Overview of Included Studies

This review included 21 studies, of which 19 were conducted in the United States, 1 in Canada, and 1 in Germany. Study designs included 10 qualitative studies and 11 quantitative studies, of which 10 were cross-sectional studies and 1 was longitudinal. Qualitative studies primarily relied on in-depth interviews or focus group discussions.

Quantitative studies included sample sizes ranging from 128 [17] to 8,530 [18], while qualitative studies typically included 6 [19] to 73 participants [20], with the exception of one autoethnographic study involving two authors’ self-reflections [21].

Sampling strategies and data sources varied across studies. Quantitative studies most commonly used national probability surveys [22,23,24], online panel surveys [25, 26], registry-based samples [17], or school-based cohorts [18, 27] while qualitative studies primarily relied on purposive, maximum variation, or convenience sampling, as reported by study authors. Several qualitative studies recruited participants through healthcare clinics [28], community-based organizations [29], or LGBTQ-focused organizations [20], while others used online recruitment via social media platforms such as Facebook and X [30, 31].

Study populations included children and adolescents, adults across the BMI spectrum, postpartum women, and groups defined by race and ethnicity, gender identity, sexual orientation, or body size. One qualitative study recruited multiple participant groups such as patients, healthcare providers and staff [20]. Weight stigma was examined across a range of contexts, including healthcare settings, schools, public and social spaces, and general societal contexts (see Table 1).

Quality Appraisal of Included Studies

Among quantitative studies, four were rated as good, six as fair, and one as poor. Overall quality ratings are summarized in Supplementary Table S1. Quality appraisal of qualitative studies indicated that all clearly articulated research aims, employed appropriate qualitative methodologies, and reported findings that addressed their stated research objectives. Most demonstrated adequate rigor in data analysis and reflexivity and addressed ethical considerations. CASP appraisal results are summarized in Supplementary Table S2.

Weight Stigma Constructs or Measurement

All qualitative studies examined weight stigma through participants’ narratives, rather than standardized scales. Across these studies, authors used terms such as weight stigma, sizeism, fatphobia, or anti-fatness to describe lived experiences and social interactions identified through interview data and thematic analysis.

Across qualitative studies, weight stigma was consistently characterized as a relational and context-dependent social process rather than a singular exposure [20, 21, 28]. Participants described it as enacted through interpersonal interactions, institutional encounters, and cultural norms, often alongside other forms of marginalization such as racism, cissexism, and ableism [28, 32]. Commonly reported manifestations included attribution of health concerns to body weight, moral judgments about personal responsibility, and exclusion within healthcare, family, social, and community settings. These constructs were articulated using varied terminology but were consistently grounded in lived experiences of social devaluation and unequal treatment [19, 30].

Among the quantitative studies, weight stigma was most commonly operationalized as experience of weight-based discrimination. Nine studies examined experienced discrimination, typically measured using single-item attribution questions [23], binary indicators of unfair treatment [1], or adaptations of the Everyday Discrimination Scale that included weight as an attributed reason [24].

Internalized weight stigma was examined in five quantitative studies. Four studies measured internalized weight stigma using the modified Weight Bias Internalization Scale (WBIS-M) [1, 25], while one study used the Weight Self-Stigma Questionnaire (WSSQ) [33]. In some studies, internalized weight stigma was examined alongside measures of experienced weight-based discrimination [1, 17, 25]. A small number of quantitative studies examined weight stigma as part of broader measures of multiple forms of discrimination, in which weight-based discrimination was assessed alongside other forms of discrimination, including race or ethnicity and sexual orientation [18].

One quantitative study examined public obesity stigma using vignette-based measures, in which respondents were randomly assigned to audio vignettes depicting individuals with obesity that varied by gender and occupational position as a proxy for socioeconomic status, and stigma was assessed using standardized scales capturing fat phobia, emotional reactions, and desire for social distance [22].

Conceptualization of Intersectionality in Weight Stigma Studies

Many studies explicitly cited intersectionality theory, most commonly drawing on Crenshaw’s formulation of intersectionality [1, 26, 27, 32, 34, 35]. A smaller number of studies explicitly referenced Black feminist scholarship as the primary theoretical grounding for their intersectional approach [24, 28, 36]. Several studies cited intersectionality alongside additional theoretical perspectives, including minority stress theory [17], life course perspectives [32], social identity threat theory [21], and theories of discrimination and health [34].

Across studies that cited intersectionality, authors generally treated it as a framework for examining intersecting social identities and systems of oppression, including race or ethnicity, gender or gender identity, sexual orientation, socioeconomic position, disability or chronic illness, and body size or weight. A small number of studies referenced intersectionality without citing a specific theoretical framework, using it to signal attention to multiple social identities rather than articulating a theoretically grounded intersectional approach [19, 20, 22, 33].

Intersectional Axes Examined Across Studies

Race and/or ethnicity were the most frequently examined intersectional axes and were included in 18 of the 21 studies (see Table 2). These studies examined weight stigma among racially and ethnically diverse populations or tested differences across racial and ethnic groups. Gender-related axes, including gender, gender identity, sex assigned at birth, or gender presentation, were examined in 12 studies. Several studies focused on cisgender women, transgender men, or gender-diverse populations, while others examined gender as a binary variable in quantitative analyses.

Sexual orientation was examined in 9 studies, including studies of sexual minority women and broader LGBTQ populations. In these studies, sexual orientation was examined alongside weight stigma either descriptively or through subgroup or interaction-based analyses. Socioeconomic position or class was examined in 7 studies, most commonly operationalized using income, education, subjective socioeconomic status, or class-based indicators.

A smaller number of studies examined additional axes, including disability status or chronic illness (n = 4), age or age-related marginalization (n = 3), immigration status (n = 2), and skin color (n = 1). Across studies, most examined two or more intersectional axes in relation to weight stigma, with the number and combination of axes varying by study.

Methodological Implementation of Intersectionality

Studies varied in the analytic approaches used to examine intersecting social identities in relation to weight stigma (Table 2).

Across the ten qualitative studies, intersectionality was operationalized through interpretive analyses of participants’ narratives, including reflexive thematic analysis, phenomenological analysis, life history–informed approaches, and one autoethnographic study. These analyses examined how experiences of weight stigma were articulated in relation to multiple social identities, as described by study authors. For example, a study applied a life history–informed, reflexive thematic analytic approach in which intersectionality guided analytic decisions, examining weight stigma as it unfolded over the life course of sexual minority women, with interpretive attention to how sexual orientation and body size intersected with participants’ racialized and gendered experiences [32].

Six studies used interaction-based regression models, testing interaction terms between weight-related variables and other social identities, such as race or sexual orientation. For instance, one study operationalized intersectionality by estimating interaction terms between weight-based discrimination and race/ethnicity and household income, testing whether the mental health consequences of discrimination were conditioned by respondents’ racial/ethnic and socioeconomic positions [23].

Three studies used stratified or subgroup-based comparisons to assess differences in weight stigma across predefined social identity groupings. For example, one study compared experienced and internalized weight stigma between sexual minority and heterosexual women matched on age, race, and BMI in a U.S. registry sample, operationalizing intersectionality through comparative group design, positioning sexual orientation as the intersecting axis with weight stigma [17].

One study operationalized intersectionality among ethnically diverse U.S. adolescents by applying latent class analysis to identify person-centered patterns of co-occurring attributed discrimination and bullying, based on race/ethnicity, immigration status, perceived sexual orientation, and weight within a school-based survey sample [27].

Another quantitative study longitudinally examined intersectionality by modeling accounts of discrimination experiences attributed to race/ethnicity, perceived sexual orientation, and weight among U.S. children aged 9–12 years, and estimating these associations separately for youth with no, single and intersecting marginalized identities, including overweight status [18].

Outcomes and Phenomena Examined

Across study designs, outcomes and phenomena reflected a range of individual-, interpersonal-, and institutional-level experiences related to weight stigma.

Among qualitative studies, the primary phenomena examined were lived experiences of weight stigma and its co-occurrence with other forms of stigma. These studies focused on stigma in healthcare settings, family and social contexts, public spaces, and across the life course. They also examined how such experiences shaped healthcare access and interactions, identity development, body image, social belonging, and everyday interactions, including the navigation of sexual relationships [20, 28, 30].

Among the quantitative studies, the most commonly examined outcomes were mental health–related outcomes, including psychological distress, depressive symptoms, perceived stress, and eating-related psychopathology [1, 23, 24, 33]. Several studies also examined internalized weight stigma or experienced weight-based discrimination as primary outcomes [1, 17, 25]. Additional quantitative outcomes included substance use intention [18], self-rated health [33], and coping responses to weight stigma [1]. One study examined public obesity stigma outcomes, including fat phobia, emotional reactions, and desire for social distance toward hypothetical targets [22].

Key Intersectional Findings Across Studies

Across the included studies, intersectional findings are clustered into four themes: (1) co-occurring forms of stigma across identities; (2) institutional and context-specific intersectional findings; (3) group differences in weight stigma; and (4) cumulative intersectional disadvantage. The findings are summarized below with emphasis on patterns observed across studies.

Co-occurring Forms of Stigma Across Identities

Nine studies reported intersectional findings describing weight stigma as occurring alongside other forms of stigma or marginalization, based primarily on qualitative accounts [20, 29, 31, 32, 36]. In these studies, participants described experiences of weight stigma as intertwined with other stigmatized identities, including race and ethnicity, gender identity, sexual orientation, and body size.

Reported findings included descriptions of weight stigma occurring simultaneously with racism, cissexism, ableism, classism, or heteronormativity in everyday interactions and institutional encounters [21, 28, 32]. Several studies described how fatness, in combination with other marginalized identities shaped expectations around body norms, attractiveness, or social belonging, including within queer communities and racialized contexts [29, 30, 34]. Other studies described weight stigma as embedded within broader systems of oppression, with experiences framed through multiple intersecting stigmatized identities rather than as isolated forms of discrimination [20, 36].

Across studies, these co-occurring stigmas shaped experiences of healthcare access and quality. Participants described delayed or avoided care due to anticipated discrimination as well as clinical encounters in which symptoms were attributed to body weight rather than investigation, particularly among individuals with multiple marginalized identities [20, 28].

Beyond healthcare, intersecting stigmas shaped social and relational experiences, including perceptions of attractiveness, desirability, and belonging. Participants reported appearance-based scrutiny, exclusion, and conflicting body norms across family, community, and sexual contexts, reflecting the combined influence of multiple stigmatized identities on everyday interactions [29, 30, 32].

In summary, weight stigma was described as operating alongside other forms of marginalization, shaping healthcare experiences, social belonging, and everyday interactions rather than appearing as an isolated form of discrimination.

Institutional and Context-Specific Intersectional Findings

Several qualitative studies reported institution-specific manifestations of intersectional weight stigma, most frequently within healthcare settings, where participants described how clinical interactions, treatment decisions, and access to care varied across intersecting social identities [20, 21, 36]. In healthcare contexts, participants reported that symptoms and pain were frequently attributed to body weight, particularly among Black participants, gender-diverse individuals, and those with additional marginalized identities. These accounts included experiences of delayed evaluation, dismissal of concerns, or denial of care, including gender-affirming or sexual and reproductive health services [20, 28, 36].

Beyond healthcare contexts, qualitative studies described intersectional weight stigma within family environments, public spaces, educational settings, and queer or LGBTQ+ communities, where participants reported appearance-based scrutiny, exclusion, or conflicting body norms linked to body size alongside other social identities [19, 21, 29, 32].

In addition, one qualitative study examined intersectional weight stigma within casual sexual encounters among larger-bodied sexual minority men, finding that intra-minority norms and fetishization produced anticipatory stigma that constrained partner selection, shaped stigma management strategies, and altered experiences of sexual safety and embodied pleasure during sexual interactions [30].

These studies suggest that intersectional weight stigma manifested differently across institutional and social contexts, with healthcare settings emerging as key sites where intersecting identities shaped access to care, clinical decision-making, and patient experiences.

Group Differences in Weight Stigma

Nine quantitative studies examined differences in weight stigma and related health outcomes across intersecting social identities, including race, gender, sexual orientation, and socioeconomic position [1, 17, 22,23,24,25,26,