Internalized weight stigma and obesity-related quality of life in adults with obesity or overweight: a cross-sectional study across clinical and community settings

PURPOSE: Internalized weight stigma (IWS) is a known correlate of reduced quality of life (QoL) in individuals with obesity or overweight. However, few studies have examined whether this association differs across different recruitment settings. This study aimed to assess the association between IWS and obesity-related QoL in adults with obesity or overweight recruited from clinical settings or from the community, while adjusting for established psychological and demographic predictors. METHODS: A total of 313 individuals with obesity were recruited from six obesity treatment centers, and 139 with obesity (n = 72) or overweight (n = 67) were recruited from the community via online survey. Participants completed self-report measures of IWS (Weight Bias Internalization Scale), obesity-related QoL (Laval Questionnaire), depressive symptoms (BDI-II), binge eating (BES), and attitudes toward people with obesity (ATOP). Multiple regression models tested the effect of IWS across QoL domains, with interaction terms by recruitment setting and adjustment for covariates. RESULTS: First exploratory analyses revealed some significant differences across clinical centers in both predictors and QoL domains, which warranted the adjustment of the alpha level to 0.005 for all subsequent regression models. IWS significantly predicted poorer QoL in emotional, social, and sexual domains across all groups, including individuals with overweight from the community. It was also associated with lower hygiene-related QoL, but only among individuals with obesity from clinical centers. No direct effect of IWS was found on physical functioning or symptom burden. Depressive symptoms and BMI were strong covariates in most regression models. CONCLUSIONS: IWS is independently associated with psychological and interpersonal aspects of QoL across clinical and community settings. These findings underscore the importance of addressing internalized weight stigma in both therapeutic interventions and public health efforts. LEVEL OF EVIDENCE: Level III: Evidence obtained from well-designed cohort or case-control analytic studies.