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Obesity (Silver Spring). 2015 Feb;23(2):266-76. doi: 10.1002/oby.20952. Epub 2014 Dec 31.

Weight stigma "gets under the skin"-evidence for an adapted psychological mediation framework: a systematic review.

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Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Germany; Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany; Mailman School of Public Health, Department of Epidemiology, Columbia University, New York City, New York, USA.



Research consistently shows a negative view of individuals with obesity in the general public and in various other settings. Stigma and discrimination can be considered chronic stressors, as these factors have a profound impact on the psychological well-being of the affected individuals. This article proposes a framework that entails a mediation of the adverse effects of discrimination and stigmatization on mental well-being through elevated psychological risk factors that are not unique to weight but that could affect overweight and normal-weight individuals alike.


A systematic review was conducted to assess the prevalence of psychological risk factors, such as self-esteem and coping, in individuals with obesity.


Forty-six articles were assessed and included for detailed analysis. The number of studies on these topics is limited to certain dimensions of psychological processes. The best evaluated association of obesity and psychosocial aspects is seen for self-esteem. Most studies establish a negative association of weight and self-esteem in children and adults. All studies with mediation analysis find a positive mediation through psychological risk factors on mental health outcomes.


This review shows that elevated psychological risk factors are existent in individuals with obesity and that they may be a mediator between weight discrimination and pathopsychological outcomes.

[Indexed for MEDLINE]
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