Weight Bias Internalization and Psychosocial, Physical, and Behavioral Health: A Meta-Analysis of Cross-Sectional and Prospective Associations

Abstract

Coinciding with widespread efforts to address obesity, weight bias internalization (a process of self-devaluation wherein individuals apply weight-biased stereotypes to themselves) has gained increased attention as a robust correlate of poor health outcomes. The present meta-analysis aimed to provide the largest quantitative synthesis of associations between weight bias internalization and health-related correlates. Studies that provided zero-order correlations for cross-sectional or prospective associations between weight bias internalization and physical, psychosocial, and behavioral health correlates were included in the meta-analysis. Meta-regression determined whether these associations differed based on demographic (sex/gender, race, age), anthropometric (body mass index), and study-level (publication status, sample type, study quality) moderators. Data for 149 (sub)samples were identified that included between 14 and 18,766 participants (M sample size = 534.96, SD = 1,914.43; M age = 34.73, SD = 12.61, range = 9.95-65.70). Results indicated that greater weight bias internalization was concurrently associated with worse psychosocial (e.g., negative and positive mental health, social functioning), physical (e.g., BMI, weight maintenance, health-related quality of life [HRQoL]), and behavioral health (e.g., disordered eating behaviors, healthy eating, physical activity) across most constructs, with effects ranging from small to very large in magnitude. Preliminary evidence also suggested that greater weight bias internalization was subsequently associated with less weight loss and increased negative mental health. Notable variations in the nature and magnitude of these associations were identified based on the health-related correlate and moderator under consideration. These findings indicate that weight bias internalization is linked to multiple adverse health-related outcomes and provide insight into priorities for future research, theory building, and interventions in this area.

Keywords: behavioral health; health; mental health; weight bias internalization; weight stigma.

Figure 1.

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram for study selection.