Social Perceptions of Weight Loss With Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists in Black and White Women With Obesity

Abstract

Intersectionality theory suggests that because stigma arises from the interplay of multiple marginalized identities, Black women with obesity may face stronger negative attitudes than White women when using GLP-1 agonists, a newer class of obesity medications often perceived as an ‘easy way out.’ This experimental study tested how exposure to different weight loss methods affected stigma toward a Black or White woman with obesity, as well as the influence of participant race on stigma. A sample of 402 Black and White women with overweight or obesity were randomly assigned to read about a Black or White woman named Evette who lost 15% of her total body weight with either diet/exercise or a GLP-1. Participants reported stigmatizing attitudes toward Evette (fat phobia, dislike, desire for social distance, and blame) and beliefs that she took a weight loss shortcut. Stigma was higher when Evette lost weight with a GLP-1 (vs. diet/exercise) and, contrary to hypotheses, when Evette was depicted as White (vs. Black). Moderated mediation analyses demonstrated that GLP-1-assisted weight loss (vs. diet/exercise) led to higher fat phobia, dislike, desire for social distance, and blame via stronger shortcut beliefs and this effect was more pronounced when Evette was portrayed as White. Participant race did not influence how weight loss with a GLP-1 and Evette’s race, together, affected stigma through shortcut beliefs. Findings highlight the importance of challenging societal narratives about what constitutes ‘acceptable’ weight loss strategies for women with obesity to reduce stigma and protect long-term health.

GLP-1 (e.g., Semaglutide) and dual GIP/GLP-1 (e.g., Tirzepatide) receptor agonists promote weight loss through multiple biological mechanisms associated with regulating appetite, gastric emptying, and insulin secretion (Zaffina et al., 2023). Clinical trials demonstrate that these medications (henceforth referred to broadly as “GLP-1s”) can help individuals lose 15-20% of total body weight while offering notable health benefits, including cardioprotective effects, reduced blood pressure, and lower cholesterol levels (Popoviciu et al., 2023; Qin et al., 2024).

Despite the established efficacy and health benefits associated with GLP-1s, their use is often socially stigmatized. Media coverage (e.g., Pazzanese, 2024; Thompson, 2023; West-Knights, 2025) and empirical data (Naveed et al., 2025; Post et al., 2025; Post & Persky, 2024) indicate that perceptions of individuals who use GLP-1s for weight loss are often unfavorable due to beliefs that they are taking the ‘easy way out.’ For example, negative evaluations (e.g., perceptions of laziness, poor self-control) about a target woman with obesity were higher when she lost weight with a GLP-1, compared to diet/exercise, mediated by beliefs that she took a weight loss shortcut (Post & Persky, 2024, Post et al., 2025). Additionally, reading about the success of novel obesity medications did not change beliefs that obesity is caused by a lack of willpower, a core component of weight stigma, and individuals who perceived obesity as a willpower failure were more likely to report that obesity medications are an ‘easy way out’ (Goldkorn et al., 2025). Other qualitative work supports these experimental findings, demonstrating that individuals who use GLP-1s for weight loss often feel criticized and experience shame for losing weight with GLP-1s instead of ‘hard work’ or willpower (Naveed et al., 2025). Judging people with obesity who lose weight with GLP-1s is a compounded form of weight stigma – one that penalizes both individuals’ body size and personal approach to weight management.

Weight stigma involves socially rejecting, devaluing, negatively stereotyping, or discriminating against people with overweight and obesity (Puhl et al., 2009). This form of stigma is often reported by women with obesity (Lee et al., 2021; Panza et al., 2020; Spahlholz et al., 2016). As with other marginalized social groups, women with overweight and obesity may hold negative weight-based attitudes, which can be directed toward the self (i.e., internalized weight bias) or others with higher weight (Durso & Latner, 2008; Pearl et al., 2017). A substantial body of research has demonstrated the harmful impacts of weight stigma on health, including depressive and anxiety symptoms (Alimoradi et al., 2020), higher body dissatisfaction (Romano et al., 2021), poor diet (Lee et al., 2021; Zhu et al., 2022), and elevated risk for developing Type 2 diabetes mellitus and obesity (Brown et al., 2022; Wu & Berry, 2018). While reports of weight stigma and internalized weight bias can be experienced by women of varying weight statuses, women with obesity are more vulnerable to both (Brown et al., 2022; Pearl et al., 2021). In addition to differences by body size, internalized weight bias can also vary by racial background and may differentially affect associated negative consequences (Himmelstein et al., 2017), suggesting multiple layers of influence.

Emerging research has examined how weight loss with behavioral modifications (i.e., diet/exercise) and pharmaceuticals (i.e., GLP-1s) affects weight stigmatizing attitudes (Al-Mahzoum et al., 2025; Post & Persky, 2024; Tomiyama, 2025). However, there is a notable gap in weight stigma literature regarding the role of race/ethnicity and no studies have investigated perceptions of individuals with obesity from different racial groups who have lost weight with GLP-1s. Existing weight stigma-related studies often include predominantly (>70%) White samples (Himmelstein et al., 2017) and, aside from a few studies (Gullo et al., 2025; Hebl & Heatherton, 1998; Pearl et al., 2012; Puhl et al., 2013), research examining attitudes toward individuals with obesity has largely overlooked perceptions based on a target person’s race/ethnicity.

The intersectionality of race and weight

Approximately 57% percent of Black women are categorized as having obesity compared with 40% of White women (Obesity and African Americans, 2022). Black women with obesity experience worse health outcomes than White women with obesity, including higher rates of diabetes mellitus, stroke, and hypertension (Okobi et al., 2023), as well as higher mortality rates from cardiovascular events (Agyemang & Powell-Wiley, 2013).

Intersectionality theory offers an explanation as to why Black women with obesity experience disproportionate harmful health outcomes compared to White women (Crenshaw, 2013). According to this theory, having multiple marginalized or oppressed social identities negatively impacts health (Hankivsky, 2012). For example, a Black woman with a body mass index (BMI) of 30 would be categorized as having three marginalized or oppressed social categories (“Black,” “having obesity,” and “woman”) whereas a White woman with the same BMI would occupy two categories (“having obesity” and “woman”). Intersectionality theory posits that the social identities of being Black, a woman, and having obesity intersect in complex and interdependent ways that negatively influence health more substantially than a simple additive model would predict (i.e., Black + having obesity + woman; Bowleg, 2008).

Literature has documented mixed findings regarding how judgments of weight intersect with race. Hebl and Heatherton (1998) demonstrated that Black female targets with higher weight were rated as more popular and happier than White targets, regardless of the perceivers’ race. Similarly, Gullo et al. (2025) found that weight stigma was higher toward a White (vs. Black) woman with higher weight who displayed eating disorder symptoms. However, Pearl and colleagues (2012) found that attitudes toward target individuals with obesity portrayed in media images did not differ based on the target’s racial group (Black or White), whereas Puhl et al. (2013) found that dislike and desire for social distance from Black women with obesity depicted in media images were higher relative to White women. In addition, research has yielded mixed findings regarding the prevalence of weight stigma among Black and White women, with earlier research showing a positive association between everyday discrimination and BMI among Black women (Stepanikova et al., 2017) and longitudinal work indicating that Black female adolescents were more likely to be labeled ‘fat’ compared to White adolescents, which predicted the likelihood of having obesity in adulthood, independent of BMI in adolescence (Hunger & Tomiyama, 2014). However, more recent work has demonstrated similar reports of weight stigma among Black and White women (Prunty et al., 2020; Puhl et al., 2020). Thus, while this body of work has yielded varied findings, it is possible that Black women with obesity experience both negative weight-based attitudes and racial bias, which may result in a compounded form of stigma.

It remains unclear how stigma toward Black and White women is shaped by the method of weight loss – whether through lifestyle interventions or pharmacological approaches, such as GLP-1s. Intersectionality theory suggests that stigma toward Black women with obesity who lose weight with GLP-1s, a less socially accepted strategy compared to traditional methods that require willpower and ‘hard work’ (i.e., diet/exercise), may be higher compared to White women using this same method. Following parallel logic, higher stigma may be related to stronger judgments that Black (vs. White) women with obesity who lose weight with GLP-1s are taking a shortcut. Given the significant growth of GLP-1s as an obesity treatment and the disproportionately high rates of obesity among Black women (many of whom are eligible for and stand to benefit from the medications), this inquiry warrants empirical investigation. Therefore, the primary objective of this study is to examine how exposure to a target woman who is Black or White, and who lost weight with a GLP-1 or lifestyle methods, affects a range of negative attitudes. As it is challenging to assess whether negative attitudes toward Black women with obesity stem from weight stigma, racial bias, or both, henceforth negative attitudes will be characterized generally as ‘stigma.’

The influence of the perceiver’s racial group

Stigma toward Black and White women with obesity who lose weight with various weight loss methods may also be influenced by the perceiver’s own racial/ethnic group. Differences in racial/ethnic cultural ideals suggest that Black women may perceive weight and weight loss differently than White women (Burke et al., 2021). For example, Black women are less likely to endorse anti-fat attitudes (Hebl & Heatherton, 1998; Sabin et al., 2012; Scott & Rosen, 2015) and thin ideals (Chithambo & Huey, 2013; Hebl et al., 2009), and are less likely to stigmatize women with obesity (Hebl & Heatherton, 1998) compared to White women. Additionally, Black individuals may be less likely than White individuals to endorse a Protestant work ethic emphasizing self-control, discipline, and individual responsibility (Cokley et al., 2007; Rosenthal et al., 2011), beliefs tied to negative weight-based attitudes (Ringel & Ditto, 2019). Taken together, such differences suggest that Black women may have more positive attitudes toward women who lose weight with GLP-1s, as Black women may have more inclusive weight-related views and may be more accepting of weight loss methods that seemingly require less personal effort. To explore this possibility, this study also tests whether stigmatizing attitudes toward a Black or White woman with obesity who lost weight with a GLP-1 (vs. diet/exercise) differ based on whether the perceiver identifies as Black or White.

Overview

The present study investigates previously underexplored dimensions of obesity, stigma, and race/ethnicity, experimentally testing if stigma differs based on whether a Black or White target woman with obesity achieves weight loss with a GLP-1 or diet/exercise. Women between the ages of 30-49, who self-identified as having overweight or obesity and as Black or White, were randomly assigned to read about and view a photo of a target woman named Evette, who was depicted as either White or Black and as having lost weight either with a GLP-1 or diet/exercise. Then participants completed a questionnaire assessing weight loss shortcut beliefs and stigma, which was operationalized with four measures commonly used to assess negative attitudes toward people with higher weight and marginalized groups (fat phobia, feelings of dislike, blame, and desire for social distance; e.g., Latner et al., 2008; Parent et al., 2023). These four measures were used to reflect a range of negative attitudes that may stem from weight stigma, racial biases, or both, which would not be fully captured by a single measure.

We hypothesized that stigma toward a Black woman with obesity who lost weight with a GLP-1 (vs. diet/exercise) would be higher compared to a White woman (H1). We also hypothesized that the effects on stigma based on the target woman’s weight loss method would occur through stronger beliefs that the Black (vs. White) woman took a weight loss shortcut (H2). Finally, we examined the role of participant race in these relationships by posing three research questions. First (RQ1), to what extent does participant race influence stigma toward a target woman who lost weight using a GLP-1 vs. diet/exercise (controlling for the target’s race)? Second (RQ2), does participant race influence stigma expressed toward a Black vs. White target woman who lost weight (controlling for her weight loss method)? Third (RQ3), does participant race affect stigma toward a Black or White woman who lost weight using a GLP-1 vs. diet/exercise, through beliefs that GLP-1s are a shortcut?

Method

Participants

Study measures, data, and syntax are publicly available online at https://osf.io/az3c7 (Post, 2025). Participants were recruited from Prolific Academic between September 4 and October 10, 2024. Eligible participants were U.S. citizens between the ages 30-49 who self-identified as Black or White, female, and ‘woman.’ Eligible participants also self-identified as ‘a little overweight,’ ‘overweight,’ or ‘having obesity’ and reported never having taken a GLP-1 medication. Recruiting women with overweight and obesity aged 30-49 aligned participants’ gender, weight status, and approximate age with the target, reducing the likelihood that observed differences in attitudes were influenced by differences in these personal characteristics. In addition, women aged 30-49 are particularly likely to have heard of GLP-1s (Poll: Nearly Half of Adults…, 2023). Recruitment was stratified to obtain a balance of participants who self-reported their racial group as Black or White (see Table 1). Participants were compensated $6.00.

Table 1.

Demographics

	Total N = 402		By participant race
	N	%	White (n = 199)  N (%)		Black (n = 203)  N (%)
Racial Group
Black or African American	203	50.5%	-		-
White or Caucasian	199	49.5%
Household Income
< $25,000	30	7.5%	12 (6.0%)		18 (8.9%)
$25,000-$50,000	95	23.6%	36 (18.1%)		59 (29.1%)
$50,001-$74,999	100	24.9%	50 (25.1%)		50 (24.6%)
$75,000-$100,000	86	21.4%	49 (24.6%)		37 (18.2%)
$100,001-$150,000	62	15.4%	38 (19.1%)		24 (11.8%)
$150,001-$200,000	21	5.2%	11 (5.5%)		10 (4.9%)
>$200,000	8	2.0%	3 (1.5%)		5 (2.5%)
Education
High school diploma/GED	53	13.2%	28 (14.1%)		25 (12.3%)
Associates degree or trade school	53	13.2%	27 (13.6%)		26 (12.8%)
Some college	97	24.1%	52 (26.1%)		45 (22.2%)
Bachelor’s degree	122	30.3%	61 (30.7%)		61 (30%)
Master’s degree	69	17.2%	26 (13.1%)		43 (21.2%)
Doctorate	8	2%	5 (2.5%)		3 (1.5%)
Self-reported weight status
“I am a little overweight”	137	34.1%	63 (31.7%)		74 (36.5%)
“I am overweight”	157	39.1%	81 (40.7%)		76 (37.4%)
“I have obesity”	108	26.9%	55 (27.6%)		53 (26.1%)
	M	SD	M	SD	M	SD
Age	39.78	5.822	40.35	5.56	39.23	6.04
Body mass index (BMI)	34.51	8.45	33.47	7.81	35.55	8.95
Political beliefs (1-7 scale)	3.32	1.67	3.44	1.83	3.19	1.48

A power analysis using G*Power for a small effect size (f = .14) with a power of .80 and four experimental conditions, accounting for participant race as an additional moderator, showed that 403 participants were needed; 442 participants were recruited to account for possible data loss. Forty participants were excluded: 7 participants who failed a manipulation check, 10 participants who had poor data quality which was assessed by an open ended data quality check, 13 participants whose gender, race, or self-reported body size did not match eligibility criteria, and 10 participants who completed the survey in less than 40% of mean time of completion length (Cobanoglu et al., 2021), leaving a final N of 402 in the analytic sample.

Design

This study employed a 2 × 2 between-subjects experimental design. The first factor was a target woman’s weight loss method (GLP-1 or diet/exercise) as described in a written vignette. The second factor was the target woman’s racial group (White or Black) as depicted in a photo and vignette. There were four experimental conditions: diet/exercise + White target (n = 97), diet/exercise + Black target (n = 103), GLP-1 + White target (n = 102), GLP-1 + Black target (n = 100).

Procedure

Study procedures were pre-registered at https://osf.io/az3c7 and approved by The George Washington University. Eligible participants were given a Qualtrics link to the study in Prolific Academic. After providing informed consent participants were randomly assigned to one of four conditions in which they viewed a photo of a target woman named Evette, in her mid-30s, who was either White or Black (see Figure 1). Participants read that Evette lost 15% of her total body weight either with a GLP-1 medication or diet/exercise and that she “moved from the ‘obese’ to ‘overweight’ BMI range” (Post & Persky, 2024; see supplemental materials). The name Evette was chosen based on a dataset (Tzioumis, 2018) that indicated comparable representation among Black and White women. After reading the vignette and viewing the photo, participants completed dependent measures assessing weight loss shortcut beliefs, fat phobia, feelings of dislike, blame, and desire for social distance, as well as demographics. Participants were then debriefed.

Figure 1.

Experimental Stimuli: Evette Depicted as a White and Black Woman

The vignette and photo portraying Evette were pilot tested using a separate sample of women ages 30-49 with overweight and obesity who identified as Black or White (N = 47) on Prolific Academic. Participants responded to questions about Evette’s perceived age, body size, attractiveness, friendliness, likability, and competence, as well as believability. Independent samples t-tests found there were no significant differences in perceptions when Evette was depicted as a White vs. Black woman on any dimension (ps > .05; see supplemental materials).

Measures

Demographic variables

To characterize the sample and assess potential covariates, participants reported their age, height and weight (to compute BMI), self-categorized body size, racial/ethnic group, highest degree of education, annual household income, and political beliefs (coded as 1 = extremely liberal, 7 = extremely conservative).

Weight loss shortcut beliefs

Participants responded to four items assessing whether Evette “took the easy way out,” “cheated to lose weight,” “lost weight in a way that was fair” (reverse coded), and “worked hard to lose weight” (reverse coded; Post & Persky, 2024). All questions were scaled 1 (not at all) to 7 (very). The mean of the four questions was computed (α = .88) with higher scores indicating greater shortcut beliefs.

Fat phobia

Negative attitudes towards Evette were measured with the Fat Phobia Scale shortened form (Bacon et al., 2001), which includes 14 pairs of antonyms often used to characterize individuals with obesity. Participants selected a number from 1 to 5 that best described their feelings and beliefs about Evette, with antonyms such as “lazy-industrious,” “no will power-has will power,” and “under eats-over eats.” A mean score was computed (α = .90) with higher scores indicating more fat phobia.

Dislike

Feelings of dislike toward Evette were assessed with two questions (Gibbons & McCoy, 1991). Participants responded to “how likable do you think Evette is” on a scale from 1 (not at all likable) to 4 (very likable) and “how would you rate Evette’s overall appeal as a person” on a scale from 1 (very low appeal) to 4 (high appeal). Both items were reverse coded. A mean score was computed (r = .62) with higher scores indicating more dislike.

Social distance

Seeking social distance, such as from people with obesity, is a form of social rejection and a central component of stigma (Link & Phelan, 2001). Desire for social distance was assessed by asking participants how willing they would be to interact with Evette in seven scenarios (Sikorski et al., 2015), such as “having Evette as a neighbor” and “introduce Evette to a friend.” Response options ranged from 1 (not at all willing) to 7 (very willing). All items were reverse coded. A mean score was computed (α = .92) with higher scores indicating a greater desire for social distance.

Blame

Blame towards Evette was assessed with the following two questions, “To what extent do you blame Evette for her high starting weight (before she lost weight)?” and “To what extent do you feel that if Evette regains the weight she previously lost, it is her fault?” (Pearl & Lebowitz, 2014). Response options ranged from 1 (not at all) to 7 (very much). A mean score was computed (r = .69) with higher scores indicating greater blame.

Data analytic plan

All analyses were conducted with SPSS statistical software (version 29). Descriptive statistics and bivariate correlations were conducted for all study variables (see supplemental materials). Four one-way analyses of variance (ANOVAs) tested if there were significant differences between conditions based on participants’ age, BMI, income, or political views and two chi-square tests for categorical variables tested if there were significant differences based on participants’ education level or self-reported body size between experimental conditions. As there were no differences between conditions, subsequent analyses did not control for any sociodemographics. Additionally, normality of residuals was examined for all outcome variables (fat phobia, dislike, blame, and desire for social distance) via histograms and Shapiro–Wilk tests. Although the residuals for all four variables showed non-normality (fat phobia: W = .98, p < .001, skew = .45; dislike: W = .94, p < .001, skew = .48; blame: W = .91, p < .001, skew = .71; social distance: W = .84, p < .001, skew = 1.55), analyses using log-transformed variables produced substantively identical results. Because the raw metric is easier to interpret and ANCOVA is robust with our sample size, results are reported using the untransformed scores.

Four ANCOVAs tested the main effects of exposure to a White (vs. Black) target woman who lost weight with a GLP-1 (vs. diet/exercise), and their interactions, on stigma (fat phobia, dislike, blame, and social distance), while controlling for participant race (H1). Hayes’ (2017) PROCESS macro (5,000 samples), model 7, tested if the target’s woman’s race (White vs. Black) moderated the effect of her weight loss method (GLP-1 vs. diet/exercise) on the four stigma outcome variables, through weight loss shortcut beliefs, while controlling for participant race (H2). Diet/exercise was entered as the reference group in the models testing H2. Significance was determined when the 95% bias-corrected bootstrap confidence interval for the index of moderated mediation did not contain zero.

Exploratory analyses examined the role of participant race on stigma. Four ANCOVAs tested weight loss method (GLP-1 vs. diet/exercise) x participant race (White vs. Black) interactions on stigma, while controlling for the target woman’s race (RQ1). Four ANCOVAs tested target race (White vs. Black) x participant race (White vs. Black) interactions on stigma, while controlling for the target’s weight loss method (RQ2). Finally, PROCESS model 12 tested if participant race moderated the combined effects of the target woman’s weight loss method and race on stigma, through shortcut beliefs (RQ3). Significance was determined when the 95% bias-orrected bootstrap confidence interval for the index of moderated moderated mediation did not contain zero.

Results

See Table 1 for sample demographics.

Main effects of weight loss method and participant race and interactions (H1)

Table 2 displays the means and standard deviations for outcome variables based on experimental condition.

Table 2.

Means (and Standard Deviations) of Stigma Outcomes by Experimental Condition, Controlling for Participant Race

	M (SD)		M (SD)
	Diet/exercise		GLP-1
Variable	White Target	Black Target	White Target	Black Target
Weight loss shortcut beliefs (1-7 scale)	1.23 (.55)a	1.15 (.45)a	3.42 (1.71)b	2.88 (1.43)c
Fat phobia (1-5 scale)	2.0 (.44)a	1.84 (.39)a	2.91 (.65)b	2.58 (.55)c
Dislike (1-4 scale)	1.52 (.49)a	1.29 (.42)b	1.79 (.54)c	1.45 (.46)a,b
Social distance (1-7 scale)	1.96 (1.08)a	1.44 (.76)b	2.12 (1.25)a	1.56 (.89)b,c
Blame (1-7 scale)	2.56 (1.42)a	2.68 (1.64)a	2.81 (1.69)a	2.79 (1.69)a

Note. Values with different letters in the row are significantly different (p < .05).

There was a main effect of weight loss method on fat phobia, F(1, 397) = 253.17, p < .001, η_p² = .389, and dislike, F(1, 397) = 21.36, p < .001, η_p² = .051, with higher ratings in the GLP-1 (M = 2.75, SD = .62) vs. diet/exercise (M = 1.92, SD = .43) condition. There was also a main effect of target race on fat phobia, F(1, 397) = 21.33, p < .001, η_p² = .051, and dislike, F(1, 397) = 35.52, p < .001, η_p² = .082, in the opposite direction than expected, such that ratings were higher toward the White (fat phobia: M = 2.46, SD = .72; dislike: M = 1.51, SD = .49) vs. Black target (fat phobia: M = 2.21, SD = .60; dislike: M = 1.29, SD = .60). For desire for social distance, there was no main effect of weight loss method (p = .14); however, there was a main effect of target race, F(1, 397) = 31.56, p < .001, η_p² = .074, such that social distance was higher for the White (M = 2.04, SD = 1.17) vs. Black target (M = 1.50, SD = .83). There were no main effects of weight loss method or target race on blame, and no significant weight loss method x target race interactions on any stigma outcome (ps > .10). In sum, fat phobia and dislike (but not blame or desire for social distance) were higher when Evette lost weight with a GLP-1 (vs. diet/exercise) and all stigma outcomes (except blame) were higher when Evette was portrayed as White (vs. Black).

Moderated mediation through weight loss shortcut beliefs (H2)

Across all models, there was a significant effect of the target woman’s weight loss method on shortcut beliefs with stronger shortcut beliefs toward Evette when she lost weight with a GLP-1 (vs. diet/exercise). There was a significant weight loss method x target race interaction on shortcut beliefs, again in the opposite direction than expected, whereby shortcut beliefs were stronger when Evette was depicted as White (vs. Black) and as losing weight with a GLP-1 (see Figure 2).

Figure 2.

Target Race x Weight Loss Method Interaction on Weight Loss Shortcut Beliefs, Controlling for Participant Race

Shortcut beliefs were a significant predictor of all four stigma outcomes, and weight loss with a GLP-1 (vs. diet/exercise) was a significant direct predictor of fat phobia and blame only. The conditional indirect effects of weight loss with a GLP-1 (vs. diet/exercise), through shortcut beliefs, and the indices of moderated mediation were significant for all four stigma outcomes (see Figure 3 for fat phobia and supplemental materials for dislike, social distance, and blame figures). These results indicate that stigma was higher when Evette was depicted as a White (vs. Black) woman who lost weight with a GLP-1 (vs. diet/exercise), through stronger beliefs that she took a weight loss shortcut.

Figure 3.

Weight Loss with a GLP-1 (vs. Diet/exercise) on Fat Phobia, through Shortcut Beliefs, Dependent on Target Race, Controlling for Participant Race

Note. Index of moderated mediation: −.12, CI [−.25, −.01]. Solid lines = significant predictor; dotted lines = non-significant predictor; dotted circle = covariate.

Exploratory analyses

Supplemental materials contain results tables for RQ1-RQ3.

RQ1.

First, we examined main effects and participant race x weight loss method interactions on stigma, controlling for the target woman’s race. There were no significant main effects of participant race on fat phobia, blame, or dislike (ps > .05). However, there was a significant effect of participant race on social distance, F(1, 397) = 21.38, p < .001, η_p² = .051 with Black (M = 1.98, SD =1.18) vs. White (M = 1.55, SD = .84) participants reporting higher desire for social distance towards the target overall. There were no significant participant race x weight loss method interactions on any stigma outcome (ps < .25).

RQ2.

Next, we tested main effects and participant race x target race interactions on stigma, controlling for the target’s weight loss method. The main effects of participant race on desire for social distance (F(1, 397) = 21.66, p < .001, η_p² = .052) and dislike (F(1, 397) = 3.63, p = .057, η_p² = .009) were consistent with RQ1, with no significant effects of participant race on fat phobia or blame. There were no participant race x target race interactions on fat phobia, dislike, or blame (all ps > .16). However, there was a marginally significant participant race x target race interaction on social distance, F(1, 397) = 3.523., p = .061, η_p² = .01, such that Black (vs. White) participants exposed to the White (vs. Black) target reported higher desire for social distance. While the interaction approached significance, pairwise comparisons showed that for Black participants, social distance was significantly higher towards the White (M = 2.37, SD = 1.30) vs. Black (M = 1.63, SD = 0.94; p < .001) target. For White participants, pairwise comparisons showed a similar pattern but with a smaller difference in the means, with higher social distance ratings towards the White (M = 1.73, SD = 0.94) vs. Black target (M = 1.36, SD = 0.67; p = .009).

RQ3.

Finally, we examined the role of participant race in stigma toward a Black or White target woman who lost weight with a GLP-1 or diet/exercise, as mediated by shortcut beliefs. Across all models, there were no significant effects of participant race and no participant race x target race x weight loss method interactions on weight loss shortcut beliefs (all ps > .23). There were also no significant effects of participant race and no participant race x target race x weight loss method interactions on fat phobia, blame, or dislike. For social distance, there was a significant effect of participant race, but there was no participant race x target race x weight loss method interaction. The indices of moderated moderated mediation were not significant for any stigma outcome. These results indicate that participant race did not influence stigma toward a White (vs. Black) target woman who lost weight with a GLP-1 (vs. diet/exercise), through shortcut beliefs.

Discussion

This experimental study tested how reading about a target woman with obesity named Evette, who was depicted as either Black or White and as losing weight with either a GLP-1 or diet/exercise, affected stigma toward Evette, among a sample of Black and White women with overweight and obesity. We also examined if negative attitudes toward Evette occurred through beliefs that she took a weight loss shortcut, and if participants’ racial group influenced how Evette’s weight loss method and race, together, affected stigma.

Consistent with previous work (Naveed et al., 2025; Post & Persky, 2024; Post et al., 2015), negative attitudes toward Evette were stronger when she lost weight with a GLP-1 compared to diet/exercise on several stigma outcomes. However, contrary to hypotheses, stigma was higher when Evette was portrayed as a White (vs. Black) woman. Intersectionality theory suggests that attitudes toward Black women with obesity are shaped by a complex interplay between racial biases and weight stigma (Bowleg, 2008), which could result in distinct or amplified forms of stigma. However, the present results revealed that fat phobia, dislike, and desire for social distance were all higher when the target woman was depicted as White. Although this finding is inconsistent with some earlier research showing that attitudes toward Black women with higher weight depicted in media images were more negative than White women (Puhl et al., 2013), results align with two recent experimental studies. Gullo et al. (2025) demonstrated that weight stigma was higher toward a White (vs. Black) woman with obesity who displayed eating disorder symptoms, and Persky et al. (2024) found that medical students expressed more negative attitudes about a virtual, simulated patient with obesity when she appeared as White (vs. Black) when no information about weight etiology was provided (as is the case in the current study). It is also conceptually consistent with research showing that White women experience greater social penalties for having a higher weight relative to Black women (Dutton et al., 2014; Maralani & McKee, 2017), despite evidence that Black and White women report similar levels of weight stigma (Panza et al., 2020; Prunty et al., 2020; Puhl et al., 2020). Additionally, while initial models showed that stigma was higher toward Evette when she was depicted as White, regardless of her weight loss method, further analyses revealed that the White target woman who lost weight with a GLP-1 was more likely to be seen as taking a shortcut than the Black woman, a perception that predicted greater fat phobia, dislike, desire for social distance, and weight-based blame.

Racial differences in desirable and normative body ideals may help explain why negative attitudes were stronger when Evette was depicted as a White woman. Several studies indicate that Black females with overweight and obesity are perceived to be more attractive than their White counterparts (Ali et al., 2013; Chithambo & Huey, 2013; Richmond et al., 2012; Roberts et al., 2006), even when judged by White women. Additionally, Black women tend to endorse larger ideal body silhouettes (Kronenfeld et al., 2010; Overstreet et al., 2010) and frequently perceive themselves to have a smaller body than their objective BMI classification would suggest (Bell & Blackman Carr, 2020; Bennett & Wolin, 2006; Edmonds et al., 2024), indicating that larger body sizes may be more socially normative and desirable for Black women. Perceptions that White women with higher weight are less socially accepted than Black women with a similar weight status likely stem from societal standards around weight and thinness promoted by Western, White-majority cultures (DiGioacchino et al., 2001). As such, Evette may have faced higher scrutiny when depicted as a White woman due to perceptions that she fell short of societal body size standards. Such rigid body standards for White women may have also prompted heightened perceptions that Evette should have been able to lose weight with willpower and “gold standard” methods like diet and exercise when portrayed as White (Sombra & Anastasopoulou, 2024; Tyson & Kikuchi, 2024) and evoked stronger beliefs that she took a shortcut by using a GLP-1. Stronger shortcut beliefs may also have stemmed from perceptions that Evette had the resources to lose weight the “right way” (e.g., being able to afford gym memberships) or had undeserved access to high cost weight loss medications, reflecting societal privileges often afforded to White women (McIntosh, 2017).

Exploratory analyses identified notable patterns regarding the relationship between participants’ racial group and desire for social distance from Evette. Black participants consistently reported higher social distance ratings compared to White participants, an effect that was robust across models. However, there were no racial differences among participants for fat phobia, dislike, or blame. This finding contrasts work showing that Black individuals, in general, tend to report less desire for social distance than White individuals across a variety of target identities (Parrillo & Donoghue, 2013; Weaver, 2008; Williams et al., 2018). The selective effect on social distance in the present study, but not the other stigma measures, suggests that social distance may capture more nuanced attitudes toward women with obesity who lose weight. Reading about a woman with obesity who successfully lost weight may have made societal ideals around body weight and thinness more salient – ideals that Black women are less likely to personally endorse (Chithambo & Huey, 2013; Hebl et al., 2009). This contrast may have led Black women to view Evette as more culturally or socially distinct from their own experiences, prompting more social distance without influencing broader attitudes.

Another notable finding is that, among Black participants, the mean social distance rating was substantially higher toward the White (vs. Black) target woman, regardless of weight loss method. For White participants, desire for social distance was also higher toward the White target, but the mean difference in ratings toward the Black and White target was narrower. These findings may reflect some level of in-group preference (Tajfel et al., 1971; Turner et al., 1987), among Black participants who had significantly more favorable attitudes toward a woman who was part of their racial in-group. This finding may also reflect the interpersonal racism and discrimination experienced by Black women (Bleich et al., 2019), which could prompt a stronger desire to maintain distance from an unknown White woman. Additionally, exploratory analyses found that participant race did not independently predict shortcut beliefs, nor did it moderate the extent to which Evette’s weight loss method and race, together, affected stigma through shortcut beliefs. Although research shows that Black individuals tend to place less emphasis on individual responsibility (Cokley et al., 2007; Hunt, 2004) and have more inclusive views about body diversity (Chithambo & Huey, 2013), these results imply that assumptions about GLP-1-assisted weight loss being an “easy way out” operate similarly across racial groups and may persist regardless of the perceiver’s race.

Lastly, although fat phobia and dislike were stronger when Evette lost weight with a GLP-1, desire for social distance and blame were not initially affected by her weight loss method. The lack of direct effects on blame and social distance in the GLP-1 conditions contradict research showing that less perceived effort is associated with a stronger desire for social distance from individuals with obesity who attempt weight loss (Beames et al., 2016; Black et al., 2014), and work showing that individuals who lose weight with medical means are often blamed for their weight (Chao et al., 2022; Homer et al., 2016). In the present study, losing weight with a GLP-1 activated negative weight-based stereotypes and less warmth toward Evette, but it did not prompt strong enough negative judgments to warrant ascribing blame or socially avoid the target, that is, until weight loss shortcut beliefs were considered. This suggests that perceptions of GLP-1-assisted weight loss being an ‘easy way out’ provided a cognitive justification for higher blame and social distance toward Evette.

Future Directions

The present findings point to several future directions. Testing communication strategies that alter perceptions of GLP-1s as a shortcut to weight loss and improving health, such as messages that focus on their short- and long-term protective health benefits (Drucker, 2024) and the benefits of combining pharmacotherapy with behavioral changes (Zakaria et al., 2024), may help reduce negative attitudes toward women with obesity who pursue GLP-1-assisted weight loss. In addition, investigating factors that influence weight loss method attributions, including target and perceiver race, socioeconomic status, gender, and the magnitude of weight loss, may provide insights into assumptions about perceived effort in relation to how people with obesity lose weight in the modern GLP-1 landscape. Such assumptions may influence social judgments toward individuals who are perceived to have lost weight with medical means.

Exploring additional psychological mechanisms that may influence stigma toward GLP-1 users from varied racial backgrounds, such as endorsements of thin ideals (Warren & Akoury, 2020), weight bias internalization (Himmelstein et al., 2017), and misinformed etiological beliefs about obesity (Luck-Sikorski et al., 2017), is also a worthwhile pursuit. Such work may guide culturally-informed interventions aimed at challenging widely held beliefs that obesity therapies that seemingly require less effort are inferior (Beames et al., 2016; Mattingly et al., 2009) and ultimately help reduce stigma towards individuals who use medical weight loss strategies. Additionally, current findings suggest that it would be valuable to explore whether patients’ racial (or gender) identity affects healthcare providers’ treatment decisions regarding GLP-1 use. Understanding the influence of group membership may provide insights as to whether healthcare providers are more likely to stigmatize patients with obesity from social outgroups who request or use GLP-1s for weight management. This inquiry is especially relevant since healthcare providers often hold racial (Hall et al., 2015) and anti-fat biases (Moore et al., 2022), and convey implicit moral evaluations when assessing whether patients with obesity should be prescribed GLP-1s (Andreassen et al., 2024).

Future research should also investigate attitudes toward women and men from other racial groups who use GLP-1s for weight loss, including Asian and Hispanic/Latinx women, who also often experience weight stigma (Reddy & Crowther, 2007; Reid et al., 2016). Finally, while the present study demonstrated that stigma was higher toward the White target woman, Black women with obesity face worse health outcomes compared to White women and historically have been underrepresented in weight stigma (Himmelstein et al., 2017) and medical research (Le et al., 2022). Thus, examining how racial and weight-related biases intersect to influence health, including psychosocial and behavioral outcomes, among Black women with obesity both generally and among GLP-1 users, is a critical pursuit.

Limitations

There were several limitations to the current study. First, the sample consisted of primarily middle class, middle-aged women who self-identified as Black or White which may limit the generalizability of findings to other socioeconomic, age, or racial groups. The sample included only women to increase internal validity. However, men tend to hold stronger anti-fat attitudes than women (Pearl et al., 2012) and thus future research should examine perceptions of GLP-1-assisted weight loss with broader samples. While it was a strength that the two photos of Evette were pretested, having multiple photos of Evette presented as a White and Black woman would have ensured responses to stimuli were not driven by specific features of a single image. For example, the White target may have been perceived to be slightly rounder in her mid-section than the Black target, which could have influenced attitudes (Krems & Neuberg, 2022).

In addition, the mean attitude ratings in the GLP-1 conditions fell below the scale midpoint for most outcome variables (except fat phobia), suggesting that while stigma was higher when Evette was portrayed as White and as losing weight with a GLP-1, overall attitudes were neutral or trending positive. However, because this sample was limited to women with overweight and obesity, the extent of negative attitudes toward Evette may be greater in broader samples as there is an inverse association between weight stigmatizing attitudes and BMI (Elran-Barak & Bar-Anan, 2018). Finally, it is possible that participants responded to stigma questions in socially desirable ways to conceal implicit or explicit biases or overcompensate for the racial discrimination and prejudice that Black women experience (Bleich et al., 2019). Documented decreases in explicit, but not implicit, weight-related biases over time (Charlesworth & Banaji, 2019) suggest that implicit measures may more accurately capture negative weight-based attitudes.

Conclusion

Nearly 100 million Americans are clinically eligible to use GLP-1 medications for weight loss (Wong et al., 2023) and approximately 18% of the population is currently using or has previously used a GLP-1 (Poll: 1 in 8 Adults…,2025). Our findings suggest that even as GLP-1 use becomes more widespread, women with obesity who use novel obesity medications for weight loss, White women in particular, are more likely to be seen as taking a shortcut compared to those who lose weight with lifestyle changes. Such perceptions translate to more negative judgments toward individuals who may choose or need to manage their weight with medical means. Challenging societal narratives about what constitutes ‘acceptable’ weight loss strategies for women with obesity will be critical for reducing stigma and protecting long-term health.

Clinical impact statement:

This study demonstrated that White women with obesity who lose weight with GLP-1s may be judged more harshly than Black women with obesity through stronger beliefs that White women are taking a weight loss shortcut. Findings underscore the need for challenging biases about ‘acceptable’ weight loss strategies for women with obesity to reduce stigma, ensure appropriate care, and protect long-term health.

Code and data available online on Open Science Framework: http://bit.ly/3K3YqwZ