Dissertation
Weight stigma in sexual minority women and its relation to health and health behaviors
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Summer 2023
DOI: 10.25820/etd.007118
Abstract
Weight stigma negatively impacts the health and health behaviors of individuals. It has been associated with physical and mental health outcomes in different populations. However, no studies have examined weight stigma in sexual minority women (SMW). SMW have unexplained health outcomes that have led to health disparities when compared to heterosexual populations. Limited research has been conducted to help understand the frequency of health disparities present in SMW. One of the health disparities present in SMW are the rates of obesity and overweight compared to heterosexual women. This could make SMW more susceptible to weight stigma. Therefore, the purpose of this research is to explore the prevalence of weight stigma in a sample of SMW and examine the relationship of weight stigma to health and health behaviors.
Weight stigma is the mistreatment of others because of their weight and/or body size. Despite the ongoing evidence of the negative effects weight stigma can have, it remains an accepted form of discrimination and mistreatment in society including work environments and the healthcare field. There are two forms of weight stigma, external and internal weight stigma. External weight stigma is experiencing things such as discrimination and teasing. Internal weight stigma is feeling ashamed and negatively about self.
The Health Equity Promotion Model (HEPM) was used to guide this research. The application of weight stigma to HEPM helps to view it in a holistic matter where individual’s social positions (e.g. race, age, income) can influence and determine who weight stigma is experienced. As individuals experience weight stigma, they may be affected in behavioral, psychological, social and biological ways, which are labeled as health promotion or adverse pathways in the model. Engaging in these pathways can then affect health outcomes. For example, individuals who are exposed to weight stigma eat more calories which can then affect their cardiovascular health.
The cross-sectional study included 3,821 total participants with 459 identified as SMW. The sample was primarily non-Hispanic weight and ages 18-44 who completed an online survey that measured external and internal weight stigma, health outcomes, and health behaviors. External weight stigma was measured using a series of five questions and internal weight stigma was measured using the Weight Bias Internalized Scale (WBIS). The prevalence of external weight stigma ranged from n=118-259 (26-64%), depending on the question and for internal weight stigma it was n=264 (57%). Overall bisexual women had the highest prevalence of internal weight stigma (n=162, 35%). Bisexual women also had the highest prevalence of external weight stigma for all questions. When examining demographic characteristics as predictors of weight stigma, overweight, obesity, and gay/lesbian sexual identity significantly predicted internal weight stigma. Being overweight or obese means having two to five odds higher of having internal weight stigma. For external weight stigma demographic predictors depended on the question but for all being obese was a predictor of having any kind of external weight stigma.
When examining health outcomes hyperglycemia (n=289, 63%), chronic pain (n=112, 24%), and hypertension (n=92, 20%) were the most commonly reported physical health issues. Anxiety and depression diagnosis were reported by over 50% of this sample of SMW. The most common health behaviors reported were being up to date on routine health screenings and partaking in past diet or exercise to lose weight (>70%). Internal weight stigma and external weight stigma due to teasing were significantly associated with all mental health outcomes. When furthering analyzing the relationship of stigma to health outcomes and health behaviors there were only a few that were significant. Internal weight stigma predicted having two to four higher odds of hypertension, anxiety, depression, and eating disorders. Only external weight stigma due to discrimination predicted hypercholesteremia. For health behaviors, having internal weight stigma, external weight stigma due to discrimination, and treated less predicted at two higher odds of delaying or avoiding healthcare due to weight. The opposite was true for predicting drinking and exercise were having internal weight stigma and/or external weight stigma due to discrimination meant lower odds of partaking in these activities.
Details
- Title: Subtitle
- Weight stigma in sexual minority women and its relation to health and health behaviors
- Creators
- Alejandra Gonzalez
- Contributors
- Melissa Lehan Mackin (Advisor)Paul A. Gilbert (Committee Member)Catherine H. Cherwin (Committee Member)Samantha L. Solimeo (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Nursing
- Date degree season
- Summer 2023
- Publisher
- University of Iowa
- DOI
- 10.25820/etd.007118
- Number of pages
- x, 145 pages
- Copyright
- Copyright 2023 Alejandra Gonzalez
- Language
- English
- Date submitted
- 05/22/2023
- Description illustrations
- Illustrations, tables, graphs, charts
- Description bibliographic
- Includes bibliographical references (pages 75-92).
- Public Abstract (ETD)
Individuals perceived as violating social norms of acceptable weight are subject to poor treatment. These norms can affect all regardless of weight or body size and can cause feelings of shame and guilt. A term used to describe these experiences is weight stigma. Weight stigma is present in healthcare, workplaces, and school settings and can be experienced by all age groups. Numerous studies have found weight stigma negatively affects physical and mental health of individuals and influences health behaviors such as delaying healthcare. Therefore, reducing weight stigma and minimizing its effect may help improve health. To accomplish this, populations such as sexual minority women (SMW) that identify as non-heterosexual should be examined for prevalence of weight stigma and its effect on health.
SMW were the focus because findings found how prevalent being overweight and obese are in this population. This means a greater risk for experiencing weight stigma. Other health outcomes present in SMW and associated with weight stigma include increase anxiety, depression, and avoiding healthcare. To understand weight stigma in SMW and how it affects health, a nationwide survey was distributed.
A total of 459 SMW completed the survey. Findings include up to 64% had experienced weight stigma. Weight stigma was common among those with different physical and mental health outcomes. Also, behaviors such as avoiding exercising and healthcare were common in those with weight stigma. Knowing how weight stigma impacts populations such as SMW will help for advocating the minimizing and elimination of weight stigma in different settings.
- Academic Unit
- Nursing
- Record Identifier
- 9984454436402771
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