Discrimination and Stigma Associated with Obesity: A Comparative Study between Spain and Egypt. Data from the OBESTIGMA study

Introduction: This study explores the under-investigated area of obesity-related discrimination and stigmatization across different countries, specifically comparing Spain (Europe) and Egypt (Middle East). Methods: We conducted a cross-sectional observational study involving 2,090 participants from both countries. Participants completed three well-validated questionnaires to assess their attitudes towards obesity, experiences of weight-related stigma, and internalization of weight bias: Antifat Attitudes Scale (AFA), Stigmatizing Situations Inventory (SSI), and Weight Bias Internalization Scale (WBIS). Participants were categorized into four groups based on BMI and history bariatric surgery. Results: Egyptian participants [BMI = 30.2±6.7 kg/m2 (range: 18.5 to 69.0 kg/m2)] showed significantly higher aversion towards obesity, as indicated by higher AFA score, compared to their Spanish counterparts [BMI = 35.4±10.1 kg/m2 (18.5 to 71,9 kg/m2)]. In contrast, Spanish participants reported higher levels of weight bias internalization with increasing BMI, while in Egypt, this association was negative. The association of bariatric surgery on stigma reduction also differed between the countries. Multivariate analysis revealed that residing in Egypt was an independent risk factor for higher scores in AFA and WBIS (Odds Ratio 8.20 [95% confidence interval: 6.78 to 9.62], p