The association of age of onset of obesity with experienced weight stigma in adulthood

Abstract

Background: Experienced weight stigma (EWS) is linked to adverse physical and mental health outcomes, including maladaptive health behaviors and attenuated weight loss in people with obesity. Limited research is available regarding the association between the age of onset and severity of obesity and lifetime experience of EWS among adults with obesity. Methods: Cross-sectional survey data (n = 686) from a single-site academic obesity medicine program was analyzed, including demographics, anthropometric measures, and the Stigmatizing Situations Inventory (SSI-B). The median SSI-B score was used to dichotomize the EWS outcome variable. Crude associations were assessed by chi-square and logistic regression analyses. Multivariable logistic regression determined age-adjusted odds ratios (aOR) of EWS with body mass index (BMI) at age 18 years and peak BMI. Results: Participants had a mean age of 55.8 years (SD = 12.7), and the majority were female and white. EWS was correlated with BMI at age 18 years (r = 0.38; p = 0.001) and peak BMI (r = 0.48; p = 0.001) before and after adjustment. Those with severe obesity (BMI ≥ 40) by 18 years had 2.79 times higher odds (aOR = 2.79; 95% CI: 1.38, 5.62; p < 0.01) of severe EWS vs. those who developed severe obesity after 18 years; 2.17 higher odds [aOR = 2.17; 95% CI: 1.08, 4.35; p = 0.009] of severe EWS versus those with BMI < 40 at 18 years; 2.98 times higher odds [aOR = 2.98; 95% CI: 1.44, 6.15; p = 0.001] of severe EWS vs. those with BMI < 30 at 18 years; and 4.06 times higher odds [aOR = 4.06; 95% CI: 1.39, 6.73; p = 0.001] of severe EWS vs. those with BMI < 25 at 18 years. Conclusion: Those with severe obesity before the age of 18 years were nearly 3 times more likely to report severe EWS than people who developed severe obesity later in life. Healthcare providers should consider screening for EWS in people with early onset of severe obesity, to identify those who may benefit from weight stigma interventions and support.