# Cross-cultural validation of the Weight Stigma Exposure Inventory (WeSEI): secondary data analysis from Taiwan, China, Hong Kong, Indonesia, Türkiye, and Malaysia

## TL;DR

The study tested a tool to measure weight stigma across six Asian regions and found it works well overall, though some items need cultural adjustments.

## Contribution

The study provides cross-cultural validation of the WeSEI in six Asian regions, highlighting the need for cultural adaptation in some items.

## Key findings

- The WeSEI showed strong internal consistency and unidimensionality across all domains.
- Minimal DIF was observed by sex and weight status, but 19 items showed significant DIF by jurisdictional region.
- Malaysian participants reported more exposure to slim-normative and family-based weight stigma than Chinese participants.

## Abstract

The Weight Stigma Exposure Inventory (WeSEI) is a newly developed instrument designed to assess weight stigma exposure across both interpersonal and non-interpersonal contexts. While prior studies have supported its use in individual regions, its cross-cultural applicability has not been comprehensively evaluated.

The present study examined the psychometric properties and cross-cultural measurement equivalence of the WeSEI across six culturally diverse jurisdictional regions in Asia (i.e., Taiwan, China, Hong Kong, Indonesia, Türkiye, and Malaysia).

A total of 7,787 participants completed the 35-item WeSEI via various online platforms. The WeSEI assesses weight stigma exposure across seven domains: social media, traditional media, television/movies, parents/siblings, friends/peers, significant others, and strangers. Rasch analysis was conducted to evaluate item fit, rating scale functioning, person separation reliability, and unidimensionality for each domain. Differential item functioning (DIF) was assessed across sex, weight status, and jurisdictional region.

The WeSEI demonstrated strong internal consistency, acceptable item fit, and unidimensionality across all domains, with only two items showing misfit (i.e., Friends/Peers_2 and Significant Other_2). Person separation indices exceeded 2.0 for each domain, confirming the scale’s ability to distinguish individuals with varying levels of stigma exposure. Minimal DIF was observed by sex and weight status, supporting measurement equivalence across these groups. However, 19 out of 35 items showed significant jurisdictional region-level DIF, particularly those related to slim-normative attractiveness and family-based stigma. Malaysian participants consistently endorsed these items more than Chinese participants, suggesting cultural variation in the exposure of weight stigma.

The WeSEI is a psychometrically sound and culturally responsive tool for assessing weight stigma exposure across diverse populations in Asia. Cultural adaptation is recommended for cross-national comparisons.

People who live in larger bodies often face unfair treatment because of their weight. This is called weight stigma. It can occur in many areas of life, such as on social media, on television and in movies, and in everyday interactions with family, friends, or strangers. To better understand how often and in what ways people experience weight stigma, researchers need good instruments that can assess these experiences clearly and fairly across different groups and cultures.

In this study, we examined the Weight Stigma Exposure Inventory (WeSEI). The WeSEI asks people about how often they encounter weight stigma in seven areas of life: social media, traditional media, TV and movies, parents or siblings, friends or peers, romantic partners, and strangers. We collected responses from 7,787 adults living in six regions in Asia: Taiwan, China, Hong Kong, Indonesia, Türkiye, and Malaysia. We then tested whether the WeSEI works well and assesses stigma exposure in a reliable way.

Our results showed that the WeSEI is a strong and consistent instrument for assessing weight stigma across all seven areas. Almost all items behaved as expected, and the instrument distinguished between people who experienced more stigma and those who experienced less. The WeSEI also worked similarly for people of different sexes and body weight categories, which suggests it is fair to these groups. However, some items worked differently across regions, especially those that focused on cultural ideas about being slim and on family-related weight comments. For example, individuals from Malaysia tended to report more agreement with these items than individuals from China, which may reflect differences in how weight stigma appears in daily life in these places.

Overall, the WeSEI appears to be a useful and culturally responsive instrument for studying weight stigma in diverse Asian populations. At the same time, the findings highlight that culture shapes how weight stigma is experienced and reported. Researchers and clinicians who use the WeSEI in cross-country studies should take these cultural differences into account and consider adapting specific items so that comparisons across regions are fair and accurate.