Internalized weight stigma and associated clinical features in treatment-seeking adults with obesity: a multicenter Italian study

Abstract

Abstract Background This study aimed to evaluate the prevalence and clinical correlates of internalized weight stigma in patients with obesity seeking treatment in various clinical centers across Italy. Methods A total of 438 patients with obesity were included. Patients completed a baseline clinical interview and the Weight Bias Internalization Scale (WBIS) to evaluate the internalized weight stigma. Moreover, they completed the following self-report instruments: Eating Disorder Examination Questionnaire (EDE-Q), Brief Symptom Inventory (BSI), and 36-Item Short Form Health Survey (SF-36) to assess eating disorder psychopathology, general psychopathology, and quality of life, respectively. Results High internalized weight stigma, defined as a WBIS score ≥4, was observed in 211 participants (48.2%). WBIS scores were significantly higher in female patients and were negatively associated with age and the SF-36 mental component score. WBIS scores were positively associated with eating disorder psychopathology, general psychopathology, and 12-month weight-loss expectations, but were not associated with BMI and showed no consistent association with cardiometabolic parameters. In multivariable linear regression, age, EDE-Q global score, and SF-36 mental component score were independently associated with WBIS scores. Conclusions Internalized weight stigma emerged as a common and clinically relevant feature among patients seeking treatment for obesity, showing strong associations with psychological distress and impaired mental well-being independent of body mass index. The findings underscore the importance of systematically assessing internalized weight stigma and addressing it through tailored psychological strategies within multidisciplinary obesity care.