In the Journals Plus

Mixed results concerning association between weight bias internalization, risk for metabolic syndrome

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January 31, 2017

Adults with obesity seeking weight-loss treatment who scored high on a weight bias internalization scale were more likely to have metabolic syndrome vs. those with lower scores, whereas overall weight bias internalization was associated with only one component of the syndrome, according to findings published in Obesity.

“The only individual component of metabolic syndrome that was significantly associated with [weight bias internalization] was high triglycerides/use of medication for dyslipidemia,” Rebecca L. Pearl, PhD, assistant professor of psychology at the University of Pennsylvania Perelman School of Medicine, and colleagues wrote. “Internalized weight bias could elicit a chronic stress response similar to that observed in reaction to experiences of weight stigma, such as heightened levels of oxidative stress and cortisol secretion. The act of self-stigmatizing may lead to a state of physiological arousal that itself increases risk for metabolic abnormalities through biological pathways (eg, cortisol secretion).”

Rebecca Pearl
Rebecca L. Pearl

Pearl and colleagues analyzed data from 178 adults with obesity enrolled in a weight-loss trial (88.1% women; 67.3% black; mean BMI, 41.4 kg/m²); 159 completed the Weight Bias Internalization Scale and the Patient Health Questionnaire (PHQ-9) to assess depressive symptoms. Researchers determined ORs for metabolic syndrome adjusting for BMI, demographics and PHQ-9 scores.

Within the cohort, 51 adults met criteria for metabolic syndrome. After adjustment for BMI and depressive symptoms, adults with higher weight bias internalization scores had a greater likelihood of having metabolic syndrome (OR = 1.41; P = .042), but results did not persist after adjustment for demographics (OR = 1.46; P = .052), and age remained the only covariate associated with metabolic syndrome (OR = 1.05; P = .004).

In secondary analyses assessing the relationship between weight bias internalization and individual components of metabolic syndrome, researchers found that only the relationship between weight bias and triglycerides was statistically significant, with adults with a higher weight bias score more likely to have high triglycerides (OR = 1.88; P = .013).

In logistic regression analyses adjusted for all covariates, adults with a high weight bias internalization score ( 4.18) were three times more likely to have metabolic syndrome (P = .039) and six times more likely to have high triglycerides or take medication for dyslipidemia (P = .018) vs. those with a low weight bias internalization score.

“It is important for health care providers to be aware that many patients with obesity have experienced weight-based stigmatization, and some may have internalized these stigmatizing messages,” Pearl told Endocrine Today. “When discussing weight with patients, health care providers can play a role in preventing and reducing this internalization by treating patients with respect, discussing weight with sensitivity and without judgment, and giving support and encouragement to patients who struggle with weight management.”

Pearl said providers can be on the lookout for signs of internalized weight bias in their patients, such as self-criticism because of their weight, and challenge negative, internalized stereotypes (such as people with obesity are “lazy”) by educating patients about the complex biological and environmental factors that contribute to obesity.

“Future studies should test specific pathways by which weight bias internalization may affect health,” Pearl said. by Regina Schaffer

For more information:

Rebecca L. Pearl, PhD, can be reached at the Perelman School of Medicine at the University of Pennsylvania, Building 421 5162, 3400 Civic Center Blvd., Philadelphia, PA 19104; email: rpearl@mail.med.upenn.edu.

Disclosure: One of the study authors reports serving on advisory boards for Novo Nordisk, Nutrisystem and Weight Watchers, as well as receiving grant support on behalf of the University of Pennsylvania from Eisai Pharmaceutical Co.