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

Journal Article (Journal Article)


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.


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.


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).


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

Full Text

Duke Authors

Cited Authors

  • Pearl, RL; Wadden, TA; Hopkins, CM; Shaw, JA; Hayes, MR; Bakizada, ZM; Alfaris, N; Chao, AM; Pinkasavage, E; Berkowitz, RI; Alamuddin, N

Published Date

  • February 2017

Published In

Volume / Issue

  • 25 / 2

Start / End Page

  • 317 - 322

PubMed ID

  • 28124502

Pubmed Central ID

  • PMC5300503

Electronic International Standard Serial Number (EISSN)

  • 1930-739X

International Standard Serial Number (ISSN)

  • 1930-7381

Digital Object Identifier (DOI)

  • 10.1002/oby.21716


  • eng