Weight Bias Internalization Research Articles

Associations among negative weight-related experiences, weight bias internalization, and body-related self-conscious emotions in adolescents: A daily diary study.

The present study examined the between- and within-person associations among negative weight-related experiences, weight bias internalization, and body shame, embarrassment, and pride in adolescents. Participants were 93 Canadian students (Mage = 15.54, 59.10% girls, 40.86% white) who completed a 5-day daily diary study in 2021. Multilevel models were estimated to examine the between- and within-person associations, as well as the cross-level interactions. Fifty-nine negative weight-related experiences were reported from 22 participants (23.66%) over the 5-day study period. Adolescents with higher average negative weight-related experiences (OR = 19.60, 95% CI = 1.90-202.67) and weight bias internalization (OR = 3.66, CI = 2.07-6.46) had greater odds of reporting shame. Similarly, higher average negative weight-related experiences (OR = 16.29, CI = 3.65-72.75) and weight bias internalization (OR = 2.08, CI = 1.53-2.82) was associated with greater odds of embarrassment. No within-person effects were noted, such that reporting more negative weight-related experiences or weight bias internalization than one's own average was not related to body emotions. This distinction underscores that the persistent, rather than episodic, aspects of negative weight-related experiences and weight bias internalization are most impactful on adolescents' body image. These findings have implications for recruitment and screening for individual-level interventions for internalized weight bias and body image, and highlight the need for system-level policies and changes that prohibit negative weight-related experiences and messages to reduce likelihood of internalizing weight bias among adolescents.

The role of weight stigma and internalized weight bias in health care avoidance and mistrust.

The role of weight stigma and internalized weight bias in health care avoidance and mistrust.

Supplemental Material for The Role of Weight Stigma and Internalized Weight Bias in Health Care Avoidance and Mistrust

Supplemental Material for The Role of Weight Stigma and Internalized Weight Bias in Health Care Avoidance and Mistrust

Body image is associated with persistence. A study of the role of weight-related stigma.

The study replicates a preliminary report from 2019 on therelationship between body image and persistence. The aim of our study was to analyze the associations between body image, persistence, and body weight stereotypes. A total of 750 individuals were recruited for the study. The research was carried out in computer labs. The procedure consisted of psychological questionnaires (Persistence Scale, The Body Esteem Scale, Perceived Weight Stigma Questionnaire, Weight Bias Internalization Scale, Hospital Anxiety and Depression Scale, Formal Characteristics of Behavior - Temperament Inventory, and NEO-PI-R) and The Maze Test (a computer tool). After completing the Simple Maze Test, saliva samples were collected. Next, the subjects proceeded to the laboratory where anthropometric and body composition measurements were taken. The hormone levels (cortisol and dehydroepiandrosterone) in the collected saliva samples were analyzed via ELISA to determine stress. 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. Body-related stigma affects not only overweight and obese individuals and its mechanisms may be shaped differently.

Hindi Translation, Cultural Adaptation, and Validation of Modified Weight Bias Internalization Scale (WBIS-M): A Cross-Sectional Study from the Metabolic Surgery Clinic in North India

Background: The lack of culturally-sensitive tool masks the epidemiology of weight-bias and internalized-stigma. This study aimed to translate, adapt, and validate the Modified Weight-Bias Internalization Scale (WBIS-M) into Hindi. Methods: The translation and adaptation process followed the World Health Organization guidelines. Three psychiatrists translated the original WBIS-M into Hindi. The bilingual panel comprised four psychiatrists, two laparoscopic bariatric surgeons, a professor of English, and an individual with severe obesity (with an International English Language Testing System (IELTS) score of Band 8.5) who was familiar with Western culture. The panel identified and resolved inadequate expressions of translations or discrepancies. An independent translator, whose mother tongue was English, back-translated it into the English language. Focused group discussions with individuals with severe obesity were conducted. The final H-WBIS-M was administered to undergraduates ( n = 120) after seven days. Test–retest reliability was assessed. The original WBIS-M, Eating Disorder Diagnostic Screen, and Fat Phobia Scale-Short Form were administered to 120 undergraduates and 55 individuals with severe obesity ( n = 175)]. Reliability and validity of H-WBIS-M were analyzed. Results: Kaiser–Meyer–Olkin measure of sampling adequacy was 0.788, and Bartlett’s test of sphericity was χ2 = 1381.892, p = 0.000. The exploratory factor analysis extracted three components. Spearman-Brown coefficient for H-WBIS-M was 0.875. The internal consistency was α = 0.875 ( p = 0.000), intraclass correlation coefficient was 0.857 (95% confidence interval [CI] = 0.812–0.893) ( p = 0.000), and Pearson correlation ranged from 0.869 to 0.989 ( p = 0.000). Cross-language concordance revealed a significant intraclass correlation coefficient (0.877–0.986) ( p = 0.000) and Pearson correlation ranging from 0.781 to 0.972 ( p = 0.000). Conclusions: The H-WBIS-M demonstrated good psychometric properties based on standard testing procedures.

Internalized weight stigma and psychological distress mediate the association of perceived weight stigma with food addiction among young adults: A cross-sectional study

BackgroundPerceived weight stigma (PWS) and internalized weight stigma (IWS) are both associated with psychological distress and food addiction (FA). Using the previously proposed ‘cyclic obesity/weight-based stigma’ (COBWEBS) model, the present study extended the framework to investigate the mediating effects of IWS and psychological distress in the association between PWS and FA among young adults. Given that individuals who are overweight/have obesity have different vulnerabilities, this population was separately analyzed alongside the total study population.MethodsAn online survey comprising the Perceived Weight Stigma Scale, Weight Bias Internalization Scale (WBIS), Depression, Anxiety and Stress Scale-21 (DASS-21), and modified Yale Food Addiction Scale Version 2 was completed by 601 participants (59.6% females; mean age 29.3 years [SD = 6.07]). A total of 219 participants were categorized as being overweight/having obesity.ResultsA direct correlation was found between PWS and FA (standardized coefficient [β] = 0.28, p < 0.001) among both populations, and was mediated by IWS and psychological distress (β [95% CI] = 0.03 [0.01, 0.05] for WBIS score and 0.10 [0.06, 0.14] for DASS-21 score) among the total participants, but only mediated by psychological distress among participants who were overweight/had obesity (β [95% CI] = 0.14 [0.06, 0.24]).ConclusionsThe results demonstrated novel perspectives by showing the direct association between PWS and FA and the mediating roles of IWS and psychological distress. Treatment strategies such as psychological acceptance and psychoeducation could be used to reduce weight stigma, which could have positive downstream benefits of ameliorating FA. Future research may seek to study strategies for reducing weight stigma and psychological distress, to investigate their efficacy in improving disordered eating.

Negative Affect as a Mediator Between Exposure to Fitspiration and Thinspiration and Disordered Eating Behaviors: An Ecological Momentary Assessment Study.

Although social media use, such as Instagram, has been associated with ED pathology, mechanisms connecting social media use to disordered eating behaviors (DEBs) remain largely unevaluated. Based on Dual Process, Tripartite, and Affect Regulation models of ED pathology, we proposed a moderated mediation model evaluating impacts of exposure to fitspiration/thinspiration on Instagram. We evaluated a hypothesized pathway from exposure to fitspiration/thinspiration (i.e., ED-salient content) on Instagram to disordered eating mediated by negative affect and tested individual differences in weight bias internalization, trait self-esteem, and trait self-comparison as moderators. We recruited 173 undergraduate women who reported engaging in DEBs on average at least once per week over the past 3 months. Participants completed a seven-day ecological momentary assessment protocol, during which they reported their ED-salient content exposure on Instagram, affect, and engagement in DEBs. Multilevel modeling was used to assess moderated mediation. Negative affect partially mediated associations between viewing ED-salient content and subsequent engagement in objective binge eating and restricting but did not mediate the pathway to purging or excessive exercise. Higher weight bias internalization intensified the association between viewing ED-salient content and negative affect. The association between viewing ED-salient content and engaging in objective binge eating and restricting may be a partial consequence of elevated negative affect; however, effects were small. Individuals with higher weight bias internalization may be more vulnerable to negative consequences from viewing ED-salient content. Findings suggested that reducing negative affect responses (e.g., via emotion regulation) could reduce negative consequences of viewing ED-salient content.

The validation of short eating disorder, body dysmorphia, and Weight Bias Internalisation Scales among UK adults

BackgroundWhen collecting data from human participants, it is often important to minimise the length of questionnaire-based measures. This makes it possible to ensure that the data collection is as engaging as possible, while it also reduces response burden, which may protect data quality. Brevity is especially important when assessing eating disorders and related phenomena, as minimising questions pertaining to shame-ridden, unpleasant experiences may in turn minimise any negative affect experienced whilst responding.MethodsWe relied on item response theory to shorten three eating disorder and body dysmorphia measures, while aiming to ensure that the information assessed by the scales remained as close to that assessed by the original scales as possible. We further tested measurement invariance, correlations among different versions of the same scales as well as different measures, and explored additional properties of each scale, including their internal consistency. Additionally, we explored the performance of the 3-item version of the modified Weight Bias Internalisation Scale and compared it to that of the 11-item version of the scale.ResultsWe introduce a 5-item version of the Eating Disorder Examination Questionnaire, a 3-item version of the SCOFF questionnaire, and a 3-item version of the Dysmorphic Concern Questionnaire. The results revealed that, across a sample of UK adults (N = 987, ages 18–86, M = 45.21), the short scales had a reasonably good fit. Significant positive correlations between the longer and shorter versions of the scales and their significant positive, albeit somewhat weaker correlations to other, related measures support their convergent and discriminant validity. The results followed a similar pattern across the young adult subsample (N = 375, ages 18–39, M = 28.56).ConclusionsThese results indicate that the short forms of the tested scales may perform similarly to the full versions.

Effects of weight bias internalization on quality of life among selected BPE students

Effects of weight bias internalization on quality of life among selected BPE students

Internalized weight bias and eating disorder risk: The moderating role of self-construal among culturally diverse female young adults.

Internalized weight bias and eating disorder risk: The moderating role of self-construal among culturally diverse female young adults.

Testing the validity of the Norwegian translation of the modified weight bias internalization scale

BackgroundIndividuals with higher weight (overweight or obesity) may experience social stigma due to their weight. Weight stigma can be internalized with adverse health effects. Internalized weight stigma is relevant across different weight categories, but no validated weight-neutral measure of internalized weight bias currently exists in Norway. The current study aimed to examine the validity of a Norwegian translation of the Modified Weight Bias Internalization Scale.MethodsA Norwegian translation of the Modified Weight Bias Internalization Scale (WBIS-M) was administered in an adult Norwegian sample (N = 315, of which 251 women) ranging from self-reported “very underweight” to “very overweight”.ResultsA confirmatory factor analysis was conducted on 11 of the original 11 items in the WBIS-M. Based on previous factor analyses with this scale, we expected a one-factor model. One of the items related to competence showed poor model fit, and concern was raised around possible item ambiguity partway through the study. Two versions of this item were therefore tested, neither of which yielded an acceptable fit. After exclusion of this item, the results showed high loadings for the remaining 10 items on one factor with a high internal consistency (α = 0.94). Convergent validity was approached by looking at the relationship between answers on the WBIS-M, self-perceived weight, and items on overall health and psychological/emotional state.ConclusionThe 10-item Norwegian version of the WBIS-M shows sound psychometric properties and can be used to measure internalized weight bias in a weight-neutral fashion in a Norwegian-speaking population. Internalized weight bias was correlated with psychological/emotional state and overall health, with those reporting more internalized weight bias also reporting that they felt worse. This relationship was stronger for women than men in our sample and was partially dependent on weight. The women also showed higher internalized weight bias than the men. Future studies should include more male participants and explore alternative versions of the missing item related to competence.

Differences in Thinness- and Muscularity-Oriented Eating and Body Image Disturbances and Psychosocial Well-Being in Chinese Sexual Minority Men Reporting Top, Bottom, and Versatile Sexual Self-Labels.

In addition to describing sexual partner preferences, sexual self-labels in gay and bisexual (henceforth, sexual minority) men, such as top, bottom, and versatile, are associated with psychological characteristics (e.g., gendered personality traits). No research has explored the association between sexual self-labels and eating and body image disturbances in sexual minority men. Research in sexual minority men from China is particularly valuable and needed due to recent rises in rates of eating and body image disturbances and unique, minority-specific stressors experienced by Chinese sexual minority populations. We adopted an online, cross-sectional study in a sample of sexual minority men from China (N = 403; tops, n = 256, bottoms, n = 95, versatiles, n = 52). Bottoms reported higher thinness internalization, lower muscularity internalization, higher body fat dissatisfaction, and higher psychological distress than tops. Bottoms' weight bias internalization was higher than tops' and versatiles' reports and, compared to versatiles, bottoms also reported higher psychosocial impairment related to eating disorder psychopathology. Compared to versatiles, tops reported higher drive for muscularity and muscularity-oriented disordered eating. Adjusting for age, psychological distress, and psychosocial impairment, tops reported higher muscularity internalization than bottoms and higher drive for muscularity and muscularity-oriented disordered eating than both bottoms and versatiles. Findings suggested unique relations between sexual self-labels and eating and body image disturbances in Chinese sexual minority men. Replication and validation of the temporal order between sexual self-labels and eating and body image disturbances is needed, including assessment of social factors (e.g., femmephobia, minority stress) that may help explain the links between sexual self-labels and eating pathology.

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 toward 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 body mass index (BMI) and history bariatric surgery. Results: Egyptian participants (BMI = 30.2 ± 6.7 kg/m2 [range: 18.5–69.0 kg/m2]) showed significantly higher aversion toward obesity, as indicated by higher AFA score, compared to their Spanish counterparts (BMI = 35.4 ± 10.1 kg/m2 [18.5–71.9 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: 6.78–9.62], p < 0.001 and odds ratio (OR) 6.28 [95% CI: 4.78–7.78], p < 0.001, respectively). In contrast, Spaniards experienced more stigmatizing situations than Egyptians (OR −2.54 [95% CI: 6.78–9.62], p < 0.001). Conclusion: Our study underscores the complex and diverse nature of obesity-related attitudes across cultures. Understanding these cultural differences is crucial for developing effective, culturally sensitive strategies to tackle weight stigma. This research opens avenues for further studies and interventions tailored to cultural contexts.

Women's Relationships With Healthcare and Providers: The Role of Weight Stigma in Healthcare and Weight Bias Internalization.

Weight stigma (devaluation due to body weight) in healthcare is common and influences one's engagement in healthcare, health behaviors, and relationship with providers. Positive patient-provider relationships (PPR) are important for one's healthcare engagement and long-term health. To date, no research has yet investigated whether weight bias internalization (self-stigma due to weight; WBI) moderates the effect of weight stigma on the PPR. We predict that weight stigma in healthcare is negatively associated with (i) trust in physicians, (ii) physician empathy, (iii) autonomy and competence when interacting with physicians, and (iv) perceived physician expertise. We also predict that those with high levels of WBI would have the strongest relationship between experiences of weight stigma and PPR outcomes. We recruited women (N = 1,114) to complete a survey about weight stigma in healthcare, WBI and the previously cited PPR outcomes. Weight stigma in healthcare and WBI were associated with each of the PPR outcomes when controlling for age, BMI, education, income, race, and ethnicity. The only exception was that WBI was not associated with trust in physicians. The hypothesis that WBI would moderate the effect of weight stigma in healthcare on PPR outcomes was generally not supported. Overall, this research highlights how weight stigma in healthcare as well as one's own internalization negatively impact PPRs, especially how autonomous and competent one feels with their provider which are essential for one to take an active role in their health and healthcare.

The role of food reward in the associations between weight-based discrimination and feeding practices among caregivers of young children

Certain caregiver feeding practices, including restrictive feeding for weight control, restrictive feeding for health, emotion regulation feeding, and reward feeding, are known to negatively influence short- and long-term child eating and health outcomes. Beyond body size, the precise psychosocial characteristics of caregivers more likely to engage in such feeding practices are unknown. In particular, caregivers who have experienced discrimination based on their weight, who have internalized those biased beliefs, or who find food to be very rewarding may be more likely to use restrictive or controlling feeding practices. The present study investigated the associations among experiences of weight-based discrimination, internalized weight bias, and food reward (i.e., reward-based eating drive) with use of restriction for weight control, restriction for health, emotion regulation feeding, and reward feeding in an online US sample of caregivers (M = 35.27 ± 9.08 y/o) of 2–5 year-old children (N = 305). About half (50.8%) of respondents self-identified as women and most as non-Hispanic (88.5%) and White (75.1%). There were significant positive correlations among caregivers' experience of weight-based discrimination, internalized weight bias, and use of all four feeding practices. Regression results showed that caregivers’ food reward moderated the main effect of weight-based discrimination on restrictive feeding for weight control and emotion regulation feeding, such that caregivers who were high in food reward and who experienced discrimination were most likely to engage in these feeding practices. These results can inform interventions aimed at improving child food environments and health.

Effects of a Cognitive-Behavioral Group Counseling Program on Weight Bias Internalization and Psychological Outcomes Among Obese Youth in Mahasarakham University, Thailand.

Weight bias internalization (WBI) is a serious challenge because of its negative impact on psychological consequences. Although the cognitive-behavioral intervention has been applied to reduce WBI, little is known about its effectiveness among Thai obese youth. Thus, this study sought to determine the effects of a cognitive-behavioral group counseling (CBGC) program on WBI and psychological outcomes in obese youths. Study Design: A randomized controlled trial. Eighty obese youths were randomly allocated to two intervention (n=40) and control (n=40) groups. The intervention group received a CBGC program in three sessions with ten activities, while the control group performed their usual counseling process. Data were collected through standardized interviewers with a structured interview questionnaire. The chi-square test, independent samples t-test, Mann-Whitney U test, repeated measure ANOVA, and multivariate linear regression were applied for data analyses. At the follow-up visit, the intervention group had a significant decrease in the mean of WBI, depression, and perceived stress and an increased mean of self-esteem compared to the control group. After adjusting baseline characteristics and baseline outcome values, the intervention also significantly improved WBI (B=-6.82, P<0.001), depression (B=-4.17, P<0.001), perceived stress (B=-6.01, P<0.001), and self-esteem (B=5.07, P<0.001). The CBGC program effectively reduced WBI, depression, and perceived stress while improving self-esteem among obese youths. This study recommends that group counseling programs be employed as part of a counseling process for obese youth who have experienced WBI.

The Relationship between Weight Bias Internalization and Quality of Life among Overweight and Obese Youths in Thailand

The Relationship between Weight Bias Internalization and Quality of Life among Overweight and Obese Youths in Thailand

Weight bias internalization and its association with psychological distress and weight-related factors among youths in university, Thailand.

Weight bias internalization (WBI) is associated with poor weight-related health and psychological health problems in adults. However, less is known about WBI in Thai youths, and its associated factors are scarce. This study aimed to assess the association between psychological, weight-related factors, and WBI among Thai youths. A cross-sectional design was conducted on 1185 university youths from three universities in northeastern, Thailand from January to June 2023, with multistage sampling methods. The data were collected by self-administered questionnaire. Multinomial logistic regression was applied to explore factors that influence WBI. Most of the youth were female; with the average body mass index (BMI) was 23.3 ± 3.2 kg/m2. More than half (n = 628; 52.9%) of them reported a high level of WBI that was present across the weight spectrum. Approximately 41.4% (n = 490) reported being dissatisfied with their body image, and 50.6% (n = 600) had peers with obesity. WBI was positively related to depressive symptoms, perceived stress, the experience of weight stigma, BMI, and body image dissatisfaction. Conversely, it was negatively related to self-esteem and peers with obesity. WBI is influenced by several psychological and weight-related factors. Additionally, youths across body weight categories could be vulnerable to high WBI. Hence, consideration of these potential factors could be useful in designing targeted interventions to reduce WBI.

Experienced and internalized weight stigma among Spanish adolescents

Background and objectiveWeight stigma has negative consequences for both physiological and psychological health. Studies on weight stigma in adolescence, particularly from general populations, are scarce in the Mediterranean area. The main aim of this study is to describe the prevalence of experienced and internalized weight stigma among a representative sample of adolescents from the Spanish city of Terrassa, and to determine its association with sociodemographic variables and weight status.MethodsDrawing on data from the initial assessment of a longitudinally funded project on weight stigma in adolescents, a cross-sectional survey-based study was conducted using random multistage cluster sampling. Weight stigma experiences, their frequency and sources, and weight bias internalization with the Modified Weight Bias Internalization Scale (WBISM) were assessed in a sample of 1016 adolescents. Adjusted odds ratios (AOR) between sociodemographic variables, weight status and having experienced weight stigma, and having reported high scores of WBISM (WBISM ≥ 4) were estimated by multiple logistic regression models.ResultsThe prevalence of weight-related stigma experiences was 43.2% in the sample (81.8 in adolescents with obesity) and the prevalence of high levels of weight bias internalization was 19.4% (50.7 in adolescents with obesity). Other kids and school were the most prevalent sources of weight stigma, with society and family being other significant sources of stigma reported by girls. A significantly higher risk of having experienced weight stigma was observed in girls (AOR = 2.6) and in older adolescents (AOR = 1.9). Compared to normal weight adolescents, all weight statuses showed higher risk, being 3.4 times higher in adolescents with underweight and reaching 11.4 times higher risk in those with obesity. Regarding high levels of weight bias internalization, girls had a risk 6.6 times higher than boys. Once again, a “J-shaped” pattern was observed, with a higher risk at the lowest and highest weight statuses. The risk was 6.3 times higher in adolescents with underweight, and 13.1 times higher in adolescents with obesity compared to those with normal weight.ConclusionsConsidering the high prevalence of experienced and internalized weight stigma among adolescents in Spain, especially in adolescents with obesity and girls, it seems important to implement preventive strategies in different settings and address all sources of stigma.

Weight bias among Canadians: Associations with sociodemographics, BMI and body image constructs

This cross-sectional study examined the associations between sociodemographic characteristics, BMI, and body image constructs (body satisfaction and weight bias internalization; WBI) and explicit weight bias. A near-representative sample of 995 English-speaking Canadian adults (52% Female) completed a survey which assessed explicit weight bias (Anti-Fat Attitudes questionnaire), body satisfaction (Body Shape Satisfaction Scale), WBI (Modified Weight Bias Internalization Scale), and self-reported height and weight. Multiple linear regression analyses were run. Results showed that the variable that explained the most variance in explicit weight bias was WBI, followed by BMI. Higher levels of WBI and a lower BMI were both significantly associated with greater explicit weight bias. Male sex was associated with both disliking people with obesity and thinking obesity is attributable to lack of willpower, whereas female sex was associated with worrying about weight gain. The current findings emphasize the importance of future research efforts aimed at preventing or mitigating WBI to reduce negative attitudes about people with obesity.