The Burden from Within-An Indian Pilot Study on Weight Bias Internalization

Internalized bias and stigma is consistently linked to increased depression, anxiety, sadness, low self-esteem, negative body image, disordered eating behaviours, and decline in mental health-related quality of life (HRQOL). Internalization of weight bias has also been associated with higher degree of obesity, lesser motivation to engage in physical activity, poorer adherence to dietary modification and weight-regain post bariatric surgery. While it has been studied extensively in the Western world, limited data exists on its prevalence in India.

To assess the degree of weight bias internalization (WBI) among people with obesity seeking consultation for metabolic and bariatric surgery in the Indian context.

A cross-sectional study to assess weight bias internalization was conducted among 142 participants attending a metabolic and bariatric clinic using the Weight Bias Internalization Scale (WBIS). 78.9% of the study participants were women. The participants were classified based on their average WBIS scores. Correlation of WBI scores with BMI and age was performed.

The mean WBIS score was 4.7 ± 1.2, with 71.1% of participants scoring above the neutral threshold, indicating a high prevalence of internalized weight bias for all items. Responses to individual items further reflected a general pattern of dissatisfaction with body weight, low self-worth, and emotional distress associated with obesity. Age showed negative correlation with WBIS scores suggesting that younger the person, more the bias. BMI on the other hand had a positive correlation and participants with higher BMI showed greater internalized bias.

This is the first study in India that throws some light on the high burden of internalized weight bias among individuals with obesity seeking metabolic and bariatric surgery consultation. The findings underscore the need for focused interventions to address internalized bias and stigma to enhance psychological well-being, and encourage health-seeking behaviour in people living with obesity.