Table I.
Overview of Included Studies
| Authors (year) | Design | Weight stigma |
N | Demographics (mean age [SD], % female) | % With OV/OB | Quality | Mental health outcome | Brief description of outcome | |
|---|---|---|---|---|---|---|---|---|---|
| Measure | Type | ||||||||
| Balantekin et al. (2018) | Cross-sectional | 1 question (Project EAT family) | External | 166 | 15 (NA) years, 100% female | NR | Poor | UWCBs (list of UWCBs) | Maternal and friend weight stigma positively associated with unhealthy weight control behaviors. Paternal weight stigma not statistically significant |
| Blanco et al. (2019) | Cross-sectional | POTS-S | External | 100 | 10.14 (1.35) years, 60% female | 50.0 | Fair | Anxiety (STAI-C), Depression (CDI), Self-esteem (LAWSEQ) | Weight stigma correlated with poorer psychological well-being, including greater depression and anxiety and lower self-esteem |
| Ciupitu-Plath et al. (2018) | Cross-sectional | WBIS | Internal | 191 | 15.06 (1.49) years, 51.31% female | 100 | Fair | Quality of life (KIDSCREEN), Self-esteem (RSE) | WBIS negatively correlated with quality of life and self-esteem |
| Eisenberg et al. (2019) a | Cross-sectional | 1 question (Project EAT family) | External | 1,577 | 14.5 (NR) years, 49.5% female | NR | Poor | Body dissatisfaction (Likert response to list of body parts), Depression (Depressive Mood Scale), Self-esteem (RSE), UWCB (endorsement of behaviors via list) | Those who reported experiencing weight stigma reported poorer outcomes across all mental health outcomes compared to those who did not report experiencing weight stigma |
| Gayes and Steele (2015) | Cross-sectional | POTS, WCA | External | 307 | 9.85 (0.72) years, 50.64% female | NR | Fair | Quality of life (PedsQL) | Both weight stigma scales were negatively correlated with HRQoL |
| Gerke et al. (2013) | Cross-sectional | POTS | External | 92 | 13.92 (1.84) years, 67.4% female | 100 | Fair | Disordered eating (ChEDE-Q), Depression (CDI), Self-esteem (CSEI) | Weight stigma positively correlated with depression and disordered eating, negatively correlated with self-esteem |
| Goldfield et al. (2010) | Cross-sectional | MRSF-III (parent and peer subscales) | External | 1,491 | 14.7 (1.8) years. 57% female | 24.0 | Poor | Anxiety (MASC-10), Depression (CDI), Disordered eating (DEBQ) | Weight stigma positively correlated with anxiety, depression, and disordered eating |
| Greenleaf et al. (2014) | Cross-sectional | 1 author-created question (yes/no) | External | 1,419 | 12.41 (0.97) years, 55% female | NR | Poor | Depression (CES-DC), Self-esteem (SDQII-GSE) | Those who reported experiencing weight stigma reported higher depression and lower self-esteem compared to those who did not report experiencing weight stigma |
| Greenleaf et al. (2017) | Cross-sectional | WST/PARTS | External | 343 | 12.3 (0.8) years, 41.7% female | 100 | Fair | Body satisfaction (BPSS-R), Depression (CES-DC), Self-esteem (SDQII-GSE) | Weight stigma positively correlated with depression and negatively correlated with body satisfaction and self-esteem |
| Guardabassi et al. (2018) | Cross-sectional | POTS | External | 600 | 9.64 (0.88) years, 51.8% female | 35.8 | Fair | Quality of life (PedsQL™4.0) | Weight stigma negatively correlated with PedsQL |
| Himmelstein and Puhl (2019) | Cross-sectional | 1 author-created question of frequency of weight teasing | External | 148 | 15.97 (1.25) years, 50% female | 82.0 | Poor | Author-created questions related to negative emotions and unhealthy eating behaviors | Weight stigma from peers positively correlated with negative emotions and eating, weight stigma from teachers negatively correlated with negative emotions and eating. Weight stigma from family and friends not statistically significant |
| Himmelstein et al. (2019) | Cross-sectional | 2 questions (Project EAT family and peers and frequency of teasing) | External | 9,838 | 15.6 (1.26) years, 44% cisgender female | 37.2 | Poor | Binge eating (4 yes/no questions), UWCB (9 questions), Stress (1 question) | Frequency of weight stigma correlated with more severe binge eating, UWCB, and stress |
| Hutchinson and Rapee (2007) | Cross-sectional | POTS | External | 1,094 | 12.3 (0.52) years, 100% female | NR | Fair | Body image concern (BAQ); Disordered eating (EDI-Bulimia subscale, DEBQ-Restraint subscale), UWCB (EWLB) | Weight stigma positively correlated with disordered eating behaviors and body image concern |
| Ievers-Landis et al. (2019) | Cross-sectional | POTS | External | 334 | 14.59 (1.38) years, 63.7% female | NR | Fair | Depression (CES-DC); Self-esteem (RSE) | Weight stigma negatively correlated with self-esteem and positively with depression |
| Jensen and Steele (2012) | Longitudinal | POTS | External | 93 | 11.7 (2.6) years, 59% female | 100 | Good | Quality of life (PedsQL™4.0) | Weight stigma negatively correlated with quality of life |
| Lin et al. (2020) | Longitudinal | WBIS | Internal | 934 | 15.7 (1.2) years, 52.5% female | 100 | Poor | Psychological dysfunction (DASS-21), Quality of life (PedsQL) | WBIS positively correlated with psychological dysfunction and negatively correlated with quality of life |
| López-Guimerà et al. (2012) | Cross-sectional | POTS | External | 1,501 | 14.3 (1.4) years, 48% female | 15.5 | Fair | Body dissatisfaction (EDI-2), Disordered eating (ChEAT), Self-esteem (RSE) | Weight stigma positively correlated with disordered eating and body dissatisfaction, negatively associated with self-esteem |
| Maïano et al. (2019) | Cross-sectional | WSSQ | Internal | 156 | 16.31 (0.8) years, 48.1% female | 100 | Poor | Anxiety (HADS), Depression (HADS), Disordered eating (EAT-26), Self-esteem (SDQ-12) | WSSQ negatively correlated to self-esteem and positively correlated to anxiety, depression, and disordered eating |
| McCormack et al. (2011) | Cross-sectional | 2 author-created questions | External | 148 | 11.2 (NR) years, 52.4% female, | 45.2 | Poor | Body dissatisfaction (5 yes/no questions) | Those who reported weight stigma had lower body satisfaction than those did not report weight stigma |
| Modi and Zeller (2008) | Cross-sectional | Sizing Them Up Teasing/Marginalization subscale (3 items) | External | 220 | 11.6 (3.3) years, 68% female | 100 | Fair | Quality of life (PedsQL-Kids) | Weight stigma negatively correlated to quality of life |
| Nelson et al. (2011) | Cross-sectional | POTS | External | 382 | 10.8 (0.6) years, 46% female | 32.8 | Fair | Body dissatisfaction (figure scales), Self-esteem (5 items modified from CSEI and RSE) | Weight stigma positively correlated to body dissatisfaction and negatively correlated to self-esteem |
| Neumark-Sztainer et al. (2002) b | Cross-sectional | 2 questions (Project EAT family and peers) | External | 4,746 | 14.9 (1.7) years, 49.8% female | NR | Poor | Disordered eating and unhealthy weight control behaviors (yes/no unstandardized questionnaire) | Weight stigma associated with greater disordered eating and unhealthy weight control behaviors |
| Neumark-Sztainer et al. (2010) | Cross-sectional | 1 author-created question | External | 356 | 15.8 (1.2) years, 100% female | 46.0 | Poor | Disordered eating (2 questions), UWCB (Project EAT questions) | Weight stigma associated with greater unhealthy and extreme weight control behaviors, and binge eating |
| Olvera et al. (2013) | Cross-sectional | MRFS-IV | External | 141 | 11.1 (1.5) years, 100% female | 100 | Poor | Disordered eating and UWCB (McKnight Risk Factor Survey-IV) | Parental weight stigma positively associated with binge eating |
| Pearlman et al. (2019) | Cross-sectional | 2 author-created questions based upon Puhl et al. (2013) | External | 128 | 14.35 (1.5) years, 54% female | 100 | Poor | Depression (BDI), Disordered eating (EDE-Q), Self-esteem (RSE) | Weight stigma positively correlated with disordered eating and depression, and negatively correlated with self-esteem |
| Porter et al. (2013) | Cross-sectional | POTS | External | 119 | 13.9 (1.7) years, 72% female | 100 | Fair | Body satisfaction (BDS, MBSRQ), Depression (CDI), Self-esteem (CSEI) | Weight stigma negatively correlated with self-esteem and body satisfaction and positively correlated with depression |
| Puhl and Himmelstein (2018) | Cross-sectional | Modified WBIS | Internal | 148 | 15.97 (1.2) years, 50% female | 71.6 | Poor | Disordered eating (4 validated questions regarding binge eating symptoms) | WBIS correlated with more severe binge eating |
| Puhl and Luedicke (2012) | Cross-sectional | 28 author-created items assessing forms of teasing and 8 items assessing location of teasing | External | 394 | 16.4 (1.0) years, 56% female | 35.0 | Poor | Affect and disordered eating responses to bullying (author-created questions) | Weight stigma correlated with negative affect for boys only |
| Puhl et al. (2019) c | Cross-sectional | 2 author-created questions (peers and family) | External | 9,839 | 15.6 (1.2) years, 44% cisgender female | 37.2 | Poor | Depression (KADS), Self-esteem (RSE) | Weight stigma negatively correlated with self-esteem and positively correlated with depression |
| Rojo-Moreno et al. (2013) | Cross-sectional | POTS | External | 57,997 | Age NR (13–16 years), 49.1% female | ∼14% | Fair | Body dissatisfaction (EDI), Disordered eating (ChEAT, EDI), Low self-esteem (EDI) | Weight stigma positively correlated to all mental health variables |
| Stice and Whitenton (2002) | Longitudinal | 2 author-created questions | External | 496 | Age NR (11–15 years), 100% female | NR | Good | Body dissatisfaction (BPSS-R), Depression (K-SADS) | Weight stigma positively correlated with body dissatisfaction and depression |
| Suisman et al. (2008) | Cross-sectional | POTS | External | 265 | 12.5 (1.4) years, 100% female | NR | Fair | Disordered eating (MEBS), Negative affect (EATQ-R) | Weight stigma positively correlated with disordered eating and negative affect |
| Thompson et al. (1995) | Cross-sectional and longitudinal | 2 author-created questions on frequency of teasing and how upset were by teasing; PARTS | External | 210 | Age NR (10–15 years), 100% female, | NR | Fair | Body image (Body Figure Ratings; EDI), Disordered Eating (EDI, EAT-26) | Weight stigma history positively correlated with disordered eating and negatively with body image |
| Thompson et al. (1995) | Cross-sectional | 1 author-created question on frequency of teasing; PARTS | External | 169 | 16 (NR) years, 100% female | NR | Fair | Body image (MBSEQ-AE, BIATQ-PSS), Global Psychological Function (CDI, STAI, COOP), Disordered Eating (BULIT-B, EDI, EAT-26) | Weight stigma positively correlated with disordered eating, worse global psychological functioning, and poorer body image |
| Turker et al. (2012) | Cross-sectional | 3 author-created items | External | 945 | 14.7 (1.2) years, 100% female | 21.5 | Fair | Body dissatisfaction (BSQ), Depression (BDI), Disordered eating (EAT-26), Self-esteem (RSE) | Weight stigma positively correlated with body dissatisfaction, depression, and disordered eating |
| Van Dale et al. (2014) | Cross-sectional | PARTS | External | 651 | Age NR (14–18 years), 54.8% female, | NR | Fair | Self-esteem (RSE) | Weight stigma positively correlated with low self-esteem |
| Van den Berg et al. (2002) | Cross-sectional | 5 author-created items regarding frequency | External | 470 | 15.5 (0.2) years, 100% female | NR | Poor | Body dissatisfaction (BAQ), Global psychological function (BDI, RSE) | Weight stigma positively associated with body dissatisfaction |
| Wertheim et al. (2001) | Longitudinal | POTS | External | 130 | 12.82 (NR), 100% female | NR | Fair | Depression (BDI), Disordered eating (DEBQ) | Weight stigma positively correlated with depression and disordered eating; weight stigma predicted disordered eating |
| Wertheim et al. (2001) | Longitudinal | POTS | External | 174 | 13.71 (NR), 100% female | NR | Fair | Body dissatisfaction (EDI), Disordered eating (EDI) | Weight stigma positively correlated with disordered eating and body dissatisfaction |
| Wertheim et al. (2001) | Longitudinal | POTS | External | 131 | 15.75 (NR), 100% female | NR | Fair | Body dissatisfaction (EDI), Depression (BDI), Disordered eating (EDI), Self-esteem (RSE) | Weight stigma positively correlated with depression, disordered eating, body dissatisfaction, and negatively correlated with self-esteem |
| Wojtowicz and Von Ranson (2012) | Longitudinal | POTS | External | 393 | 15.8 (0.6) years, 100% female | NR | Fair | Body dissatisfaction (BPS), Self-esteem (RSE) | Weight stigma positively correlated to body dissatisfaction and negatively to self-esteem |
| Zeller and Modi (2009) | Cross-sectional | Sizing Me Up Teasing/Marginalization Subscale | External | 141 | 9.2 (2.2) years, 67% female | 100 | Fair | Quality of Life (PedsQL™4.0) | Weight stigma negatively correlated with quality of life |
| Zuba and Warschburger (2018) | Cross-sectional | WBIS-C | Internal | 1,484 | 10.55 (0.9) years, 51.9% female | 19.0 | Fair | Anxiety (Kinder-Angst-Test II), Body dissatisfaction (1 item), Depression (German Depression Test for Children), Disordered eating (DEBQ), Psychosocial/emotional problems (Strengths and Difficulties Questionnaire), Self-esteem (CHQ) | WBIS positively correlated with depression, anxiety, body dissatisfaction, psychosocial/emotional problems, and disordered eating; WBIS negatively correlated with self-esteem |
Note. NA = Not applicable; NR = Not reported; BAQ = Body Attitudes Questionnaire; BESAA = Body Esteem Scale for Adolescents and Adults; BDI = Beck Depression Inventory; BIATQ = Body Image Automatic Thoughts Questionnaire; BPSS-R = Body Parts Satisfaction Scale Revised; BSQ = Body Shape Questionnaire; BUILT-B = Bulimia Test Binge Eating Subscale; CDI = Children’s Depression Inventory; CES-DC = Center for Epidemiological Studies-Depressive Scale for Children; ChEAT = Children’s Eating Attitude Test; ChEDE-Q = Children's Eating Disorder Examination Questionnaire; CHQ = Child Health Questionnaire; COOP = Coopersmith Self-Esteem Inventory; CSEI = Coopersmith Self-Esteem Inventory; DEBQ = Dutch Eating Behaviour Questionnaire; EATQ-R = The Early Adolescent Temperament Questionnaire—Revised; EDDS = Eating Disorder Diagnostic Scale; EDE-Q = Eating Disorder Examination Self-Report Questionnaire; EDI = Eating Disorder Inventory; EWLB = Extreme Weight Loss Behaviors Checklist; FRS = Figure Rating Scale; HADS = Hospital Anxiety and Depression Scale; HRQoL = Health-Related Quality of Life; KADS = Kutcher Adolescent Depression Scale; KIDSCREEN = KIDSCREEN 10-Index; K-SADS = Schedule for Affective Disorders and Schizophrenia for School-Age Children; LAWSEQ = Lawrence’s Self-Esteem Questionnaire; MASC-10 = Multidimensional Anxiety Scale for Children; MBSRQ = Multidimensional Body-Self Relations Questionnaire; MEBS = Minnesota Eating Behavior Survey; NPS = Negative Physical Self Scale; MRSF = McKnight Risk Factor Survey; PANAS = Positive and Negative Affect Scale; PARTS = Physical Appearance Related Teasing Scale, weight-related only; POTSWeight Teasing Subscale of the Perception of Teasing Scale; POTS-S = Spanish version of the POTS; RSE = Rosenberg Self-Esteem Scale; SDQII-GSE = Self-Description Questionnaire II General Self-Esteem Scale; STAI = State-Trait Anxiety Inventory; STPI = Spielberger State-Trait Personality Inventory; UWCB = Unhealthy weight control behaviors; WBIS = Weight Bias Internalization Scale; WCA = Weight Criticism Scale; WSSQ = Weight Self-Stigma Questionnaire.
a
Both used Project Eat 2010 dataset.
b
Both used Project Eat 1 dataset.
c
Both used LGBTQ Teen Study dataset.