In recent years, there has been a significant increase in interest in obesity. This results from the critical increase in weight among the population. According to the WHO, in 2022, 2.5 billion adults over the age of 18 were overweight, and more than 890 million adults suffered from obesity (1). Researchers in various disciplines are constantly searching for risk factors and causes of obesity. Moreover, they have analyzed the costs and consequences of excessive body weight and related phenomena as well as constructed practical solutions to limit the physical, mental, and social effects of obesity.

Currently, obesity is known to be a multifactorial disease. The main causes of this disorder are the mutual, multilevel interrelationships between genetic, physiological, and environmental factors (2–5). The consumption of foods whose energy value exceeds the body’s energy expenditure is considered the primary mechanism responsible for the development of obesity. This approach, although correct, does not fully explain the phenomenon of the worldwide trend of weight gain.

The human body tolerates weight gain more easily than weight loss, making it relatively simple to consume more calories than a person needs (6). Today, in a world with easy access to food, eating behavior is motivated not only by hunger but also by the satisfaction of eating (7). Studies show that reward sensitivity affects diet—the greater it is, the greater the consumption of fast food and sugar-rich foods (8). Self-control and persistence can be helpful in resisting the temptation of a high-energy and unhealthy diet by constructing and maintaining healthy eating habits. Persistence, according to FrazierKliknij tutaj, aby wprowadzić tekst (9)., is a trait that is positively associated with health behaviors with the goal of preventing diseases that are common causes of death (e.g., cardiovascular diseases, stroke). People with obesity are at risk of premature deaths associated with being overweight and having comorbidities. Persistence may, therefore, be one of the protective factors against the negative effects of obesity.

People struggling with excess body weight may have a reduced ability to self-regulate. A lower BMI is linked to greater persistence in achieving long-term goals. Compared with normal-weight individuals, obese people may have a weaker ability to delay gratification, which translates into persistence in maintaining proper diets (10). This was also the case for the Styk study (11); reinforcing effort can be a protective factor in maintaining self-control. Low persistence in obese and overweight people is mainly related to difficulties in stopping irrelevant thoughts or memories (12). Other studies, in turn, found that regardless of the normality of one’s weight, people who rated their weight as too high had lower persistence rates than those who perceived their weight as normal (13). The importance of persistence in preventing obesity, especially among children and adolescents, is also highlighted by Yu et al. (14), who found that schools should focus on increasing persistence and promoting a positive body image to prevent obesity in children and adolescents.

In the literature concerning obesity, much attention has been given to the issue of body image, which is defined as a way of perceiving one’s own body that takes into account related thoughts and feelings. Body image is a multidimensional construct and can be positive or negative. On the one hand, people adequately evaluate their body and are satisfied with it. On the other hand, negative body image is associated with inaccurate perceptions and critical evaluation of the body (15, 16). Research conducted by Aime (17) in eight countries and seven different languages showed some similarities in terms of assessing the various indicators that make up the self-image construct, which was explained by globalization processes. However, Aime et al. noted that measures of self-image are sensitive to cultural context. A negative body image can cause inappropriate eating behavior (18) and limit the possibility of weight loss. In contrast, a positive body image may be a predictor of maintaining health habits even two years after bariatric surgery (19). Numerous studies indicate that many obese individuals show dissatisfaction with their bodies, which negatively affects quality of life and functioning in various spheres. According to Troisi (15), women are more dissatisfied with their bodies than men compared to their normal-weight peers.

The suffering of individuals struggling with excessive body weight is exacerbated by the supremacy of the slim beauty ideal promoted by most cultures. Sociocultural factors determine how people view their appearance. Western culture in particular makes beauty dependent on low body weight, which negatively affects the mental health of people with obesity, although the relationship is not conclusive (20). Appearance pressure primarily affects women, resulting in a lack of satisfaction with their appearance (21), while research by Silva (22) has shown that young women who are subjected to environmental pressures internalize a slim figure, which negatively affects their satisfaction with their bodies. Unattainable canons of beauty are promoted primarily by the media, and comparison with an ideal model promotes low evaluation of one’s own body. The use of appearance-focused media adversely affects self-image whereby a positive self-image is associated with the capacity to engage in healthy behaviors and resist unrealistic appearance canons promoted by the media (23).

Widespread stereotypes about people with obesity contribute to the prevalence of negative physical and mental health phenomena. The literature indicates that people with excessive body weight may experience, among other things, stress, mood disorders, decreased self-esteem and self-worth [especially among women (24)], or various eating disorders (25–28). Re-education on weight-related stigma may predict improvements in mental health (29).

Body weight can cause discrimination in various aspects of life; it is common in work, education, health care, sports, or interpersonal relationships (30–36). In the case of obese people, the body becomes a key criterion for judging them against social norms constructed for a particular trait. Thus, the difference between expectations and actual body weight determines who will be stigmatized and how they will cope with devaluation and lower status (34). At the same time, oppressive attitudes toward obese people seem to be more socially acceptable than other forms of prejudice (37) and discrimination based on body weight. It is socially tolerated, even though research shows that it may increase the risk of obesity (38–41).

The internalization of socially defined, negative attitudes about the body also contributes to self-devaluation and lower self-esteem (35, 42, 43). People with internalized weight stigma tend to evaluate themselves negatively and expect others to stigmatize them because of this aspect of their appearance (44). Consequently, they develop difficulties in regulating their weight, which increases overeating and body image deterioration (45). A protective factor against the impact of prejudice on self-esteem may be the awareness of being a target of prejudice; rejection of discrimination may be associated with less suffering (46). Haga (47) showed that people with obesity use a variety of defense strategies to cope with negative social reactions and judgments about their body weight.

Stigmatization due to excessive body weight is a common phenomenon (48). The main feature of these biases is the perceived ability to control weight (49). Overweight people are perceived as lazy, passive, lacking willpower and control, and unattractive (45, 50). The stereotype of obesity, leading to prejudice and discrimination, assumes a lack of persistence in building healthy habits and taking care of one’s figure (e.g., ‘just eat less and exercise more’). Responsibility for being overweight or obese is attributed only to overweight individuals, even though the mechanisms involved are complex (51).

The analysis of the collected data began with determining whether there were differences according to sex and the normality of the subjects’ body weight (BMI_groups). The normality of body weight was estimated using BMI with the subjects divided into three groups: underweight, normal weight, and overweight or obese. Due to the volume of data, tables with descriptive statistics are included in the Supplementary Material , and the results of the analyses are presented below.

The conducted analyses did not show that sex or BMI significantly differentiated the results of persistence as a trait and situational persistence indicator. The results of the analyses are shown in Table 2 and Figure 3 .

Analysis of the mean values on the BES revealed differences according to sex and BMI group. The mean scores on the BES indicated that women rated their bodies lower than men (p=0.04). Differences due to BMI were found to be significant for the normal weight, overweight, and obese groups (p_tukey<0.01). Overweight and obese respondents rated their bodies lower than those with normal body weight. As determined by the WBIS scale, the internalization of body weight stereotypes did not appear to differ according to sex. Differences were shown due to BMI groups and the interaction of sex and BMI groups. There were significant differences (p_tukey<0.01) in the following comparisons: underweight females vs. overweight and obese females; normal weight females vs. overweight and obese females; normal weight males vs. overweight and obese females; and overweight and obese females vs. overweight and obese males. In contrast, the mean PWSs were differentiated only by BMI group. On average, overweight and obese individuals scored higher on the PWS scale than normal-weight subjects (p_tukey<0.01). The results of these comparisons are presented in Table 3 and Figure 4 .

The analyses showed that the average levels of both chronic and acute stress differed according to BMI group and sex, but these differences were not statistically significant. The results are presented in Table 4 and Figure 5 .

The analysis of the collected data with the HADS questionnaire revealed differences only in the HADS_AG. The mean scores for aggression were lower in the overweight and obese group than in the normal weight group (_Ptukey<0.01). The results are shown in Table 5 and Figure 6 .

The presented analyses indicate that controlled variables in the form of sex and BMI groups should be included in subsequent analyses.

The next step was to establish the relationships between the variables. For this purpose, a correlation analysis was performed. The results are presented in Supplementary Table 1 . The analysis showed a statistically significant correlation between persistence and the number of tasks performed (r=0.47; p<0.001). A weaker association was shown between persistence and time spent on tasks (r=0.16; p<0.001). A negative relationship was also shown between acute stress level and persistence indices, as determined by The Maze Test. No relationship was observed between acute stress and persistence as a trait. The persistence indices were also shown to depend on temperamental personality factors to a greater extent than persistence, as measured by the PS-20 test. Depressive symptoms were negatively associated with the studied persistence factors, while anxiety and anger were positively associated.

Body image, as measured by the BES scale, was found to be associated with persistence regardless of how it was measured. There was a significant relationship between the strength of the BES and the persistence trait (r=0.46; p<0.001) as well as between the strength of the BES and the number of tasks performed (r=0.48; p<0.001). The association between BES and time spent on tasks was also significant, but the strength of the association was low. There was also a negative relationship between the medium-strength BES and the PWS (r=-0.46; p<0.001) as well as a negative association between the low-strength BES and the WBIS (r=-0.27; p<0.001). PWS was also negatively associated with persistence_trait (r=-0.64; p<0.001) and number of tasks performed (r=-0.41; p<0.001). On the other hand, WBIS was negatively associated with the number of tasks performed (r=-0.14; p<0.001) and time spent on tasks (r=-0.28; p<0.001).

The analyses showed a relationship between persistence and body image as well as between weight-related stereotypes and stigmas. These associations are characterized by medium strength correlations. Persistence, regardless of approach, is also related to personal-temperamental characteristics.

Comparisons were also made between the strength of correlations of body image with persistence and variables describing the internalization of stereotypes and perceived stigma as well as with regard to the controlled variables of sex and normality of body weight. The association of PWS with BES was shown to be significantly (p<0.01) stronger in the female group (r=-0.56) than in the male group (r=-0.31). The relationship between BES and persistence is strongest in the underweight group. A comparison of the association between BES and persistence in the normal weight, overweight, and obese groups revealed significant differences only in time spent on tasks (p=0.01). A difference was also shown at the trend level with the number of tasks performed (p=0.06). In contrast, the relationship between the BES and the WBIS was found to be strongest in the normal weight group. The association of the PWS with BES was strongest in the underweight group (r=-0.82) and second-strongest in the overweight and obese group (r=-0.41). It was the weakest in the normal weight group. The results of these comparisons are presented in Table 6.

To confirm the obtained results and graphically depict the relationships between the main variables in this study, a network analysis was conducted. The estimated network models contain variables (nodes) and estimated links between them (edges). The analysis of network stability indicates that the proximity between nodes is not stable. Node strength and closeness performs better and can be interpreted with caution. The stability and accuracy of the network are shown in Figures 7 and 8 . Two models were created for comparison; the first is presented in Figure 7 , with separate groups stratified by sex. A comparison of the models shows that the BES linkage of variables appears in the female group. The edges connecting the BES node to the PWS, WBIS, and Time are between -0.22 and -0.36. These links are weaker in the male group, however, in contrast to the female group, a stronger association of PWS with Persistence_Trait and PWS with Time was observed. The association of BES with NoTasks was weaker. The second model included separate BMI groups and is presented in Figure 8 . This model shows an increase in the association of WBIS with the study variables as BMI increases. The model also showed the strongest PWS-BES-NoTasks-Persistence associations in the underweight group. In the overweight and obese group, the strongest associations were observed between the nodes Persistence - PWS and WBIS - Time persistence (PWS), and WBIS time points.

Persistence is a construct that has rarely been analyzed in the context of its association with body image, especially in relation to the normality of one’s body weight. The main aim of our study was to replicate this study by presenting preliminary results focused on the relationship between body image and persistence. We additionally searched for answers to questions about the relationships between the studied associations and body weight stereotypes.

In accordance with previous research, our study confirmed that women rate their bodies less favorably than men do and this effect has been observed over the years (69–71). Women pay particular attention to the assessment of their face and figure (72) and there is clear pressure to meet strict standards of appearance, making body and beauty key categories for women’s evaluation. Therefore, the link between body image and the experience of being stereotyped and prejudiced was found to be stronger for women than for men.

Stigma and stigmatization toward appearance are formulated not only against excessive body weight but also against people with an atypical body shape in general, which can significantly affect their body image. A number of studies indicate that dissimilarity from the contemporary standard of beauty in terms of body weight is stigmatized in both overly slim and overly fat figures (73). This effect was also confirmed in our study, which showed that respondents’ body image significantly depends on body weight. We know from empirical reports that negative experiences of self-perception can affect people’s ability to cope with life difficulties. Dealing with excessive body weight is a demanding, long-term effort. Unfortunately, being overweight is related to prejudice and the daily experience of various problems associated with it. Trying to control one’s diet requires persistence, but stigma can result in uncontrollable overeating and less interest in physical activity (74, 75). In the academic literature, there is less interest in the stigmatization of thin people. This may be due to the focus on the obesity epidemic. However, our findings suggest that the problematic weight experiences of thin people should receive similar attention.

The study also revealed that respondents’ BMI, rather than sex, was associated with the internalization of stereotypes. Moreno-Domingues (76) suggested that BMI may not only be responsible for poorer self-image but also may moderate the relationship between the internalization of the beauty ideal and self-image. Our study revealed an association between BMI and the internalization of weight stereotypes as well as between BMI and the level of experience of stereotypes and prejudice. We believe that people with a higher BMI internalize cultural stereotypes more strongly and that the perceived difference between their own appearance and the promoted body shape matters for self-image. At the same time, they experience more negative behaviors that stigmatize their body weight. The acceptance of social judgments regarding obesity exacerbates the negative motivational effects of obesity stigma (77). Consequently, it can inhibit actions aimed at coping with excessive body weight. It is also fostered by the depletion of resources needed to modify one’s weight and is used to cope with the stigma of obesity in the long term (78).

The results on persistence demonstrate that it is not dependent on either the sex or BMI of the respondents. The level of persistence was significantly associated with body perception, confirming previous findings by Styk et al. (13) The current study revealed an association between persistence and the experience of weight stigma, particularly in individuals with below-normal body weight and overweight participants. It is known from other studies that body nonconformity with beauty can be significantly stigmatized (29, 50, 79). Obese individuals experience dehumanization that fosters prejudice (80). In the case of nonnormal-weight individuals, we can expect weaker persistence; thus, oppressive social messages about weight may more strongly affect their evaluation of their body. Based on the literature review and our study, it is possible to speculate that this process may sabotage any attempts at weight modification; however, this requires further research.

In summary, among the studied variables (temperament, personality, body image, experience of stereotypes and prejudices, and internalization of stereotypes), only body stigma is socially controlled. The obtained results may indicate a self-sustaining mechanism that makes it difficult for overweight or obese people to correct their weight. As indicated in the original study⁵³, deficits in persistence can affect, among other things, problems in maintaining a proper and healthy diet, which in turn can increase body weight and lead to being overweight and obese. Obesity and being overweight, in turn, can build up a negative body image. Therefore, it cannot be ruled out that overweight and obese individuals may experience a kind of feedback loop that increases persistence deficits along with negative body image. Consequently, these persistence deficits may lead to problems maintaining one’s diet, which may result in weight gain and further exacerbation of negative body image. In the current study, the strength by which this loop is coupled is likely to be influenced by existing weight stereotypes, as the results indicate. A new and extremely interesting result was the demonstrated relationship in the underweight group. The association between body image and the experience of weight stigma was strongest in this group. The second strongest relationship was between body image and persistence. This indicates that body-related stigma not only affects overweight and obese individuals but also that its mechanisms may be shaped differently.

We should, therefore, seek interventions to break this loop and unleash the potential in obese people to persistently and effectively manage their excess body weight. By investing in the de-stereotyping of obese people, prejudice reduction and inclusion activities can support a positive self-image in this group.

Like any study, this one has certain limitations. First, it included people only up to the age of 30, so it is not possible to generalize the results to the entire population. A smaller group of men results in a lower possibility of drawing conclusions, especially for underweight men. Future studies should focus on this group and include factors related to social media and the ultraslim female and supermuscular male physiques promoted in the media.

Body image and persistence are related variables. They are associated with the internalization of stereotypes and perceived stigma related to body weight. These associations are differentially shaped according to sex and the regularity of body weight. In women, a stronger association of these variables with body image was observed, while in men, the relationship with body image was weaker, with a stronger association shown by perceived weight-related stigma. In the group of participants with a BMI<18.5, there was no significant association between the internalization of stereotypes and the analyzed variables. This relationship appeared in the group of subjects with a normal body weight and was strongest in the group of participants who were overweight or obese. Perceived weight-related stigma was most strongly associated with body image in the group with BMI<18.5 kg/m2 and with persistence in the group with BMI>25 kg/m2.

Public education on the complex determinants of not only obesity but also body weight in general is key to reducing ‘weight stigma’. The implications of this study should include actions to eliminate stigmatizing language in public spaces, especially in educational settings, the healthcare system, and the media. In addition to the medical aspects, the psychological consequences of prejudice and discrimination should be addressed, and positive bodily content and empathetic attitudes should be promoted to reduce harmful behavior.