INTRODUCTION

Obesity and overweight are significant public health issues globally¹. Currently, it is estimated that over one billion people worldwide are overweight according to their body mass index (BMI), while approximately 650 million are diagnosed with obesity². In Chile, according to data from the National Health Survey (ENS, by its Spanish acronym) 2016-2017, 31.2% of adults are obese, while 3.2% are classified as morbidly obese, and 39.8% are overweight¹.

This growing epidemic of obesity not only brings physical complications but also entails significant psychological and social effects, among which weight stigma stands out³. A WHO report indicates that 54% of adults with obesity report being stigmatized by their coworkers, and 69% of adults with obesity report experiences of stigma from healthcare professionals³. Weight stigma refers to the discrimination, prejudice, and social stigmatization experienced by individuals with excessive malnutrition, with severe implications for their mental and physical well-being, including decreased self-esteem, depression, anxiety, and even social exclusion⁴.

In the Chilean context, although there is legislation prohibiting discrimination, weight stigma is not considered a protected aspect⁵. The adoption of measures to safeguard the rights of people with overweight and obesity is crucial to prevent injustice and harm arising from stigma^5-6.

An important aspect in the study of weight stigma is the perception people have of their own body and that of others. It has been observed that individuals with a normal BMI tend to perceive those with overweight or obesity as lazy or sedentary, with a lack of willpower or self-discipline, which contributes to negative stereotypes⁷. Previous research suggests that those diagnosed with obesity tend to have a more compassionate view toward individuals with the same body condition, which is associated with a lower level of weight stigma⁸.

Weight stigma, besides impacting the quality of life of people with obesity, also involves those who work or study in the health field. In Chile, research on weight stigma among health students is still limited. Some studies have revealed high levels of stigma and discrimination towards people with obesity among Nursing, Medicine, and Nutrition and Dietetics students^9-11. These findings are concerning, as they could negatively influence the quality of care and treatment that future health professionals provide to those with excessive malnutrition. Therefore, the objective of this study is to examine the association between weight stigma and nutritional status among health students at a private university in the Ñuble region, Chile.

MATERIALS AND METHODS

RESULTS

A sample of 156 students was analyzed. Table 1 shows that women represented 72.43% of the participants. 43.58% reported an age between 21-23 years; 96.79% were Chilean; 30.76% indicated studying Occupational Therapy, and 92.94% reported not living in university residence. Table 2 shows that 50.64% of the participants were classified with a normal nutritional status.

When studying the potential association between nutritional status (BMI) and weight stigma (Table 3), it was found to be statistically significant (p=0.0145). The post hoc test for proportion differences revealed that normal nutritional status was significantly associated with the presence of weight bias (p=0.016).

Using logistic regression (Table 4), it was found that students with a normal BMI were significantly associated with having weight bias (p=0.0163), with a magnitude of OR=6.27 (95% CI: 1.52 - 32.86). After adjusting for sex and field of study, the statistically significant association between normal nutritional status and weight bias remained, withp=0.0028 (Table 5).

Post hoc test of differences in weight bias proportions (reference: no predisposition). Reference groups for nutritional status comparison:^a: overweight, and^b: obesity (underweight category was not used due to zero cases in one cell): ^a:p=0.016;^b:p=0.4900

DISCUSSION

The main objective of this study was to verify the association between weight stigma and nutritional status in a sample of university students enrolled in health-related fields. A statistically significant association was found between students with normal nutritional status (BMI) and the presence of weight stigma, compared to those students who had excess malnutrition. Additionally, it was observed that being female was associated with a higher likelihood of presenting weight bias. These findings are consistent with existing evidence on the levels of stigmatization observed in other health professions^7,9,10,15,16.

A possible explanation for this association could be that individuals with a normal BMI tend to perceive obesity as a personal failure or behavioral problem, reflecting an internal weight-related bias¹⁷. Furthermore, factors associated with the female gender, such as social and cultural norms promoting stricter beauty standards than for men, and the internalization of stigma, influence women's perception and experience regarding their body weight^18-20.

A recent study evaluating weight-related bias attitudes among health professionals showed that they maintain both implicit and explicit bias attitudes towards people with obesity²¹. This increases health care inequalities, leading to lower utilization of health services and interfering with treatment²¹.

The absence of associations between weight stigma and overweight or obesity in this population may be due to various factors, such as differences in self-perception of weight not being considered negative; the presence of coping mechanisms against stigma; internalization of stigma as something normal; and other confounding factors, such as high social support or elevated self-esteem^20,22,23.

It is important to highlight some limitations of this research that should be considered when interpreting the results. First, the cross-sectional design does not allow for the inference of causal relationships or longitudinal changes between variables. Second, the data were based on self-reports, which may introduce potential information biases, such as selection bias and confirmation bias. Third, there is a lack of consensus in the international literature on how to define and measure weight stigma, making it difficult to compare and generalize the findings^24-26. In particular, it is necessary to distinguish between internalized weight stigma, which is a form of negative self-perception affecting eating by making it more restrictive and can generate depressive symptoms; experienced weight stigma, which can act as a motivator or inhibitor of eating behaviors; and caused weight stigma, which implies that the stress generated by exposure to stigmatizing situations increases food intake and unhealthy behaviors in individuals with excess malnutrition^25,27,28. These conceptual differences can create confusion and misinformation among the public interested in this field of research¹⁸.

Despite these limitations, this research opens the discussion in the field of human capital being trained in careers aimed at serving the community, seeking empathetic professionals in many areas, including body perception. Implementing educational and preventive strategies that promote a positive body image and a respectful attitude towards body diversity is crucial. Furthermore, it is suggested to delve deeper into the study of internalized, perceived, and caused weight stigma; concepts that are often confused or masked in scientific literature. In this way, it will be possible to contribute to the generation of knowledge and evidence on this social phenomenon that affects the population with excess malnutrition and future professionals in nutrition and dietetics and other health careers who work directly with patients.

CONCLUSION

In conclusion, this study provides evidence on the association between nutritional status (BMI) and weight stigma in university students in health-related fields, highlighting the importance of addressing weight stigma to avoid prejudice and improve respect towards users. Future studies should consider longitudinal designs and diverse methodologies to deepen the understanding of weight stigma, its associated factors, and its effects on health and psychological well-being.