title: The Role of Stigma in Weight Loss Maintenance Among U.S. Adults.
abstract: BACKGROUND
  Challenges of maintaining long-term weight loss are well-established and present significant obstacles in obesity prevention and treatment. A neglected but potentially important barrier to weight-loss maintenance is weight stigmatization.
  
  
  OBJECTIVE
  We examined the role of weight stigma-experienced and internalized-as a contributor to weight-loss maintenance and weight regain in adults.
  
  
  METHODS
  A diverse, national sample of 2702 American adults completed an online battery of questionnaires assessing demographics, weight-loss history, subjective weight category, experienced and internalized weight stigma, weight-monitoring behaviors, physical activity, perceived stress, and physical health. Analyses focused exclusively on participants who indicated that their body weight a year ago was at least 10% less than their highest weight ever (excluding pregnancy), the weight loss was intentional, and that attempts to lose or maintain weight occurred during the past year (n = 549). Participants were further classified as weight regainers (n = 235) or weight-loss maintainers (n = 314) based on subsequent weight loss/gain. Data were collected in 2015 and analyzed in 2016.
  
  
  RESULTS
  Hierarchical logistic regression models showed that internalized weight stigma and subjective weight category made significant individual contributions to prediction of weight-loss maintenance, even after accounting for demographics, perceived stress, experienced stigma, physical health, and weight-loss behaviors. For every one-unit increase in internalized weight stigma, the odds of maintaining weight loss decreased by 28% (95% CI: 14-40%, p < .001).
  
  
  CONCLUSIONS
  Findings provide initial evidence that overlooked psychosocial factors, like weight stigma, may hinder weight-loss maintenance. Implications for addressing stigma in obesity-focused clinical interventions are highlighted.
authors.affiliation: Department of Human Development and Family Studies, Rudd Center for Food Policy and Obesity, University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT, 06103, USA. Rebecca.puhl@uconn.edu.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Puhl
authors.affiliation: Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Quinn
authors.affiliation: Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA.
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Weisz
authors.affiliation: University of Massachusetts Medical School, Worscester, MA, USA.
authors.forename: Young J
authors.initials: YJ
authors.lastname: Suh
mesh_terms: D000328:Adult; D015444:Exercise / Q000523:psychology; D005247:Feeding Behavior / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D057545:Social Stigma; D013315:Stress, Psychological; D014481:United States; D015430:Weight Gain; D015431:Weight Loss; D055815:Young Adult
keywords: Bias; Internalization; Obesity; Stigma; Weight loss maintenance