(PS14-28) Weight Discrimination and Cortisol Output: A Systematic Review

Individuals who are marginalized by their weight status are subject to weight discrimination, operationalized as the maltreatment of an individual due to their weight related to myriad of adverse psychological and physiological outcomes, such as higher mortality (Sutin et al., 2015), lower well-being, and greater psychological loneliness (Lewi et al., 2011). To that end, those who report weight-discrimination often experience a cumulative effect of hostile social interactions that may impact their ability to acquire equitable resources, and also have physiological effects, such as increased cortisol output (Williams & Annadale, 2019), a common index of stress that correlates with cardiovascular health (Lob et al., 2019). While the COBWEBs model suggests people in larger bodies are ‘caught’ in a cycle of stigma of weight discrimination directly influencing weight gain through increased eating and other biobehavioral mechanisms (e.g., elevated secretion of cortisol) (Tomiyama et al., 2014). This systematic review has two aims: First, to describe the relationship between measured cortisol output and weight discrimination across studies. Second, to summarize moderators and covariates in the relationship between cortisol levels and perceived discrimination. Three databases were searched for terms related to weight discrimination and cortisol output. All PRISMA steps were followed. Eligible studies reported the quantitative association between at least one measure of weight stigma and one measure of cortisol output were included. Across studies (N=15), participants were identified as being women (67%) with overweight/obesity (92%). Nine studies reported weight-related discrimination was positively related to output. Eighty-percent (80%) of studies in the present review measured saliva cortisol and 40% utilized a cross-sectional design. Relevant moderators across studies will be discussed, as well as future directions of research to implement cortisol and weight discrimination studies into a cognitive-behavioral framework that includes parsing apart weight-bias internalization and weight discrimination, as well as extending minority stress models of weight stigma that include endocrine markers of stress, such as cortisol output, will be discussed.