Perceived weight stigma among adults diagnosed with schizophrenia in China: a cross-sectional study

Perceived weight stigma is increasingly recognised as an important psychosocial stressor associated with adverse psychological well-being, impaired healthcare engagement, and poorer treatment outcomes. Adults diagnosed with schizophrenia may be especially vulnerable because of antipsychotic-related weight gain and the intersection of weight stigma and mental illness stigma. However, evidence regarding perceived weight stigma in this population remains scarce, particularly in low- and middle-income countries.

To characterise perceived weight stigma and identify factors associated with it among adults diagnosed with schizophrenia in China.

In this cross-sectional study, 301 adults diagnosed with schizophrenia completed standardized self-report measures assessing perceived weight stigma, weight bias internalisation, psychological distress, social support, coping styles, and sociodemographic characteristics. A generalized linear model with a negative binomial distribution and log-link function was used to identify factors associated with perceived weight stigma.

Overall, 54.2% of participants reported perceived weight stigma, operationalised as endorsement of at least one PWSQ item (PWSQ score ≥1). Lower monthly income, higher weight bias internalisation and greater psychological distress were associated with higher perceived weight stigma. BMI was not significantly associated with perceived weight stigma.

This study provides quantitative evidence on perceived weight stigma, an under-researched psychosocial issue among adults diagnosed with schizophrenia. In this Chinese clinical sample, perceived weight stigma was common and was associated with lower income, greater weight bias internalisation, and greater psychological distress. These findings highlight that perceived weight stigma is a clinically relevant psychosocial phenomenon. Shifting from symptom-focused psychiatric care to a broader social psychology determinants framework may be essential for supporting more comprehensive recovery-oriented interventions within this population.