Do Associations Between Young Adults' Perceived Weight-Based Discrimination and Health-Related Outcomes Differ by Perceived Body Image and/or Weight Status?

Introduction: Little is known about the experience of perceived weight-based discrimination among young adults and if these experiences impact physical and psychological health or increase the risk of engaging in unhealthy behaviors.  Additionally, body image, feeling satisfied with one’s body, or perceived weight status may be important moderators.  Therefore, the purpose of this study was to examine the association between perceived weight-based discrimination and negative health behaviors and outcomes among first-year undergraduate students, and to assess if perceived body image or perceived weight moderated this association.

Methods: Participants included 844 students (57% female; 50% White, mean age=18.98) who completed an online survey assessing a variety of health behaviors.  Students’ reported whether they experienced weight-based discrimination in any of eight situations (e.g. at work, at school, in social settings).  Responses were summed and students were dichotomized into two groups (never experienced=0, experienced=1).  Cigarette and alcohol use over the past month were assessed as were average number of cigarettes consumed on weekdays and weekends.  Stress was self-reported from 1 (not stressed) to 10 (very stressed).  Five items assessing frequency of sleep problems over the past week were summed, with higher scores indicating greater sleep problems.  Students rated overall health (very poor to very good), perceived weight status (underweight to obese), and body image (never to always satisfied).  Linear regression analyses were conducted to determine the relationship between perceived weight-based discrimination and health behaviors/outcomes, controlling for race, body mass index, and gender.  Body image and perceived weight status were tested as moderators.

Results: Approximately 26% of students reported weight-based discrimination.  Perceived weight-based discrimination was significantly, positively associated with smoking cigarettes during weekdays (p=.03), stress (p< .001), and sleep problems (p<.01).  However, perceived weight-based discrimination was negatively associated with reported overall health (p=.001). No significant associations were found between perceived weight-based discrimination and alcohol use.  While body image and perceived weight status were not significant moderators for any relationships, each was significantly associated with perceived weight-based discrimination (p<.001).

Conclusions: Findings suggest that weight-based discrimination is positively associated with weekday cigarette use, stress, and sleep problems.  These results also support a link between weight-based discrimination and poorer perceived overall health.  However, the relationship between weight-based discrimination and health behaviors and outcomes did not differ by body image or weight status.  Further research should examine other psychological mechanisms that may mediate or moderate the relationship between weight-based discrimination and negative health behaviors and outcomes.