Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity

Obesity (Silver Spring). 2017 Feb;25(2):317-322. doi: 10.1002/oby.21716.


Objective: Weight stigma is a chronic stressor that may increase cardiometabolic risk. Some individuals with obesity self-stigmatize (i.e., weight bias internalization, WBI). No study to date has examined whether WBI is associated with metabolic syndrome.

Methods: Blood pressure, waist circumference, and fasting glucose, triglycerides, and high-density lipoprotein cholesterol were measured at baseline in 178 adults with obesity enrolled in a weight-loss trial. Medication use for hypertension, dyslipidemia, and prediabetes was included in criteria for metabolic syndrome. One hundred fifty-nine participants (88.1% female, 67.3% black, mean BMI = 41.1 kg/m2 ) completed the Weight Bias Internalization Scale and Patient Health Questionnaire (PHQ-9, to assess depressive symptoms). Odds ratios and partial correlations were calculated adjusting for demographics, BMI, and PHQ-9 scores.

Results: Fifty-one participants (32.1%) met criteria for metabolic syndrome. Odds of meeting criteria for metabolic syndrome were greater among participants with higher WBI, but not when controlling for all covariates (OR = 1.46, 95% CI = 1.00-2.13, P = 0.052). Higher WBI predicted greater odds of having high triglycerides (OR = 1.88, 95% CI = 1.14-3.09, P = 0.043). Analyzed categorically, high (vs. low) WBI predicted greater odds of metabolic syndrome and high triglycerides (Ps < 0.05).

Conclusions: Individuals with obesity who self-stigmatize may have heightened cardiometabolic risk. Biological and behavioral pathways linking WBI and metabolic syndrome require further exploration.

Trial registration: NCT02388568.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Body Weight
  • Female
  • Humans
  • Male
  • Metabolic Syndrome* / blood
  • Middle Aged
  • Obesity / psychology*
  • Obesity / therapy*
  • Patient Acceptance of Health Care*
  • Risk Factors
  • Self Concept*
  • Social Stigma*
  • Surveys and Questionnaires
  • Waist Circumference
  • Young Adult

Associated data