Assessment of obesity stigma and discrimination among Spanish subjects with a wide weight range: the OBESTIGMA study

Enric Sánchez; Andreea Ciudin; Ana Sánchez; Sonsoles Gutiérrez-Medina; Nuria Valdés; Lilliam Flores; Amelia Marí-Sanchis; Fernando Goñi; Marta Sánchez; Joana Nicolau; Concepción Muñoz; Olaia Díaz-Trastoy; Guillem Cuatrecasas; Silvia Cañizares; Marta Comas; Carolina López-Cano; Albert Lecube

doi:10.3389/fpsyg.2023.1209245

Assessment of obesity stigma and discrimination among Spanish subjects with a wide weight range: the OBESTIGMA study

Front Psychol. 2023 Sep 18:14:1209245. doi: 10.3389/fpsyg.2023.1209245. eCollection 2023.

Authors

Enric Sánchez¹, Andreea Ciudin^{2

3}, Ana Sánchez⁴, Sonsoles Gutiérrez-Medina⁵, Nuria Valdés⁶, Lilliam Flores^{3

7}, Amelia Marí-Sanchis⁸, Fernando Goñi⁹, Marta Sánchez¹⁰, Joana Nicolau¹¹, Concepción Muñoz¹², Olaia Díaz-Trastoy¹³, Guillem Cuatrecasas¹⁴, Silvia Cañizares^{15

16}, Marta Comas², Carolina López-Cano¹, Albert Lecube^{1

3}

Affiliations

¹ Obesity Unit, Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova de Lleida, Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University of Lleida, Lleida, Spain.
² Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain.
³ Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
⁴ Obesity Unit, Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain.
⁵ Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario Rey Juan Carlos, Madrid, Spain.
⁶ Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario de Cabueñes, Gijón, Spain.
⁷ Obesity Unit, Endocrinology and Nutrition Department, Hospital Clínic Barcelona, Barcelona, Spain.
⁸ Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario de Navarra, Pamplona, Spain.
⁹ Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario de Basurto, Bilbao, Spain.
¹⁰ Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain.
¹¹ Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Palma, Spain.
¹² Obesity Unit, Endocrinology and Nutrition Department, Hospital Universitario Reina Sofia de Córdoba, Córdoba, Spain.
¹³ Obesity Unit, Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain.
¹⁴ Obesity Unit, Endocrinology and Nutrition Department, Clínica Sagrada Familia-CPEN Barcelona, Health Science Department, UOC University, Barcelona, Spain.
¹⁵ Obesity Unit, Psychiatry and Psycology Department, Hospital Clínic Barcelona, Barcelona, Spain.
¹⁶ Clinical Psycology and Psycobiology Department, Universitat de Barcelona, Barcelona, Spain.

Abstract

Introduction: This study aims to assess the extent of rejection and instances of stigmatization linked to obesity within the Spanish population, encompassing a diverse spectrum of weights ranging from normal weight to morbid obesity. Additionally, the study seeks to identify the primary factors influencing these experiences and further examines the impact of bariatric surgery on such dynamics.

Materials and methods: Multicenter observational study with involving a total of 1,018 participants who were recruited from various Obesity Units. Negatives attitudes towards people with obesity were assessed through three questionnaires: (i) Antifat Attitudes Scale (AFA), (ii) Stigmatizing Situations Inventory (SSI) and (iii) Weight Bias Internalization Scale (WBIS). Subjects were categorized into four groups based on their BMI and history of prior bariatric surgery.

Results: The cumulative score across all questionnaires (AFA, SSI and WBIS) exhibited a progressive increase, from participants with normal weight to those with obesity (p < 0.001 for all). Within the AFA questionnaire, males showed more rejection towards people with obesity than women, also perceiving obesity as a disease linked to a lack of willpower (p = 0.004 and p = 0.030, respectively). The overall SSI score was negatively associated with age (r = -0.080, p = 0.011), with young participants encountering more stigmatizing experiences than their adult counterparts. Neither employment status nor educational demonstrated a significant association with any of the questionnaires. Interestingly, patients who underwent lost weight following bariatric surgery did not exhibit improved outcomes.

Conclusion: Individuals with obesity demonstrate a heightened level of aversion towards the disease compared to those with normal weight. Concurrently, the incidence of stigmatizing encounters displays a concerning escalation among younger individuals.

Keywords: bariatric surgery; discrimination; obesity; stigma; weight bias.