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

Authors

  • Rebecca L. Pearl,

    Corresponding author
    1. Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • Thomas A. Wadden,

    1. Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • Christina M. Hopkins,

    1. Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
    2. Department of Psychology, Duke University, Durham, North Carolina, USA
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  • Jena A. Shaw,

    1. Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • Matthew R. Hayes,

    1. Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
    2. Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • Zayna M. Bakizada,

    1. Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • Nasreen Alfaris,

    1. Department of Medicine Gastrointestinal Unit, MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
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  • Ariana M. Chao,

    1. Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
    2. Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • Emilie Pinkasavage,

    1. Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • Robert I. Berkowitz,

    1. Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
    2. Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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  • Naji Alamuddin

    1. Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
    2. Department of Medicine, Institute for Diabetes, Obesity, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • See Commentary, pg. 280.

  • Funding agencies: This study was supported by an investigator-initiated grant from Eisai Pharmaceutical Co. (TAW). AMC was supported by an NRSA postdoctoral fellowship from the NINR/NIH #T32NR007100.

  • Disclosure: TAW discloses 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. The other authors declared no conflict of interest.

  • Author contributions: RLP held primary responsibility for this specific study design, data analysis, and manuscript preparation. TAW was responsible for the design and oversight of the clinical trial and assisted with manuscript preparation. CMH, ZMB, AMC, and EP assisted with data collection and manuscript preparation. JAS and NAla assisted with data collection, data analysis, and manuscript preparation. MRH assisted with manuscript preparation. NAlf and RIB assisted with design and oversight of the clinical trial and manuscript preparation.

  • Clinical trial registration: ClinicalTrials.gov identifier NCT02388568.

Abstract

Objective

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.

Methods

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.

Results

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).

Conclusions

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

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