lower physically activity levels (p=<0.001) in 2011 but not in 2012.
Conclusions: Midlife New Zealand women appear to experience internalised weight-stigma and to a similar extent to their US counterparts. Women with a BMI >30kg/m2, of New Zealand European ethnicity and who live without a partner are most at risk. When measured at the same time point (2011), the experience of weight related self-stigma was associated with binge eating and physical inactivity.