Sleep Quality, Not Sleep Duration, Is Independently Associated with Internalized Weight Bias: The Greek Lifestyle and...

Internalized weight bias-the self-directed endorsement of weight-related stereotypes-has emerged as a psychologically potent correlate of health outcomes in individuals with overweight and obesity, yet its relationship with sleep remains largely unexplored. In a cross-sectional manner, 495 Greek adults with a history of overweight/obesity were assessed regarding sleep quality and duration, internalized weight bias (Modified Weight Bias Internalization Scale; WBIS-M), and expressed anti-fat attitudes (Anti-Fat Attitudes Questionnaire, AFA: Dislike, Fear of Fat, Willpower). Insomnia prevalence, assessed with the Athens Insomnia Scale (AIS), was high at 57.6%-nearly doubling across ascending WBIS-M tertiles (39.9% to 73.1%). In hierarchical linear regression models, AIS score remained independently associated with WBIS-M after adjustment for depression, anxiety, BMI, and a comprehensive range of sociodemographic and clinical covariates (B = 0.058; 95% CI: 0.036-0.079; p < 0.001), with the fully adjusted model explaining 58.5% of total variance in WBIS-M. AFA subscales did not remain significant in the model post-full adjustment, and sleep duration failed to show independent association with either bias dimensions. The sleep-weight bias association was therefore specific to the internalized dimension and to sleep quality, rather than quantity. These findings highlight a clinically relevant and dimension-specific link between insomnia symptoms and internalized weight stigma, and suggest that routine sleep assessment may be warranted in individuals with a history of overweight or obesity presenting with elevated internalized weight bias-and vice versa.