Exploring the relationships among weight stigma, weight bias internalisation, feeling fat, and self-esteem across preconception, pregnancy, and postpartum

Introduction Weight stigma permeates women's reproductive experiences with significant psychological consequences, yet remains understudied across different reproductive stages and country contexts. This study addresses this gap by investigating weight stigma experiences and their associations with weight bias internalisation (WBI), feeling fat, and self-esteem across preconception, pregnancy, and postpartum (PPP) stages in Western and non-Western contexts.Methods In this cross-sectional study, a convenience sample of women aged 18–45 years from five countries completed an anonymous online survey assessing weight stigma experiences, WBI, feeling fat, and self-esteem. For exploratory comparison, countries were grouped into Western (Australia, United Kingdom, United States) and non-Western (Singapore, Philippines) contexts. Hierarchical regressions and mediation analyses examined relationships between variables.Results In total, 511 women completed the survey (preconception n = 216, pregnant n = 125, postpartum n = 170). Overall, 62.6% of women reported experiencing weight stigma, with sources varying by PPP stage. Weight stigma from the media was most prevalent during preconception, workplace during pregnancy, and family in postpartum. Women residing in Western countries reported more healthcare-related stigma (p = .01), while non-Western women reported more stigma from friends (p < .001) and workplace (p = .001). Weight bias internalisation, feeling fat, and self-esteem levels were similar across countries. Weight bias internalisation consistently mediated the relationship between weight stigma experiences and both feeling fat and self-esteem across all PPP stages; weight stigma promoted greater WBI, which in turn promoted higher scores on feeling fat and lower scores on self-esteem.Conclusion While sources of weight stigma differed by reproductive stage and between Western and non-Western contexts, WBI consistently mediated how these experiences related to both feeling fat and self-esteem. Interventions should target stage-specific stigma sources while addressing WBI as a key mediating mechanism to improve health and wellbeing outcomes for PPP women.