The Weight of Stigma: Untangling the Links between Body Size, Discrimination, and Health

Sadie O Ridgeway

doi:10.7273/000005069

This dissertation investigates the role of social mechanisms in the relationship between body size and health among adolescents and young adults, focusing on enacted stigma (i.e. discriminatory behavior towards stigmatized individuals). Drawing on two rich data sources, the Panel Study of Income Dynamics (PSID) Transition to Adulthood Supplement (TAS) and Adolescent to Adult Health (Add Health), I test two novel measures of enacted stigma and discrimination, both as it is perceived (through self-reported interpersonal discrimination), and in how it can be observed in behaviors (through social network marginalization). In addition, I focus on youth and young adults, as these important and understudied life stages are sure to shape the links between body size, weight stigma, and health. This dissertation is comprised of three interrelated studies. The first study uses Add Health panel data on adolescents to investigate the relationship between body size, social network characteristics (a measure of enacted stigma), and health, as well as the potential role of gender in shaping these links. The results show that adolescents of size experience social network disadvantage and marginalization and that network characteristics are related to health. However, evidence on the link between body size and health is mixed, and social network characteristics do not explain this relationship when it is present. Results indicate that gender also shapes some of these links. The second study uses the 2017 wave of the Panel Study of Income Dynamics (PSID) Transition to Adulthood Supplement (TAS) data with a sample of young adults to test the role of perceived weight discrimination in the link between body size and health. In addition, drawing upon weight-based social identity threat and stress theories, it examines the mechanisms through which weight discrimination harms health. This study finds that weight discrimination mediates the relationship between body size and psychological distress. In addition, weight discrimination is associated with poor/fair self-rated health partially through its impact on self-esteem, and psychological distress through its impact on largely self-esteem as well as smoking and risky behaviors. The third study uses the PSID data with a sample of only overweight young adults to examine if key social characteristics (i.e., body size, gender, race/ethnicity, and class) and social resources (social integration, social support, and social well-being from both parents and romantic partners) shape the impact of weight discrimination on mental health, revealing factors that facilitate vulnerability or resiliency. Results show that race and body size significantly shape the effect of weight discrimination on psychological distress. In addition, marriage, parental closeness, and social well-being significantly moderate the effect of perceived weight discrimination, providing substantial protection from psychological distress as a result. Together, these studies reveal the role of weight stigma and discrimination in producing health disparities across body size, the mechanisms through which these disparities are produced, and protective and exacerbating factors for youth and young adults. It underscores body size as an under-examined yet salient social characteristic shaping well-being and demonstrates the health implications of weight stigma.

The Weight of Stigma: Untangling the Links between Body Size, Discrimination, and Health

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