AccScience Publishing / JCBP / Online First / DOI: 10.36922/JCBP026250034
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ORIGINAL RESEARCH ARTICLE

Complex associations among weight selfstigma, depression, and treatment acceptance self-efficacy in Japan

Karin Hayashi1†* ,  Ken Ichiro Koyama2† ,  Kozue Hashi1 ,  Takehiro Nozaki3
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1 Department of Neuropsychiatry, Toho University Sakura Medical Center, Chiba , Japan
2 Department of Human and Social Sciences, Faculty of Integrated Human Studies and Social Sciences, Fukuoka Prefectural University, Fukuoka , Japan
3 Graduate School of Nutritional Sciences, Nakamura Gakuen University, Fukuoka , Japan
†These authors contributed equally to this work.
JCBP, 026250034 https://doi.org/10.36922/JCBP026250034
Received: 16 June 2026 | Revised: 24 August 2026 | Accepted: 29 September 2026 | Published online: 2 November 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Weight-related self-stigma has been recognized as an important psychosocial factor associated with obesity, depression, and reduced healthcare engagement. However, its characteristics and clinical implications in Japan remain insufficiently understood. This study aimed to examine the relationships among body mass index (BMI), weight self-stigma, depressive symptoms, and treatment acceptance in a Japanese population. A cross-sectional web-based survey was conducted among 309 Japanese adults recruited through a commercial survey panel. Participants completed the Japanese versions of the Weight Self-Stigma Questionnaire (WSSQ-J), Patient Health Questionnaire-9, and Self-Efficacy Scale for Treatment Acceptance (SESTA). Participants were classified into three BMI groups: Low BMI (<18.5 kg/m2, n = 32), Middle BMI (18.5–24.9 kg/m2, n = 223), and High BMI (>25.0 kg/m2, n = 54). The mean BMI of the sample was 22.3 kg/m2, which falls within the normal range according to international criteria. Nevertheless, participants reported relatively high levels of weight self-stigma, with mean WSSQ scores comparable to those observed among patients with obesity in Western countries. Depressive symptom scores did not differ significantly across BMI groups. However, MGSEM revealed distinct structural patterns. In the Middle BMI group, BMI showed a significant negative direct association with depressive symptoms, whereas the pathway from self-devaluation to depressive symptoms was attenuated in the High BMI group. Furthermore, a significant negative indirect effect of BMI on SESTA was observed exclusively in the High BMI group, suggesting that body weight itself may function as a barrier to healthcare engagement.

Graphical abstract
Keywords
Weight self-stigma
Depression
Treatment acceptance self-efficacy
Obesity
Japanese population
Funding
This work was supported by the Japan Society for the Promotion of Science KAKENHI (Grant Number: 23K09585).
Conflict of interest
Karin Hayashi is an Editorial Board Member of this journal, but was not in any way involved in the editorial and peer-review process conducted for this paper, directly or indirectly. The authors declare that there are no conflicts of interest regarding the publication of this paper.
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Journal of Clinical and Basic Psychosomatics, Electronic ISSN: 2972-4414 Print ISSN: 3060-8562, Published by AccScience Publishing
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