New Study Looks At Weight Stigma...

A new study published in the Journal of Health Psychology looked at weight stigma and bariatric surgery.

“In this longitudinal study, we investigated the association between weight stigma and mental health (depression and anxiety symptoms), dysregulated eating (binge eating and other disordered eating), and body mass index (BMI) before and after metabolic bariatric surgery (MBS),” study author Larissa McGarrity told us. “The key research questions were: 1) Does stigma improve from before to after surgery? 2) If so, is the improvement associated with improvement in mental health, dysregulated eating, and BMI? 3) If patients continue to experience stigma post- surgery, does that increase their risk for mental health, eating behavior, and weight challenges?”

Given the wide-ranging benefits documented in the research on MBS for physical and mental health, the researchers hypothesized improvement in weight stigma and associated distress from before to after surgery, and elevated mental health and eating behavior symptoms for those who continued to experience higher levels of stigma.

“The inspiration for this study came from my clinical work,” McGarrity told us. “I am the lead clinical psychologist in the Comprehensive Weight Management Program at the University of Utah. It is just so clear to me after seeing hundreds of patients with severe obesity for their pre-MBS psychological evaluation and pre and post-MBS psychotherapy that the stigma they experience in this world and the way they internalize those experiences is a key factor in their mental and physical health over time.”

Weight stigma shows up in the quiet, constant message that your body makes you less worthy, explained McGarrity. Being judged in the doctor’s office before you even speak, hearing jokes that are not funny, feeling like you have to work extra hard to prove your value in every room you walk into because of how you are perceived based on your weight, seeing that you do not fit physically or psychologically into public spaces. 

“It causes shame and self-blame and poor self-concept,” McGarrity told us. “It affects how you feel, your relationships, your health behaviors, your willingness to seek healthcare in the first place. It is pervasive and harmful and is the norm for patients with higher body weight, and it does not just disappear after surgery – even years after, even with significant weight loss.”

The researchers assessed 148 patients who underwent MBS at University of Utah prior to surgery and again between 1.5-3 years following surgery using well-validated psychological and social measures, including of experienced weight stigma. They used statistical models that allowed them to control for relevant variables like demographics (age, sex, race, education) and pre-surgery measures of mental health, dysregulated eating, and BMI, to increase the researchers’ confidence in the results.

“We found that stigma improves, on average, for these patients from before to approx. two years after MBS and that this improvement is associated with improvements in mental health and dysregulated eating behaviors as well as weight loss,” McGarrity told us. 

While 94% of the sample reported past week experiences of stigma and discrimination at the pre-surgery surgery, 42% reported these experiences at the post-surgery survey. 

“It is encouraging that stigma appears to improve,” noted McGarrity, “but the higher the level of stigma that patients continue to experience in the years after bariatric surgery, the higher their risk for ongoing symptoms of depression, anxiety, binge eating, disordered eating, and the higher their BMI.”

The most surprising finding, according to McGarrity, was the change in BMI from pre to post-surgery (the amount of weight patients lost) was not associated with the mental health and eating behavior variables, while the weight stigma they experienced was consistently associated with these outcomes.  

“That suggests to us that weight stigma may be the more important variable than actual weight loss in understanding patient mental health over time following MBS,” McGarrity told us. “We need targeted interventions.” 

Bariatric care must go beyond the body to address whole person health, including stigma, notes McGarrity. Psychologists and other mental health professionals should be involved not just at the time of the pre-surgery evaluation but in the years following surgery to best support patients. 

“Bariatric surgery clinical teams cannot change the amount of stigma patients face in the world but they can convey to patients that they understand weight is much more complicated than the ‘just eat less and exercise more’ message they so often receive,” McGarrity told us. “The team can explicitly discuss stigma the same way they discuss any other risks to the patient’s health and work with them to avoid internalizing it. We also need to go beyond healthcare changes to address weight stigma in public education, policy, and media portrayals.”