Pearl Rebecca L, Puhl Rebecca M, Lessard Leah M, Himmelstein Mary S, Foster Gary D
Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
SSM Popul Health. 2021 Feb 17;13:100755. doi: 10.1016/j.ssmph.2021.100755. eCollection 2021 Mar.
Weight bias internalization (WBI) is an understudied form of internalized stigma, particularly among treatment-seeking adults with overweight/obesity. The current study surveyed 13,996 adults currently engaged in weight management in the first multinational study of WBI. From May to July 2020, participants in six Western countries completed the Modified Weight Bias Internalization Scale (WBIS-M) and measures of weight change, health behaviors, psychosocial well-being, and health-related quality of life (HRQOL). Participants were majority white, female, middle-aged, and categorized as having overweight or obesity based on body mass index. Results showed higher mean WBIS-M scores among participants in the UK, Australia, and France than in Germany, the US, and Canada. Across all countries, and controlling for participant characteristics and experiences of weight stigma, WBIS-M scores were associated with greater weight gain in the past year. Participants with higher WBIS-M scores also reported poorer mental and physical HRQOL, less eating and physical activity self-efficacy, greater engagement in eating as a coping strategy, more avoidance of going to the gym, poorer body image, and greater perceived stress. Few interaction effects were found between experiences and internalization of weight stigma. Overall, the current findings support WBI as a robust correlate of adverse weight-related health indices across six Western countries. Prospective and experimental studies are needed to determine directionality and causality in the relationship between WBI and poor health outcomes.
体重偏见内化（WBI）是一种研究较少的内化耻辱形式，尤其是在寻求治疗的超重/肥胖成年人中。在第一项关于WBI的跨国研究中，当前的研究对13996名正在进行体重管理的成年人进行了调查。2020年5月至7月，来自六个西方国家的参与者完成了改良的体重偏见内化量表（WBIS-M）以及体重变化、健康行为、心理社会幸福感和健康相关生活质量（HRQOL）的测量。参与者大多为白人、女性、中年，根据体重指数被归类为超重或肥胖。结果显示，英国、澳大利亚和法国的参与者的WBIS-M平均得分高于德国、美国和加拿大。在所有国家中，在控制参与者特征和体重耻辱经历的情况下，WBIS-M得分与过去一年中更大的体重增加相关。WBIS-M得分较高的参与者还报告了较差的心理和身体HRQOL、较低的饮食和身体活动自我效能感、更多地将饮食作为一种应对策略、更多地避免去健身房、较差的身体形象以及更大的感知压力。在体重耻辱的经历和内化之间几乎没有发现交互作用。总体而言，当前的研究结果支持WBI作为六个西方国家中与不良体重相关健康指标的有力关联因素。需要进行前瞻性和实验性研究来确定WBI与不良健康结果之间关系的方向性和因果关系。
