Higher-weight social identity as a risk and protective factor in the negative health consequences of weight stigma: a systematic review

Abstract

Background: Weight stigma causes significant physical and psychological harm to its targets. Objective: This review aims to determine when identifying as a member of the higher-weight group exacerbates versus mitigates the adverse effects of weight stigma. Methods: Searches were conducted on 10 January, 2025, using PsycInfo, Medline, Scopus, Web of Science, Embase, and CINAHL. Evidence was synthesised in terms of exacerbating versus protective effects of higher-weight social identity (as moderator/mediator) in the relationship between weight stigma and 18 distinct health outcomes. This review is registered on PROSPERO (ID: CRD42023415639). Results: Fourteen studies met the inclusion criteria. Studies employing weight status measures to assess higher-weight social identity identified actual and self-perceived higher-weight as risk factors for anticipated rejection, dietary control challenges, increased physiological stress and greater functional disability following stigmatisation. Conversely, studies measuring individual connection with the higher-weight group revealed that stronger identification had protective effects on self-esteem and distress, but only for specific individuals (e.g., those with low internalised weight bias). Limitations: Grey literature and unpublished studies were not reviewed. Conclusions: Initial evidence suggests that higher-weight social identity functions as both risk and protective factor in the relationship between weight stigma and well-being. Implications: Future research should explore the emotional and evaluative components of higher-weight social identity to enhance understanding of how and when group membership influences the adverse effects of weight stigma. This knowledge can inform targeted interventions designed to improve the well-being of higher-weight individuals.