Degree Date

1-2025

Document Type

Dissertation - Public Access

Degree Name

Ph.D. Doctor of Philosophy

Academic Discipline

Community Psychology

First Advisor

Suzette Fromm Reed

Second Advisor

Bradley Olson

Third Advisor

Rutuja Patel

Abstract

The obesity epidemic is a ‘wicked’ problem with a complex web of determinants and outcomes. While generally higher for minoritized populations, prevalence rates manifest in surprising, nonlinear patterns. There is no consensus regarding treatment protocols or mitigation efforts, except that current efforts remain largely ineffective. Much research evidence that a profusion of determinants of health support obesity pathogenesis through various physiological processes and mechanisms, including the allostatic load, mitochondria functioning, the gut microbiome, and epigenetics. Intervening to support markers of the allostatic load (immunity, inflammation, and metabolic health) may provide a more effective treatment outcomes than traditional approaches, which tend to focus on behavioral modification, medication, or surgery. Internalized weight stigma is one such determinant. This study examined the relationships among chronic stressors (including childhood adversity, perceived stress, and internalized weight stigma), resilience factors (including subjective happiness and positive childhood experiences), and BMI/obesity diagnosis for adult participants in Illinois. It also explored the relationships among patient preferences for care, perceptions of clinical stigma, and demographic variables. The findings evidenced that internalized weight stigma, but not childhood adversity or perceived stress, predicted BMI/obesity diagnosis. It also found that perceived stress and childhood adversity predicted internalized weight stigma. In general, the resilience factors were not strong mediators, save for subjective happiness for perceived stress and internalized weight bias. This research suggests that chronic stress may put an individual at higher risk of internalizing weight stigma, which supports increased BMI. This study’s findings also support that White participants are at greater risk of perceiving weight stigma and that people with obesity, compared to those without obesity, perceive greater stigmatization in clinical settings and are less likely to want physicians to discuss their weight. Together, these findings may be interpreted to support the requirement for multidisciplinary, trauma-informed treatment protocols capable of addressing the mental precursors and repercussions of the disease. Obesity treatment policies and protocols must strive to eliminate stigmatic practices, language, and aspects of the environment to better support individuals to reach their weight goals.

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