Women feel more stigmatized about abdominal fat than men

Women may be more vulnerable to internalizing negative messages about weight than men.


A new study recently suggested that women, as compared to men, tend to feel more stigmatized about abdominal fat, regardless of their body mass index or weight. The study also found that this stigma may be linked to additional weight gain.

Lead study author Natalie Keirns, M.S., a doctoral candidate in clinical psychology at Oklahoma State University in Stillwater, Oklahoma, said, “Some people who struggle with managing their weight may devalue themselves based on external messages from society telling them they are unattractive, self-indulgent or weak-willed because they weigh more. When these ‘anti-fat messages are internalized, people often feel shame, which in turn, may make them vulnerable to weight gain.”

“Weight bias internalization happens when people apply negative, weight-based stereotypes to themselves.”

Scientists investigated the connection between internalized weight stigma and higher levels of visceral/abdominal fat. Visceral adiposity is fat inside the body that wraps around the abdominal organs near the body’s center. They also assessed the connection between abdominal fat and self-devaluation related to participants’ weight.

Seventy participants, ages 22 to 39, participated in the study. Their average body mass index (B.M.I.) was 29 and an average of 33% total body fat.

Scientists measure participants’ internalized weight stigma using an 11-item, self-reported questionnaire called the Weight-Bias Internalized Scale-Modified (WBIS-M). The scores on the questionnaire range from one to seven, with seven representing the highest level of weight bias internalization and one representing the least.

Using Dual-energy X-ray absorptiometry (DEXA), scientists measured visceral and total body fat. Percentage of total body fat, race, ethnicity, gender, and age were factored into the analysis.

They found that:

  • Women had higher levels of weight bias internalization (average WBIS score of 3.5) than men (average WBIS score of 2.7).
  • Higher levels of internalized weight stigma corresponded to higher levels of visceral fat in women only. For women, each one-point increase on the WBIS-M score corresponded to an average increase of 0.14 pounds of visceral fat. For men, each one-point increase on the WBIS-M score was unrelated to visceral fat.

Keirns said, “Even though men typically, on average, had more of this harmful fat than women, we didn’t see the same relationship with the psychological, social stigma. For women, the way we view our bodies and how others view and judge our bodies appears to have negative effects. Even though the women had less visceral adiposity than men, it may be impacting our health more because of the negative way we feel about ourselves.”

“Among health care professionals, we need to be more aware of our assumptions and how weight bias can negatively affect our patients. Shifting the conversation from weight loss to health gain may be a simple way to change these conversations to eliminate what amounts to bias and judgment toward patients of higher weight.”

American Heart Association volunteer expert Chiadi Ericson Ndumele, M.D., Ph.D., M.H.S., the Robert E. Meyerhoff Assistant Professor of Cardiology, Clinical Connection in the department of medicine at Johns Hopkins University School of Medicine in Baltimore said“This study highlights the important challenge of weight stigma, which is a significant barrier to us successfully addressing obesity.”

“Clinicians should be aware that weight stigma leads to more stress, higher cortisol levels, a greater likelihood of unhealthy behaviors, lower likelihood of seeking care and generally contributes to more weight gain and worse outcomes. In addition, it’s important to be aware that clinical environments often perpetuate a significant amount of weight stigma.”

“There is a lot of anti-weight bias in the communications, and the kind of care patients receive within clinical environments. It’s up to us to have a healthier approach to how we’re thinking about and addressing obesity with our patients, which relates to how well we appreciate the complexity of the factors that lead to the development of obesity.”

The research is to be presented at the American Heart Association‘s Scientific Sessions 2021. The meeting will be fully virtual, Saturday, November 13, through Monday, November 15, 2021.

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