Weight Stigma and Health-Related Quality of Life for Black Americans: The Mediating Role of Body Appreciation

Background and Purpose: Internalized weight stigma and enacted weight discrimination are commonly experienced by high weight individuals and are related to poorer health outcomes. Research on body appreciation, a modifiable and positive construct of body image, indicates beneficial relationships to health and an inverse relationship to weight stigma. Additionally, although Black individuals have a high prevalence of high weight, studies on their experiences of weight stigma in relation to health are scant. To address this gap, this study examined whether body appreciation mediated relationships between internalized weight stigma and weight-based discrimination, and physical and mental health related quality of life (HRQOL), for high weight Black individuals.

Methods: A cross-sectional survey design was applied to collect data using the Prolific platform in October and November 2025. The final sample included 473 Black men and women in the U.S. who were English speaking, 35 years or older, and with a Body Mass Index (BMI)>25. Most of our sample were female (79.8%) and had health insurance for all the prior 12 months (85.1%), and the sample had a mean age of 48.67 years (SD = 9.85, range = 35-81). Our independent variables, internalized weight stigma and weight-based discrimination, were measured using the 11-item Weight Bias Internalization Scale-Modified (WBIS) and a weight-focused version of the 9-item Everyday Discrimination Scale (EDS). Body appreciation, the hypothesized mediator, was measured using the Body Appreciation Scale-2. Our dependent variables, mental and physical HRQOL, were measured using the mental and physical component scales of the Short Form (SF)-12 Health Survey. Control variables included sex (male/female), health insurance status (uninsured at some point during prior 12 months; yes/no), age (continuous), and BMI (continuous). We used the PROCESS Macro (Hayes, 2022) in SPSS 31 to complete a series of linear regression analyses to examine the direct, indirect, and total relationships between the variables.

Results: The tested models explained between 30% and 47% of the variance in the dependent variables. Statistically significant direct relationships were found for all variables, and body appreciation mediated the relationships between 1) WBIS and physical HRQOL (B = -.024, 95% CI = -.042, -.006), 2) WBIS and mental HRQOL (B = -.071, 95% CI = -.010, -.047), 3) EDS and physical HRQOL (B = -1.232, 95% CI = -2.011, -.632), and 4) EDS and mental HRQOL (B = -3.791, 95% CI = -5.205, -2.603). The mediating role of body appreciation was strongest for relationships with mental HRQOL, accounting for 47% of the total effect for WBIS and 35% for EDS.

Conclusion: These findings have implications for research and practice aimed at understanding/mitigating weight stigma’s effect on Black Americans’ health. Most notably, body appreciation may be a particularly valuable intervention target to address the contributions of internalized weight stigma to poorer mental HRQOL for high weight Black individuals. Future research is needed to identify additional intervention targets to improve HRQOL for individuals who experience or internalize weight stigma. Additionally, intervention research is needed to test these relationships, and examine differential impacts based on background and experience characteristics.