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HIV Status, Obesity, and Risk for Weight Stigma: Comparing Weight Stigma Experiences and Internalization Among Adults with Obesity with and Without HIV

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Abstract

Little is known about weight stigma among people living with HIV (PLWH). This study examined whether levels of perceived weight stigma experiences and internalization, assessed retrospectively and naturalistically, differed among adults with obesity based on HIV status. 50 PLWH (BMI = 35 kg/m2) and 51 adults without HIV (BMI = 36 kg/m2) completed retrospective assessments of lifetime perceived weight stigma experiences/internalization. Next, participants were invited to complete an optional 2-week Ecological Momentary Assessment study. 28 PLWH and 39 adults without HIV completed five momentary assessments of perceived weight stigma experiences/internalization daily. In covariate-adjusted models, PLWH reported 1.2–2.8 times lower frequency of lifetime and momentary perceived weight stigma experiences than adults without HIV, but levels of retrospectively- and naturalistically-assessed internalized weight stigma did not differ between groups. Findings suggest that HIV status may buffer against perceptions of weight stigma events, but not internalized weight stigma, highlighting weight stigma as an important area for future research in PLWH.

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Data is available upon request and based on the journal’s policies.

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References

  1. Puhl RM, Latner J, O’Brien K, Luedicke J, Daníelsdóttir S, Forhan M. A multinational examination of weight bias: predictors of anti-fat attitudes across four countries. Int J Obes. 2015;39(7):1166–73.

    Article  CAS  Google Scholar 

  2. Himmelstein MS, Incollingo Belsky AC, Tomiyama AJ. The weight of stigma: cortisol reactivity to manipulated weight stigma. Obesity. 2015;23(2):368–74.

    Article  PubMed  Google Scholar 

  3. Drury CAA, Louis M. Exploring the association between body weight, stigma of obesity, and health care avoidance. J Am Acad Nurse Pract. 2002;14(12):554–61.

    Article  PubMed  Google Scholar 

  4. Friedman KE, Reichmann SK, Costanzo PR, Zelli A, Ashmore JA, Musante GJ. Weight stigmatization and ideological beliefs: relation to psychological functioning in obese adults. Obes Res. 2005;13(5):907–16.

    Article  PubMed  Google Scholar 

  5. Sutin AR, Terracciano A. Perceived weight discrimination and obesity. PLoS ONE. 2013;8(7):e70048.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Daly M, Sutin AR, Robinson E. Perceived weight discrimination mediates the prospective association between obesity and physiological dysregulation: evidence from a population-based cohort. Psychol Sci. 2019;30(7):1030–9.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Durso LE, Latner JD. Understanding self-directed stigma: development of the weight bias internalization scale. Obesity. 2008;16(S2):S80–6.

    Article  PubMed  Google Scholar 

  8. Puhl RM, Himmelstein MS, Quinn DM. Internalizing weight stigma: prevalence and sociodemographic considerations in US adults. Obesity. 2018;26(1):167–75.

    Article  PubMed  Google Scholar 

  9. Rudolph A, Hilbert A. A novel measure to assess self-discrimination in binge-eating disorder and obesity. Int J Obes. 2015;39(2):368–70.

    Article  CAS  Google Scholar 

  10. Pearl RL, Puhl RM. The distinct effects of internalizing weight bias: an experimental study. Body Image. 2016;17:38–42.

    Article  PubMed  Google Scholar 

  11. Pearl RL, Puhl RM, Dovidio JF. Differential effects of weight bias experiences and internalization on exercise among women with overweight and obesity. J Health Psychol. 2015;20(12):1626–32.

    Article  PubMed  Google Scholar 

  12. Pearl RL, Wadden TA, Hopkins CM, et al. Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity. Obesity. 2017;25(2):317–22.

    Article  CAS  PubMed  Google Scholar 

  13. Tate T, Willig AL, Willig JH, et al. HIV infection and obesity: where did all the wasting go? Antivir Ther. 2012;17(7):1281.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Macallan DC. Wasting in HIV infection and AIDS. J Nutr. 1999;129(1):238S-S242.

    Article  CAS  PubMed  Google Scholar 

  15. Grinspoon SK. Perspective cardiovascular disease in HIV: traditional and nontraditional risk factors. Top Antivir Med. 2014;22(4):676.

    PubMed  Google Scholar 

  16. Lake JE. The fat of the matter: obesity and visceral adiposity in treated HIV infection. Curr HIV/AIDS Rep. 2017;14(6):211–9.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Achhra A, Mocroft A, Reiss P, et al. Short-term weight gain after antiretroviral therapy initiation and subsequent risk of cardiovascular disease and diabetes: the D:A: D study. HIV Med. 2016;17(4):255–68.

    Article  CAS  PubMed  Google Scholar 

  18. Levy M, Greenberg A, Hart R, et al. High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington DC. HIV Med. 2017;18(10):724–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief, no 360. Hyattsville, MD: National Center for Health Statistics. 2020.

  20. Rice WS, Logie CH, Napoles TM, et al. Perceptions of intersectional stigma among diverse women living with HIV in the United States. Soc Sci Med. 2018;208:9–17.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Hernandez DB. Overweight and obesity in persons living with HIV: stigma and health [dissertation on the Internet]. Storrs, CT: University of Connecticut; 2016. Available from: https://opencommons.uconn.edu/dissertations/1167.

  22. Grollman EA. Multiple disadvantaged statuses and health: the role of multiple forms of discrimination. J Health Soc Behav. 2014;55(1):3–19.

    Article  PubMed  Google Scholar 

  23. Turan JM, Elafros MA, Logie CH, et al. Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Med. 2019;17(1):7.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Jones CY, Hogan JW, Snyder B, et al. Overweight and human immunodeficiency virus (HIV) progression in women: associations HIV disease progression and changes in body mass index in women in the HIV epidemiology research study cohort. Clin Infect Dis. 2003;37(2):S69–80.

    Article  PubMed  Google Scholar 

  25. Tate H, George R. The effect of weight loss on body image in HIV-positive gay men. AIDS Care. 2001;13(2):163–9.

    Article  CAS  PubMed  Google Scholar 

  26. Clark RA, Niccolai L, Kissinger PJ, Peterson Y, Bouvier V. Ethnic differences in body image attitudes and perceptions among women infected with human immunodeficiency virus. J Acad Nutr Diet. 1999;99(6):735.

    CAS  Google Scholar 

  27. Sax PE, Erlandson KM, Lake JE, et al. Weight gain following initiation of antiretroviral therapy: risk factors in randomized comparative clinical trials. Clin Infect Dis. 2019;71(6):1379–89.

    Article  PubMed Central  Google Scholar 

  28. Stutterheim SE, Bos AE, Pryor JB, Brands R, Liebregts M, Schaalma HP. Psychological and social correlates of HIV status disclosure: the significance of stigma visibility. AIDS Educ Prev. 2011;23(4):382–92.

    Article  PubMed  Google Scholar 

  29. Sharma A, Howard A, Schoenbaum E, Buono D, Webber MP. Body image in middle-aged HIV-infected and uninfected women. AIDS Care. 2006;18(8):998–1003.

    Article  CAS  PubMed  Google Scholar 

  30. Shiffman S, Stone AA, Hufford MR. Ecological momentary assessment. Annu Rev Clin Psychol. 2008;4:1–32.

    Article  PubMed  Google Scholar 

  31. Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44(2):174–99.

    Article  Google Scholar 

  32. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.

    Article  PubMed  Google Scholar 

  33. LifeData LLC 2016. https://www.lifedatacorp.com.

  34. Reichenberger J, Kuppens P, Liedlgruber M, et al. No haste, more taste: an EMA study of the effects of stress, negative and positive emotions on eating behavior. Biol Psychol. 2018;131:54–62.

    Article  PubMed  Google Scholar 

  35. Schafer MH, Ferraro KF. The stigma of obesity: does perceived weight discrimination affect identity and physical health? Soc Psychol Q. 2011;74(1):76–97.

    Article  Google Scholar 

  36. Himmelstein M, Puhl RM, Quinn DM. Intersectionality: an understudied framework for addressing weight stigma. Am J Prev Med. 2017;53(4):421–31.

    Article  PubMed  Google Scholar 

  37. Myers A, Rosen JC. Obesity stigmatization and coping: relation to mental health symptoms, body image, and self-esteem. Int J Obes. 1999;23(3):221.

    Article  CAS  Google Scholar 

  38. Vartanian LR. Development and validation of a brief version of the Stigmatizing Situations Inventory. Obes Sci Pract. 2015;1(2):119–25.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Puhl RM, Brownell KD. Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity. 2006;14(10):1802–15.

    Article  PubMed  Google Scholar 

  40. Puhl RM, Moss-Racusin CA, Schwartz MB. Internalization of weight bias: implications for binge eating and emotional well-being. Obesity. 2007;15(1):19–23.

    Article  PubMed  Google Scholar 

  41. Carr D, Friedman MA, Jaffe K. Understanding the relationship between obesity and positive and negative affect: the role of psychosocial mechanisms. Body Image. 2007;4(2):165–77.

    Article  PubMed  Google Scholar 

  42. Puhl RM, Himmelstein MS, Watson RJ. Weight-based victimization among sexual and gender minority adolescents: findings from a diverse national sample. Pediatr Obes. 2019;14(7):e12514.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Pearl RL, Puhl RM. Measuring internalized weight attitudes across body weight categories: validation of the modified weight bias internalization scale. Body Image. 2014;11(1):89–92.

    Article  PubMed  Google Scholar 

  44. Hilbert A, Baldofski S, Zenger M, Löwe B, Kersting A, Braehler E. Weight Bias Internalization Scale: psychometric properties and population norms. PLoS ONE. 2014;9(1):e86303.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Pearl R, Puhl R. Weight bias internalization and health: a systematic review. Obes Rev. 2018;19(8):1141–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Vartanian LR, Pinkus RT, Smyth JM. The phenomenology of weight stigma in everyday life. J Contextual Behav Sci. 2014;3(3):196–202.

    Article  Google Scholar 

  47. Sutin AR, Stephan Y, Terracciano A. Weight discrimination and risk of mortality. Psychol Sci. 2015;26(11):1803–11.

    Article  PubMed  Google Scholar 

  48. Panza E, Olson K, Goldstein CM, Selby EA, Lillis J. Characterizing lifetime and daily experiences of weight stigma among sexual minority women with overweight and obesity: a descriptive study. Int J Environ Res Public Health. 2020;17(13):4892.

    Article  PubMed Central  Google Scholar 

  49. Forman EM, Schumacher LM, Crosby R, et al. Ecological momentary assessment of dietary lapses across behavioral weight loss treatment: characteristics, predictors, and relationships with weight change. Ann Behav Med. 2017;51(5):741–53.

    Article  PubMed  Google Scholar 

  50. Oldenburg CE, Perez-Brumer AG, Reisner SL. Poverty matters: contextualizing the syndemic condition of psychological factors and newly diagnosed HIV infection in the United States. AIDS (Lond, Engl). 2014;28(18):2763.

    Article  Google Scholar 

  51. Sharma A, Howard A, Klein R, Schoenbaum E, Buono D, Webber MP. Body image in older men with or at-risk for HIV infection. AIDS Care. 2007;19(2):235–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Pearl RL, Hopkins CH, Berkowitz RI, Wadden TA. Group cognitive-behavioral treatment for internalized weight stigma: a pilot study. Eat Weight Disord. 2018;23(3):357–62.

    Article  PubMed  Google Scholar 

  53. Forbes YN, Moffitt RL, Van Bokkel M, Donovan CL. Unburdening the weight of stigma: findings from a compassion-focused group program for women with overweight and obesity. J Cogn Psychother. 2020;34(4):336–57.

    Article  PubMed  Google Scholar 

  54. Dunaev J, Markey CH, Brochu PM. An attitude of gratitude: the effects of body-focused gratitude on weight bias internalization and body image. Body Image. 2018;25:9–13.

    Article  PubMed  Google Scholar 

  55. Cargill V, Fenton KA. The epidemiology, prevention, and control of HIV/AIDS among African Americans. HIV/AIDS in US communities of color: Springer; 2009. pp. 1–21.

  56. Helleberg M, Afzal S, Kronborg G, et al. Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study. Clin Infect Dis. 2013;56(5):727–34.

    Article  PubMed  Google Scholar 

  57. Purcell DW, Parsons JT, Halkitis PN, Mizuno Y, Woods WJ. Substance use and sexual transmission risk behavior of HIV-positive men who have sex with men. J Subst Abuse. 2001;13(1–2):185–200.

    Article  CAS  PubMed  Google Scholar 

  58. Crenshaw K. Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. Univ Chic Leg Forum. 1989:139. Available at: http://chicagounbound.uchicago.edu/uclf/vol1989/iss1/8.

  59. Bowleg L. The problem with the phrase women and minorities: intersectionality—an important theoretical framework for public health. Am J Public Health. 2012;102(7):1267–73.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Potter L, Meadows A, Smyth J. Experiences of weight stigma in everyday life: an ecological momentary assessment study. J Health Psychol. 2020:1359105320934179.

  61. Seacat JD, Dougal SC, Roy D. A daily diary assessment of female weight stigmatization. J Health Psychol. 2016;21(2):228–40.

    Article  PubMed  Google Scholar 

  62. Carels RA, Rossi J, Solar C, Selensky JC. An ecological momentary assessment of weight stigma among weight loss participants. J Health Psychol. 2019;24(9):1155–66.

    Article  PubMed  Google Scholar 

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Acknowledgements

We wish to thank study participants for devoting their time and energy to participate in this research as well as our research team for assisting with data collection, including Bianca Obiakor and Deborah Good.

Funding

This work was supported by the Dr. George A. Bray Research Scholars Award Fund, Department of Medicine, Warren Alpert Medical School of Brown University; The Miriam Hospital Immunology Center; The Providence/Boston Center for AIDS Research (CFAR; NIH Grant P30AI042853); and training grants from the National Heart, Lung, and Blood Institute (T32HL076134), the National Institute on Minority Health and Health Disparities (K23MD015092), and the National Institute of Diabetes and Digestive and Kidney Diseases (K23DK124578).

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Authors and Affiliations

  1. Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI, 02903, USA

    Emily Panza, Jason Lillis, KayLoni Olson & Rena R. Wing

  2. Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA

    Emily Panza, Jason Lillis, KayLoni Olson & Rena R. Wing

  3. Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA

    Jacob J. van den Berg

  4. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Jacob J. van den Berg

  5. The Providence/Boston Center for AIDS Research (CFAR), Providence, RI, USA

    Jacob J. van den Berg & Karen Tashima

  6. Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA

    Jacob J. van den Berg & Karen Tashima

  7. The Miriam Hospital Immunology Center, The Miriam Hospital, Providence, RI, USA

    Karen Tashima

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  1. Emily Panza
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  2. Jason Lillis
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  4. Jacob J. van den Berg
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  6. Rena R. Wing
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Contributions

EP, JL, KO, and RW contributed to the study’s conception, design, and development of aims. EP, KT, and RW had integral roles in data collection, project administration, and provision of resources. EP acquired the software and primary funding for the study, developed the study methodology, and conducted formal analysis. EP, JL, KO, JVDB, and RW contributed to writing the original draft of the manuscript, and all authors contributed to reviewing and editing the manuscript.

Corresponding author

Correspondence to Emily Panza.

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The authors have no conflicts of interest to declare that are relevant to the content of this article.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

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Participants consented to the publication of their deidentified data for research purposes.

Ethical Approval

All study procedures were approved by the Institutional Review Board at the Miriam Hospital in Providence, Rhode Island. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Panza, E., Lillis, J., Olson, K. et al. HIV Status, Obesity, and Risk for Weight Stigma: Comparing Weight Stigma Experiences and Internalization Among Adults with Obesity with and Without HIV. AIDS Behav 26, 686–697 (2022). https://doi.org/10.1007/s10461-021-03428-0

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