Background/Objectives: Considerable evidence from U.S. studies suggests that weight stigma is consequential for patient-provider interactions and healthcare for people with high body weight. Despite international calls for efforts to reduce weight stigma in the medical community, cross-country research is lacking in this field. This study provides the first multinational investigation of associations between weight stigma and healthcare experiences across six Western countries. Methods: Participants were 13,996 adults residing in Australia, Canada, France, Germany, the UK, and the US who were actively enrolled in an internationally available behavioral weight management program. Participants completed identical online surveys in the dominant language for their country that assessed experienced weight stigma, internalized weight bias, and healthcare behaviors and experiences including perceived quality of care, avoidance or delay of seeking care, experiences with providers, and perceived weight stigma from doctors. Results: Among participants who reported a history of weight stigma (56–61%), two-thirds of participants in each country reported experiencing weight stigma from doctors. Across all six countries, after accounting for demographics, BMI, and experienced stigma, participants with higher internalized weight bias reported greater healthcare avoidance, increased perceived judgment from doctors due to body weight, lower frequency of obtaining routine checkups, less frequent listening and respect from providers, and lower quality of healthcare. Additionally, experienced weight stigma (from any source) was indirectly associated with poorer healthcare experiences through weight bias internalization, consistently across the six countries. Conclusions: Weight stigma in healthcare is prevalent among adults actively engaged in weight management across different Western countries, and internalized weight bias has negative implications for healthcare even after controlling for BMI. The similar findings across all six countries underscore the negative consequences of weight stigma on healthcare behaviors and experiences, and emphasize the need for collective international efforts to address this problem.

Weight bias internalization (WBI) is an understudied form of internalized stigma, particularly among treatment-seeking adults with overweight/obesity. The current study surveyed 13,996 adults currently engaged in weight management in the first multinational study of WBI. From May to July 2020, participants in six Western countries completed the Modified Weight Bias Internalization Scale (WBIS-M) and measures of weight change, health behaviors, psychosocial well-being, and health-related quality of life (HRQOL). Participants were majority white, female, middle-aged, and categorized as having overweight or obesity based on body mass index. Results showed higher mean WBIS-M scores among participants in the UK, Australia, and France than in Germany, the US, and Canada. Across all countries, and controlling for participant characteristics and experiences of weight stigma, WBIS-M scores were associated with greater weight gain in the past year. Participants with higher WBIS-M scores also reported poorer mental and physical HRQOL, less eating and physical activity self-efficacy, greater engagement in eating as a coping strategy, more avoidance of going to the gym, poorer body image, and greater perceived stress. Few interaction effects were found between experiences and internalization of weight stigma. Overall, the current findings support WBI as a robust correlate of adverse weight-related health indices across six Western countries. Prospective and experimental studies are needed to determine directionality and causality in the relationship between WBI and poor health outcomes.

Objective: Food noise has received attention in the media, although no validated questionnaires exist to measure it. This study developed and tested the reliability and validity of the Food Noise Questionnaire (FNQ).Methods: Participants (N = 400) successfully completed, the FNQ and a demographic questionnaire and self‐reported weight and height. A subsample (n = 150) completed the FNQ 7 days later for test–retest reliability, and this subsample's first FNQ data were subjected to exploratory factor analysis. The remaining subsample (n = 250) completed two preoccupation with food questionnaires to test convergent validity, along with mood, anxiety, and stress questionnaires to test for discriminant validity. Confirmatory factor analysis was conducted using this subsample's FNQ data.Results: Data from 396 participants were analyzed (4 participants did not complete all FNQ items). The FNQ had excellent internal consistency reliability (Cronbach α = 0.93) and high test–retest reliability (r = 0.79; p < 0.001; mean [SD] = 7.4 [1.0] days between administration). Factor analyses found that the five FNQ items loaded onto a single factor, with good fit indices (χ²[5] = 52.87, p < 0.001; root mean square error of approximation [RMSEA] = 0.20; comparative fit index [CFI] = 0.95; standardized root mean squared residual [SRMR] = 0.03). The FNQ showed good convergent (all r > 0.78; p < 0.001) and discriminant (all r < 0.39; p < 0.001) validity.Conclusions: The FNQ provides a psychometrically reliable and valid measure of food noise, although further research is needed to evaluate its clinical utility.

Inadequate vitamin and mineral intake is documented among individuals with obesity, but is unknown among long-term weight loss maintainers (WLM). This study examined dietary quality and micronutrient adequacy among WLMs in a commercial weight management program. Participants were 1207 WLM in Weight Watchers (WW) who had maintained a 9.1 kg or greater weight loss (29.7 kg on average) for 3.4 years and had a body mass index (BMI) of 28.3 kg/m². A control group of weight stable adults with obesity (controls; N = 102) had a BMI of 41.1 kg/m². Measures included the Diet History Questionnaire-II, Healthy Eating Index-2015 (HEI), and Dietary References Intakes. WLM versus controls had a 10.1 point higher HEI score (70.2 (69.7–70.7) vs. 60.1 (58.4–61.8); p = 0.0001) and greater odds of meeting recommendations for copper (OR = 5.8 (2.6–13.1)), magnesium (OR = 2.9 (1.8–4.7)), potassium (OR = 4.7 (1.4–16.5)), vitamin A (OR = 2.8 (1.7–4.8)), vitamin B6 (OR = 2.9 (1.6–5.2)), and vitamin C (OR = 5.0 (2.8–8.8)). WLM, compared to controls, also reported higher percentages of calories from carbohydrates (50.3% (49.7–50.8) vs. 46.7% (44.8–48.7); p = 0.0001) and protein (18.2% (18.0–18.5) vs. 15.9% (15.1–16.6); p = 0.0001) and lower calories from fat (32.3% (31.9–32.8) vs. 37.4% (35.8–38.9); p = 0.0001). Long-term weight loss maintenance in a widely used commercial program was associated with a healthier diet pattern, including consuming foods with higher micronutrient density.

Objective: Family‐based weight stigma can be expressed as criticism, judgment, teasing, and mistreatment by family members because of an individual's body weight. The current study compared the prevalence and psychosocial correlates of family‐based weight stigma among adult members of a weight‐management program living in Australia, Canada, France, Germany, the UK, and the US.Methods: Participants (N = 8100 adults who reported having ever experienced weight stigma; 95% female; 94% White) completed an identical online survey in their country's dominant language that assessed their experiences of weight stigma from 16 different family member sources, as well as internalized weight bias, body image, eating behaviors, perceived stress, and self‐rated health.Results: Family‐based weight stigma, especially from mothers (49%‐62%), spouses/romantic partners (40%‐57%), and fathers (35%‐48%), was highly prevalent across countries. Weight stigma from one's immediate family members was associated with indices of poorer psychosocial health across the six countries (β coefficients = |0.08‐0.13|).Conclusions: Findings highlight the need for weight stigma‐reduction efforts to help family members distinguish between supportive, encouraging discourse and potentially weight‐stigmatizing communication. Future research should examine the prevalence and correlates of family‐based weight stigma in more diverse community samples, including among racially/ethnically and gender diverse adults, and in non‐Western countries.