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Clinical Research

The association of age of onset of obesity with experienced weight stigma in adulthood

Abstract

Background

Experienced weight stigma (EWS) is linked to adverse physical and mental health outcomes, including maladaptive health behaviors and attenuated weight loss in people with obesity. Limited research is available regarding the association between the age of onset and severity of obesity and lifetime experience of EWS among adults with obesity.

Methods

Cross-sectional survey data (n = 686) from a single-site academic obesity medicine program was analyzed, including demographics, anthropometric measures, and the Stigmatizing Situations Inventory (SSI-B). The median SSI-B score was used to dichotomize the EWS outcome variable. Crude associations were assessed by chi-square and logistic regression analyses. Multivariable logistic regression determined age-adjusted odds ratios (aOR) of EWS with body mass index (BMI) at age 18 years and peak BMI.

Results

Participants had a mean age of 55.8 years (SD = 12.7), and the majority were female and white. EWS was correlated with BMI at age 18 years (r = 0.38; p = 0.001) and peak BMI (r = 0.48; p = 0.001) before and after adjustment. Those with severe obesity (BMI ≥ 40) by 18 years had 2.79 times higher odds (aOR = 2.79; 95% CI: 1.38, 5.62; p < 0.01) of severe EWS vs. those who developed severe obesity after 18 years; 2.17 higher odds [aOR = 2.17; 95% CI: 1.08, 4.35; p = 0.009] of severe EWS versus those with BMI < 40 at 18 years; 2.98 times higher odds [aOR = 2.98; 95% CI: 1.44, 6.15; p = 0.001] of severe EWS vs. those with BMI < 30 at 18 years; and 4.06 times higher odds [aOR = 4.06; 95% CI: 1.39, 6.73; p = 0.001] of severe EWS vs. those with BMI < 25 at 18 years.

Conclusion

Those with severe obesity before the age of 18 years were nearly 3 times more likely to report severe EWS than people who developed severe obesity later in life. Healthcare providers should consider screening for EWS in people with early onset of severe obesity, to identify those who may benefit from weight stigma interventions and support.

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Fig. 1: Adjusted odds ratios and 95% confidence intervals of severe EWS by class of obesity in adolescence.
Fig. 2: Adjusted odds ratios and 95% confidence intervals of severe EWS among those with an adolescent BMI and adult BMI ≥ 40 compared to other weight category combinations.

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Data availability

The datasets used or analyzed in this study are available from the corresponding author upon reasonable request.

Code availability

The code used in this study is available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

Authors

Contributions

DE, MC, LX, SM, and JA were involved in the design of the study, analysis, interpretation, writing, critical review, and final approval of the manuscript. CG and JF were involved in the writing, critical review, and final approval of the manuscript. JS, JG, GV and MM were involved in the design of study protocols, data collection, critical review, and final approval of the manuscript. AC was involved in the critical review and final approval of the manuscript.

Corresponding author

Correspondence to Jaime P. Almandoz.

Ethics declarations

Competing interests

Dr. Jaime P. Almandoz has received advisory/consulting fees and/or other support from Novo Nordisk A/S, Boehringer Ingelheim, and Eli Lilly and Company. All other authors declare no competing financial interests.

Ethics approval and consent to participate

All methods included in this study were performed in accordance with relevant guidelines and regulations. The University of Texas Southwestern Medical Center Internal Review Board approved this study (IRB# STU-2022-0265), and informed consent was obtained from all participants.

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Ernest, D.K., Cali, M., Gazda, C. et al. The association of age of onset of obesity with experienced weight stigma in adulthood. Int J Obes (2025). https://doi.org/10.1038/s41366-025-01769-7

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