- Women may be more vulnerable to internalizing negative messages about weight than men.
- Women with higher levels of abdominal fat reported higher levels of internalized stigma about their weight, while abdominal fat had no relationship to internalized weight stigma among men.
- Women who had higher levels of weight bias internalization were more likely to accumulate more visceral fat (fat in the abdominal region).
Embargoed until 4 a.m. CT/5 a.m. ET, Monday, Nov. 8, 2021
DALLAS, Nov. 8, 2021 — Women were more likely than men to report feeling stigmatized about abdominal fat, regardless of their body mass index or weight, according to preliminary research to be presented at the American Heart Association’s Scientific Sessions 2021. The meeting will be fully virtual, Saturday, November 13 through Monday, November 15, 2021, and is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science for health care professionals worldwide.
The study also reports that internalized weight stigma among women may be linked to additional weight gain. Weight bias internalization happens when people apply negative, weight-based stereotypes to themselves.
“Some people who struggle with managing their weight may devalue themselves based on external messages from society telling them they are unattractive, self-indulgent or weak-willed because they weigh more,” said lead study author Natalie Keirns, M.S., a doctoral candidate in clinical psychology at Oklahoma State University in Stillwater, Oklahoma. “When these ‘anti-fat’ messages are internalized, people often feel shame, which in turn, may make them vulnerable to weight gain.”
The study assessed the connection between abdominal, or visceral fat, and self-devaluation related to participants’ weight. Visceral adiposity is fat inside the body that wraps around the abdominal organs near the center of the body.
“We know that stress may lead to weight gain and, specifically, to higher visceral fat. Visceral adiposity is the type of fat that is more closely related to CVD risk,” Keirns said. “Shame, specifically as an emotion, is related to human stress response. When we feel shame, our production of cortisol increases, which can lead to the accumulation of visceral fat.”
For this study, Keirns and colleagues investigated if internalized weight stigma is related to higher levels of visceral fat. The study included 70 participants, ages 22 to 39, with an average body mass index (BMI) of 29 and average of 33% total body fat.
Internalized weight stigma was measured using an 11-item, self-reported questionnaire called the Weight-Bias Internalized Scale-Modified (WBIS-M). The scores on the questionnaire range from one to seven, with seven representing the highest level of weight bias internalization and one representing the least. Dual-energy X-ray absorptiometry (DEXA) scanning was used to measure visceral and total body fat. DEXA scans are a type of full body scan that use spectral imaging to measure bone density and body composition, including body fat and muscle. Percentage of total body fat, race and ethnicity, gender and age were factored into the analysis.
Among the key findings:
- Women had higher levels of weight bias internalization (average WBIS score of 3.5) than men (average WBIS score of 2.7).
- Higher levels of internalized weight stigma corresponded to higher levels of visceral fat in women only. For women, each one-point increase on the WBIS-M score corresponded to an average increase of 0.14 pounds of visceral fat. For men, each one-point increase on the WBIS-M score was unrelated to visceral fat.
“Even though men typically, on average, had more of this harmful fat than women, we didn’t see the same relationship with the psychological, social stigma. For women, the way we view our bodies, and the way others view and judge our bodies appears to have negative effects,” Keirns said. “Even though the women had less visceral adiposity than men, it may be impacting our health more because of the negative way we feel about ourselves.”
According to the researchers, this is the first study to suggest that women with higher levels of weight bias internalization are more likely to accumulate more visceral fat.
“Among health care professionals, we need to be more aware of our assumptions and how weight bias can negatively affect our patients,” Keirns said. “Shifting the conversation from weight loss to health gain may be a simple way to change these conversations in order to eliminate what amounts to bias and judgment toward patients of higher weight.”
“This study highlights the important challenge of weight stigma, which is a significant barrier to us successfully addressing obesity. Clinicians should be aware that weight stigma leads to more stress, higher cortisol levels, a greater likelihood of unhealthy behaviors, lower likelihood of seeking care and generally contributes to more weight gain and worse outcomes,” said American Heart Association volunteer expert Chiadi Ericson Ndumele, M.D., Ph.D., M.H.S., the Robert E. Meyerhoff Assistant Professor of Cardiology, Clinical Connection in the department of medicine at Johns Hopkins University School of Medicine in Baltimore. “In addition, it’s important to be aware that clinical environments often perpetuate a significant amount of weight stigma. There is a lot of anti-weight bias in the communications and the kind of care patients receive within clinical environments. It’s up to us to have a healthier approach to how we’re thinking about and addressing obesity with our patients, which really relates to how well we appreciate the complexity of the factors that lead to the development of obesity.”
A major limitation of the study is that it is a cross-sectional study, meaning data from only one point in time was analyzed. Future research is needed to confirm if weight bias internalization causes abdominal fat.
Co-authors are Bryant H. Keirns; Christina Sciarrillo, M.S., R.D.; Sam Emerson, Ph.D.; and Misty A.W. Hawkins, Ph.D. Authors’ disclosures are in the abstract.
The study was funded by Psi Chi, the International Honor Society in Psychology, and the American Society for Nutrition.
- Multimedia is available on the right column of the release link https://newsroom.heart.org/news/women-felt-more-stigma-about-abdominal-fat-than-men-regardless-of-body-weight?preview=9fd19a36e4c4df6888e17aa1a52de938
- AHA Scientific Session 2021 Online Program Planner
- More belly weight increases danger of heart disease even if BMI does not indicate obesity
- Belly fat raises risk of heart disease, stroke in older women despite normal BMI
- Waist size predicts heart attacks better than BMI, especially in women
- Keeping a Healthy Body Weight
- Mental Health and Heart Health
- Women and Stress
- Lower Stress: How does stress affect the body?
- For more news from Scientific Sessions 2021, follow us on Twitter @HeartNews #AHA21
Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.
The American Heart Association’s Scientific Sessions 2021 is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science for health care professionals worldwide. The 3-day meeting will feature more than 500 sessions focused on breakthrough cardiovascular basic, clinical and population science updates in a fully virtual experience Saturday, November 13 through Monday, November 15, 2021. Thousands of leading physicians, scientists, cardiologists, advanced practice nurses and allied health care professionals from around the world will convene virtually to participate in basic, clinical and population science presentations, discussions and curricula that can shape the future of cardiovascular science and medicine, including prevention and quality improvement. During the three-day meeting, attendees receive exclusive access to more than 4,000 original research presentations and can earn Continuing Medical Education (CME), Continuing Education (CE) or Maintenance of Certification (MOC) credits for educational sessions. Engage in Scientific Sessions 2021 on social media via #AHA21.
About the American Heart Association
The American Heart Association is a leading force for a world of longer, healthier lives. With nearly a century of lifesaving work, the Dallas-based association is dedicated to ensuring equitable health for all. We are a trustworthy source empowering people to improve their heart health, brain health and well-being. We collaborate with numerous organizations and millions of volunteers to fund innovative research, advocate for stronger public health policies, and share lifesaving resources and information. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.
For Media Inquiries and AHA Expert Perspective:
AHA Communications & Media Relations in Dallas: 214-706-1173; firstname.lastname@example.org
William Westmoreland: 214-706-1232; email@example.com
For Public Inquiries: 1-800-AHA-USA1 (242-8721)