Exploring how weight stigma relates to psychological distress, physical activity, and eating behaviors over time: a longitudinal study among young adults in Hong Kong

Abstract

Data availability: The datasets generated during and/or analyzed during the present study are available from the corresponding author upon reasonable request.Supplementary Information is available online at: https://link.springer.com/article/10.1186/s40337-026-01525-w#Sec32 .Plain English summary: Weight stigma, discrimination due to an individual’s body weight, is a public health concern. It has been found that weight stigma is harmful to an individual’s mental and physical health, and such negative impact may create a harmful cycle. However, there is little clear evidence that the cycle exists, especially among individuals from East Asia. To investigate this issue, a study followed young adults in Hong Kong to examine how weight stigma relates to mental health, eating behaviors, exercise habits, and weight changes. Young adults were surveyed over a one-year period across four timepoints; Time 1 (T₁; n = 345), T₂ (n = 253), T₃ (n = 233), T₄ (n = 235). Results indicated that relationships existed over time in the connections between (i) perceived stigma (awareness of stigma) and self-stigma (stigma towards oneself), and (ii) between self-stigma and perceived behavioral control. In summary, the rate of change of these variables did not correlate with changes in body mass index (BMI). However, self-stigma showed a negative association with BMI at later timepoints. Findings supported a clearer understanding of weight management and highlighted the harmful impact of stigma. The findings also showed significant issues with weight stigma in Hong Kong, emphasizing the need for improved public education and stigma reduction efforts. Further research is needed to determine whether weight stigma can be influenced by changes in weight.Background: Many researchers have expressed concerns that weight stigma may cause adverse health effects and worsen weight issues in a vicious cycle. However, empirical evidence evaluating this cycle is scarce, especially among Eastern Asians. The present study investigated the temporal associations among perceived weight stigma, weight-related self-stigma, psychological distress, perceived behavioral control, physical activity, eating behaviors, and body mass index (BMI) changes. Methods: A one-year longitudinal survey was carried out to explore if the weight cycle exists among young adults in Hong Kong. The study comprised 345 participants at Time 1 (T₁), 253 participants at T₂, 233 participants at T₃, and 235 participants at T₄. Participants completed self-reported psychometric instruments in an online survey. The analysis employed parallel process latent growth curve modeling and a random intercept cross-lagged panel model. Results: Temporal relationships existed in the connections between perceived stigma and self-stigma, and self-stigma and perceived behavioral control. A negative relationship between self-stigma and future BMI was found, whereas future self-stigma showed no significant association with previous BMI. Conclusion: The growth trajectories of the studied variables did not correlate with changes in BMI. However, self-stigma showed a negative association with subsequent BMI in a different model. Further research is needed to clarify whether weight stigma is impacted by changes in BMI.Open access funding provided by National Cheng Kung University. Jian-Han Chen is supported by the E-Da Hospital funding (EDAHP114007)