Internalized Weight Bias Links Gestational Attitudes to Exercise Avoidance

A cross-sectional study involving 433 pregnant women in China has identified a significant statistical association between negative attitudes toward gestational weight gain and the tendency to avoid physical activity. The research, published in Frontiers in Public Health, indicates that internalized weight bias serves as a key psychological mechanism linking these two factors. By examining both variable-centered and person-centered perspectives, the study reveals that how pregnant women perceive their weight gain can influence their willingness to engage in exercise, a behavior widely recognized for its benefits to maternal and fetal health. The findings highlight the complex interplay between psychological states and health behaviors during pregnancy, offering insights into the barriers that prevent many women from meeting recommended physical activity levels.

The study was conducted between March and May 2026 at two tertiary hospitals in Fujian Province, China. Participants were recruited from obstetric outpatient waiting areas and maternal health education sessions using convenience sampling. The final sample included 433 women who met specific inclusion criteria, such as being at least 18 years old and having a clinically confirmed pregnancy. The researchers excluded women with severe pregnancy complications that contraindicated exercise, as well as those with severe mental disorders or cognitive impairments. This selection process controlled for conditions that might independently affect physical activity or psychological well-being, though the authors note that the convenience sampling method may limit the generalizability of the findings to a broader population.

To assess the core variables, the researchers utilized three validated scales: the Pregnancy and Weight Gain Attitude Scale, the Weight Bias Internalization Tool for Use in Pregnancy, and the Tendency to Avoid Physical Activity and Sport Scale. These instruments allowed the team to measure the extent of weight-related concerns, the degree to which participants internalized negative weight stereotypes, and their propensity to avoid exercise due to weight or appearance concerns. The scales demonstrated high internal consistency, with Cronbach’s alpha values ranging from 0.894 to 0.919, indicating reliable measurement of the constructs. The data were analyzed using confirmatory factor analysis to verify the dimensional structure of the scales before proceeding with the primary statistical tests.

The results showed that attitudes toward gestational weight gain, internalized weight bias, and exercise avoidance tendencies were significantly and positively correlated. Specifically, women who reported more negative attitudes toward weight gain also reported higher levels of internalized weight bias and a greater tendency to avoid exercise. The mediation analysis revealed that internalized weight bias statistically mediated the relationship between attitudes and exercise avoidance. The indirect effect accounted for approximately 52.35% of the total association, suggesting that a substantial portion of the link between negative weight attitudes and exercise avoidance operates through the internalization of weight-related stigma. This finding underscores the importance of psychological factors in shaping health behaviors during pregnancy.

Latent profile analysis was employed to identify distinct subgroups of pregnant women based on their attitudes toward gestational weight gain. The analysis supported a two-profile solution as the optimal model, classifying participants into a “low concern profile” and a “high concern profile.” The high concern profile, which comprised 73.21% of the sample, was characterized by higher levels of weight-related distress and negative evaluation. In contrast, the low concern profile, representing 26.79% of the sample, was associated with less shame and anxiety regarding weight gain. Women in the high concern profile reported significantly higher levels of internalized weight bias and exercise avoidance tendencies compared to those in the low concern profile, with large effect sizes indicating meaningful differences between the groups.

The study’s findings have important implications for perinatal care and health promotion. The high prevalence of the high concern profile suggests that many pregnant women experience significant psychological distress related to weight gain, which may hinder their participation in beneficial physical activities. The authors suggest that non-stigmatizing, person-centred approaches to perinatal care, including attention to attitudes toward gestational weight gain, warrant further investigation. However, because the study design is cross-sectional, these suggestions are offered as directions for future research rather than as evidence-based practice recommendations. Whether such approaches should be delivered universally or in a targeted manner remains a question for future studies.

Several limitations of the study should be noted. The cross-sectional design precludes causal inferences, and the mediation model should be interpreted as associational rather than definitive. The sample was recruited from two hospitals in a specific region using convenience sampling, which may limit the generalizability of the findings. Additionally, the pre-pregnancy BMI distribution was heavily concentrated at the lower end of the spectrum, with 52.0% of participants having a BMI below 18.5. This restriction of range may have affected the observed associations between BMI and weight-related concern. Future research should employ longitudinal designs to examine the temporal sequence of these relationships and include diverse populations with a broader range of BMI values.

The study also highlights the cultural specificity of gestational weight concern in China. Factors such as the legacy of the one-child policy, the “zuo yue zi” postpartum confinement tradition, and media narratives idealizing rapid postpartum recovery may contribute to the high levels of weight-related anxiety observed in the sample. These cultural contexts shape the way pregnant women perceive and respond to weight gain, influencing their internalization of weight bias and subsequent health behaviors. The authors interpret weight-related concern not as a deficit located within individual women, but as a response to a broader weight-stigmatizing environment. Addressing these broader contexts may be more effective in reducing exercise avoidance than focusing solely on individual attitudes.

In conclusion, this study provides insights into the psychological mechanisms underlying exercise avoidance in pregnant women. The significant association between negative attitudes toward gestational weight gain and exercise avoidance, mediated by internalized weight bias, underscores the need for comprehensive perinatal care that addresses both physical and psychological aspects of pregnancy. By identifying distinct profiles of weight-related attitudes, the study offers a framework for targeting interventions to women at elevated risk of exercise avoidance. Future research should focus on longitudinal studies, objective measures of physical activity, and multi-center sampling to further validate these findings and develop strategies for promoting healthy behaviors during pregnancy.

Subject of Research: Association between gestational weight gain attitudes, internalized weight bias, and exercise avoidance in pregnant women

Article Title: Attitudes toward gestational weight gain and exercise avoidance tendencies: a latent profile analysis and mediation test of internalized weight bias in pregnant women

Article References: Xie, W., Wang, L., Ke, M., & Ni, M. (2026). Attitudes toward gestational weight gain and exercise avoidance tendencies: a latent profile analysis and mediation test of internalized weight bias in pregnant women. Frontiers in Public Health, 14, Article 1944847. https://doi.org/10.3389/fpubh.2026.1944847

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1944847

Keywords: pregnancy, gestational weight gain, exercise avoidance, internalized weight bias, latent profile analysis, perinatal health, psychological factors, cross-sectional study, Attitudes, toward, gestational, weight