Who drives weight stigma? A multinational exploration of clustering characteristics behind weight bias against preconception, pregnant, and postpartum women.

Background: Weight bias is a global health challenge and community members are endorsed as the most common source of weight bias. The nature of weight biases specifically against preconception, pregnant, and postpartum (PPP) women from the perspective of community members is not known, especially in terms of cross-cultural trends. We investigated the magnitude of explicit and implicit weight bias and profiles of characteristics associated with harbouring weight bias.

Methods: We conducted a multinational investigation of clusters of factors associated with weight bias against PPP women (May-July 2023). Community members from Australia, Canada, United States (US), United Kingdom (UK), Malaysia, and India completed a cross-sectional survey measuring explicit and implicit weight biases, beliefs about weight controllability, and awareness of sociocultural body ideals. Hierarchical multiple regression and latent profile analyses identified clusters of factors associated with weight bias.

Results: Participants from India reported the lowest explicit weight bias (B = -0.45, p = 0.02). Participants from Australia (B = -0.14, p = 0.04) and the UK (B = -0.16, p = 0.02) (vs. US) reported the lowest implicit weight bias. Three distinct profiles were identified clustering on body mass index (BMI) and weight-controllability beliefs: low-BMI/moderate-beliefs, high-BMI/more biased beliefs, and high-BMI/less biased beliefs. Profile membership varied by country of residence and weight bias outcomes with low-BMI/moderate-beliefs profiles containing more people from non-Western countries and with low explicit weight bias.

Conclusions: Explicit and implicit weight bias was harboured by participants across all included nations, although less pronounced in non-Western countries. Our profiles highlight that individuals who held a stronger belief that weight is controllable, regardless of their body weight, should be targeted for interventions to eliminate weight stigma.