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Considerable evidence from U.S. studies suggests that weight stigma is consequential for patient-provider interactions and healthcare for people with high body weight. Despite international calls for efforts to reduce weight stigma in the medical community, cross-country research is lacking in this field. This study provides the first multinational investigation of associations between weight stigma and healthcare experiences across six Western countries. Participants were 13,996 adults residing in Australia, Canada, France, Germany, the UK, and the US who were actively enrolled in an internationally available behavioral weight management program. Participants completed identical online surveys in the dominant language for their country that assessed experienced weight stigma, internalized weight bias, and healthcare behaviors and experiences including perceived quality of care, avoidance or delay of seeking care, experiences with providers, and perceived weight stigma from doctors. Among participants who reported a history of weight stigma (56-61%), two-thirds of participants in each country reported experiencing weight stigma from doctors. Across all six countries, after accounting for demographics, BMI, and experienced stigma, participants with higher internalized weight bias reported greater healthcare avoidance, increased perceived judgment from doctors due to body weight, lower frequency of obtaining routine checkups, less frequent listening and respect from providers, and lower quality of healthcare. Additionally, experienced weight stigma (from any source) was indirectly associated with poorer healthcare experiences through weight bias internalization, consistently across the six countries. Weight stigma in healthcare is prevalent among adults actively engaged in weight management across different Western countries, and internalized weight bias has negative implications for healthcare even after controlling for BMI. The similar findings across all six countries underscore the negative consequences of weight stigma on healthcare behaviors and experiences, and emphasize the need for collective international efforts to address this problem.

Background/ObjectivesDespite substantial evidence documenting weight stigma toward people with higher body weight, international comparative studies are lacking in this field. The few studies that have compared weight stigma across different countries focus on explicit weight-biased attitudes rather than people’s experiences of weight stigma. The present study conducted a multinational systematic comparison of weight stigma in six countries to assess experiences and interpersonal sources of weight stigma.Subjects/MethodsAdults (N = 13,996) enrolled in WW International (formerly Weight Watchers), residing in Australia, Canada, France, Germany, the UK, and the US completed identical online anonymous surveys in the dominant language for their country. Surveys assessed their history of experiencing weight stigma, the onset of stigmatizing experiences and associated distress from stigma in different time periods, and interpersonal sources of weight stigma.ResultsMore than half of participants (55.6–61.3%) across countries reported experiencing weight stigma. Participants with higher BMI were significantly more likely to report weight-stigmatizing experiences than individuals with lower BMI. In all countries, weight stigma experiences were most frequent in childhood and adolescence, with associated distress highest during these time periods. Participants in Germany reported a higher frequency of weight stigma across their whole life, but lower distress associated with stigmatizing experiences, compared to participants in the other five countries. High percentages of participants in each country experienced weight stigma from family members (76.0–87.8%), classmates (72.0–80.9%), doctors (62.6–73.5%), co-workers (54.1–61.7%), and friends (48.8–66.2%).ConclusionsWeight stigma is prevalent for adults actively engaged in weight management across different Western countries. There were more similarities than differences in the nature, frequency, and interpersonal sources of people’s experiences of weight stigma across the six countries in this study. Findings underscore the need for multinational initiatives to address weight stigma and interventions to support individuals engaged in weight management who experience weight mistreatment.

The continuing COVID-19 pandemic enables assessment of the adaptability of young adults to non-normative stressors threatening their social-emotional wellbeing. Focusing specifically on a developmentally critical social challenge of restricted in-person contact, the goal of the current study was to examine the role of friendships in alleviating social-emotional problems. Data were collected via online surveys from an ethnically diverse sample (n = 1557) of 20 to 24-year-olds (62% cisgender female, 31% male, 7% gender diverse or gender questioning) in spring of 2021. Longitudinal data from an earlier time point involving an age-normative social challenge (transition out of high school) were used as a comparison. The comparisons between the transition from high school and the pandemic showed that whereas social anxiety and depressive symptoms increased, loneliness decreased. Participants also reported having slightly more friends and rated the overall quality of their friendships as somewhat higher. Regression analyses revealed that a greater number of friends over time and greater satisfaction with friend electronic communication during the pandemic were most robustly related to lower social and generalized anxiety as well as depressive symptoms, over and above earlier social-emotional wellbeing and a number of relevant correlates. Loneliness was protected by higher quality of friendships, greater contact with friends, as well as more frequent and satisfying electronic communication with friends. The results suggest that although young adults are facing emotional challenges during the continued pandemic, they are also able to adapt by keeping in touch with friends to decrease subjective sense of isolation. The findings have novel intervention implications to reduce loneliness.

Adolescents identifying as sexual and/or gender minorities face many challenges at school due to stigma-based peer harassment. This study examined the extent to which sexual and gender minority adolescents experience bias-based bullying across a range of stigmatized identities and attributes, as well as the potential of gay-straight alliances (GSAs, also referred to as gender-sexuality alliances) to reduce simultaneously multiple forms of bias-based bullying, and in turn support school adjustment. Using a United States sample of diverse sexual and gender minority adolescents (N = 17,112; Mage = 15.57, SDage = 1.27), multiple mediation analyses indicated lower levels of multiple forms of bias-based bullying (based on body weight, gender, religion, disability, gender typicality, sexuality) at schools with versus without GSAs, and in turn higher perceived school safety, as well as higher grades and reduced school suspension (due to less weight- and sexuality-based bullying). The findings shed light on the broad-reaching stigma-reduction potential of GSAs.

Cross-ethnic friendships are linked to a range of positive outcomes in adolescence, but have been shown to be lower quality and less stable than same-ethnic friendships. The current study examined how classroom diversity and out-of-school contact contribute to these relational differences between cross-and same-ethnic friendships. Multilevel analyses were conducted on a sample of 9,171 classroom-based friends nested within 4,333 ethnically diverse sixth grade students (54% female; 32% Latino, 20% White, 14% East/Southeast Asian, 12% African American, 14% Multiethnic, 8% Other ethnic). Consistent with the hypotheses, lower ethnic diversity in classes shared by friends and lack of home contact (as opposed to electronic) contributed to relational differences between cross- and same-ethnic friendships. The findings suggest that while diverse classrooms enable youth to bond across ethnic groups, connecting outside of school is critical for the relational quality and longevity of cross-ethnic friendships.

Despite a proliferation of bullying prevention programs in recent time, limited work has investigated support-seeking behaviors in response to elevated bullying levels among sexual minority youth (SMY). To address this gap, the current study examined how harassment targeting SOGIE (sexual orientation, gender identity, and gender expression), sexual identity outness, school safety, and perceptions of teacher/staff support were associated with SMY talking to an adult at school about harassment. A large contemporary national sample of SMY (N = 5538) between the ages 13–18 (Mage = 15.53, SD = 1.33) who experienced at least one form of SOGIE-based harassment in the past year was leveraged for analyses. Hierarchical multivariable logistic regressions revealed more frequent SOGIE-based harassment was associated with greater odds of reporting harassment to school personnel, particularly among SMY who felt safe at school. Findings highlight the need for school-based interventions to foster school safety among SMY who experience peer harassment to promote their reporting of this behavior.

Research suggests that many parents make comments about their child’s weight, which is associated with negative adolescent health outcomes. Gaps in this literature include an underrepresentation of fathers, limited knowledge regarding positive versus negative parental weight comments and differences across race/ethnicity, and adolescent preferences for parental weight communication. The present study addressed these research gaps through a comprehensive investigation of two diverse samples of U.S. parents (n = 1936) and adolescents (n = 2032), who completed questionnaires about their experiences and perspectives of parental weight communication. Positive weight comments from parents were more frequent than negative comments, though both were commonly reported across sex, race/ethnicity, and weight status. In general, boys, fathers, Latino/a parents and adolescents, and adolescents with a high BMI and/or engaged in weight management reported more frequent parental weight-talk. Parent–adolescent weight communication occurred both in-person and digitally, and across daily life contexts. Although the majority of parents communicated positive messages of body diversity and respect, 44% and 63% of adolescents said they never want their mothers and fathers, respectively, to talk about their weight. Adolescents were offered circumstances that would increase their comfort level in having these conversations. Findings have implications for health professionals working with families to promote supportive health communication at home.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Weight-based bullying is among the most prevalent forms of peer harassment and carries significant health consequences—particularly among adolescents who identify as a sexual and/or gender minority (SGM). We examined how anti-bullying legislation that includes weight as a protected class (enumeration) contributes to the prevalence of weight-based bullying and its adverse health sequelae among SGM adolescents. We collected data on weight-based bullying and health risk (stress, unhealthy eating behaviors, self-rated health) from the LGBTQ National Teen Survey and linked these to state anti-bullying legislation obtained from the United States (US) Department of Health and Human Services. Weight-based bullying was less frequent, but associated with greater health risk for SGM adolescents in states with, versus without, weight-enumerated anti-bullying laws. Adding weight as a protected class in anti-bullying legislation may be an effective strategy for reducing weightbased bullying, but additional supports are needed to support adolescents who continue to experience weight-based bullying.