Differences in the Associations between Body Dissatisfaction and Eating Outcomes by Gender? A Lebanese Population Study

BackgroundThe objective of this study was to evaluate the impact of the interaction between body dissatisfaction and gender on eating disorders (restrained eating, binge eating, orthorexia nervosa, and emotional eating) among a sample of Lebanese adults.MethodsThis cross-sectional study, conducted between January and May 2018, enrolled 811 participants selected randomly from all Lebanese Mohafazat. The mean age of the participants was 27.6 ± 11.8 years. The majority were females (66.5%), had a high level of education (73.2%), and low income (77.9%). This study used the following scales: body dissatisfaction subscale of the Eating Disorder Inventory-second version, binge eating scale, Dutch restrained eating scale, orthorexia nervosa scale (ORTHO-15 scale), emotional eating scale, perceived stress scale, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale.ResultsBody dissatisfaction was positively correlated to restrained eating (r = 0.293, P < 0.001), emotional eating (r = 0.073, P = 0.042) and binge eating (r = 0.250, P < 0.001). The interaction between body dissatisfaction and gender was significantly associated with more restrained eating (Beta = 0.01, P < 0.001) and orthorexia nervosa (Beta = ?0.09, P < 0.001), but not with emotional (Beta = ?0.43, P = 0.103) and binge eating (Beta = ?0.08, P = 0.358). When stratifying the analysis by gender, the results revealed that higher body dissatisfaction was significantly associated with more restrained eating in both genders, but particularly among women. Body dissatisfaction was significantly associated with higher emotional eating in men only and with higher orthorexia nervosa tendencies and behaviors in females only.ConclusionThe interaction between body dissatisfaction and gender was significantly associated with orthorexia nervosa and restrained eating but not with binge or emotional eating. Higher body dissatisfaction was significantly associated with higher restrained eating, more pronounced in women, while it was significantly associated with higher orthorexia tendencies (lower ORTO-15 scores) in women only. Body dissatisfaction was associated with emotional eating in men only.     

Weight-related teasing,emotional eating,and weight control behaviors in Hispanic and African American girls

PurposeTo assess the association among parent and peer weight-related teasing, emotional eating, and weight control behaviors in minority girls.Methods141 Hispanic and African American preadolescent girls (mean age = 11.1 years, SD = 1.5 years) participated. Most of the participants were of Hispanic origin, had a bicultural orientation, and were obese. Participants completed surveys assessing weight-related teasing, emotional eating, weight control behaviors, demographic, and acculturation characteristics. Body weight and height were also assessed. Hierarchical regression analyses were run to determine the associations among study variables.ResultsFifty-nine percent of participants reported being weight-related teased by peers and 42% participants reported weight-related teasing by parents. Weight-related teasing by parent was associated with emotional eating and binge eating, whereas peer weight-related teasing was only associated with emotional eating.ConclusionsFindings demonstrated the differential association of weight-related teasing from peers and parents to emotional and binge eating in minority girls.     

The contributions of weight problem perception,BMI, gender,mood, and smoking status to binge eating among college students

College student participants (N = 1063; 77.8% response rate) completed a web-based survey assessing demographics, depression, anxiety, body image, cigarette smoking, and weight history. Among overweight participants, 42.6% of those who believed they were overweight admitted to binge eating, while only 30.1% who did not feel overweight did so (p < .05). Among non-overweight participants, 43.2% of those who believed they were overweight admitted to binge eating, while only 32.9% of those who did not feel overweight did so (p < .05). Weight Problem Perception (WPP) mediated the contribution of BMI on binge eating outcomes, and WPP contributed significantly to the prediction of binge eating, beyond the risk conferred by established correlates of binge eating (e.g., gender, mood, and cigarette smoking). Results suggest that when assessing risk for binge eating, a one-question assessment of whether or not an individual believes s/he is overweight has significant predictive power. Findings are consistent with literature on the importance of the “fat self-schema” [Stein, K.F., & Corte, C. (2007). Identity impairment and the eating disorders: Content and organization of the self-concept in women with anorexia nervosa and bulimia nervosa. European Eating Disorders Review, 15 (1), 58–69] in disordered eating and theory implicating identity in the maintenance of addictive behavior [West, R.W. (2006). Theory of Addiction. Malden, MA: Blackwell Publishing, Inc.]     

Validation of the Yale Food Addiction Scale among a weight-loss surgery population

The Yale Food Addiction Scale (YFAS), recently validated in college students and binge eaters, is a means to assess “food addiction” in accordance with DSM-IV criteria for substance dependence. Using online survey methodology, we aimed to validate the use of the YFAS among weight loss surgery (WLS) patients. Participants completed measures about pre-WLS food addiction (YFAS), emotional and binge eating, behavioral activation and inhibition, and pre- and post-WLS substance use. A sample of 67 WLS patients (59.7% Roux-en-Y) was recruited; participants were 62.7% female, 86.6% Caucasian, had a mean age of 42.7; and 53.7% met the criteria for pre-WLS food addiction. Convergent validity was found between the YFAS and measures of emotional eating (r = .368, p < .05) and binge eating (r = .469, p < .05). Discriminant validity was supported in that problematic substance use, behavioral activation, and behavioral inhibition were not associated with YFAS scores. Incremental validity was supported in that the YFAS explained a significant proportion of additional variance in binge eating scores, beyond that predicted by emotional eating (EES) and disordered eating behavior (EAT-26). Those meeting the food addiction criteria had poorer percent total weight loss outcomes (32% vs. 27%). There was a nonsignificant trend towards those with higher food addiction being more likely to admit to post-WLS problematic substance use (i.e., potential “addiction transfer”; 53% vs. 39%). Results support the use of the YFAS as a valid measure of food addiction among WLS patients. Future research with a larger sample may shed light on potentially important relationships between pre-surgical food addiction and both weight and substance use outcomes.     

Implicit,explicit, and internalized weight bias and psychosocial maladjustment among treatment-seeking adults

ObjectiveWeight bias among weight loss treatment-seeking adults has been understudied. This investigation examined the 1) levels of implicit, explicit, and internalized weight bias among overweight/obese treatment-seeking adults, 2) association between weight bias and psychosocial maladjustment (binge eating, body image, depression), and 3) association between participation in weight loss treatment and changes in weight bias.MethodsFifty-four overweight and obese individuals (BMI ≥ 27) recruited for a weight loss intervention completed measures of depression, body image, binge eating, and implicit, explicit, and internalized weight bias.ResultsParticipants evidenced significant implicit, explicit, and internalized weight bias. Greater weight bias was associated with greater depression, poorer body image, and increased binge eating. Despite significant reductions in negative internalized and explicit weight bias following treatment, weight bias remained strong.ConclusionsWeight bias among treatment-seeking adults is associated with greater psychological maladjustment and may interfere with their ability to achieve optimal health and well-being.     

Implicit bias about weight and weight loss treatment outcomes

ObjectivesThe goal of the current study was to examine the impact of a weight loss intervention on implicit bias toward weight, as well as the relationship among implicit bias, weight loss behaviors, and weight loss outcomes. Additionally, of interest was the relationship among these variables when implicit weight bias was measured with a novel assessment that portrays individuals who are thin and obese engaged in both stereotypical and nonstereotypical health-related behaviors.MethodsImplicit weight bias (stereotype consistent and stereotype inconsistent), binge eating, self-monitoring, and body weight were assessed among weight loss participants at baseline and post-treatment (N = 44) participating in two weight loss programs.ResultsStereotype consistent bias significantly decreased from baseline to post-treatment. Greater baseline stereotype consistent bias was associated with lower binge eating and greater self-monitoring. Greater post-treatment stereotype consistent bias was associated with greater percent weight loss. Stereotype inconsistent bias did not change from baseline to post-treatment and was generally unrelated to outcomes.ConclusionWeight loss treatment may reduce implicit bias toward overweight individuals among weight loss participants. Higher post-treatment stereotype consistent bias was associated with a higher percent weight loss, possibly suggesting that losing weight may serve to maintain implicit weight bias. Alternatively, great implicit weight bias may identify individuals motivated to make changes necessary for weight loss.     

Parent report of binge eating in Hispanic,African American and Caucasian youth

Binge eating is prevalent among weight loss treatment-seeking youth. However, there are limited data on the relationship between binge eating and weight in racial or ethnically diverse youth. We therefore examined 409 obese (BMI ≥ 95th percentile for age and sex) treatment-seeking Hispanic (29.1%), Caucasian (31.7%), and African American (39.2%), boys and girls (6–18 years). Weight, height, waist circumference, and body fat were measured to assess body composition. Depressive symptoms were measured with the Children's Depression Inventory and disordered eating cognitions were measured with the Children's Eating Attitudes Test. Accounting for age, sex, body fat mass, and height, the odds of parents reporting that their child engaged in binge eating were significantly higher among Caucasian compared to African American youth, with Hispanic youth falling non-significantly between these two groups. Youth with binge eating had greater body adiposity (p = .02), waist circumference (p = .02), depressive symptoms (p = .01), and disordered eating attitudes (p = .04), with no difference between racial or ethnic group. We conclude that, regardless of race or ethnicity, binge eating is prevalent among weight loss treatment-seeking youth and is associated with adiposity and psychological distress. Further research is required to elucidate the extent to which binge eating among racially and ethnically diverse youth differentially impacts weight loss outcome.     

Relationships between depression,gender, and unhealthy weight loss practices among overweight or obese college students

IntroductionUnhealthy weight loss practices are common among female college students. It is unknown if these practices are also most common among women in the subset of overweight or obese college students or if these practices are related to depression. We examined the relationship between gender, depression, and unhealthy weight loss practices among overweight or obese college students.MethodsStudents (body mass index between 25.0 and 34.9 kg/m²) from three Southern California universities (M_age = 22 years, SD = 4; 70% women) were recruited from May 2011 to May 2012 for participation in a weight loss clinical trial (N = 404). Logistic regressions were performed with baseline data to assess the cross-sectional relationship between self-reported unhealthy weight loss practices and gender and depression as measured by the Center for Epidemiologic Studies Depression short form.ResultsTwenty-nine percent of participants reported engaging in at least one unhealthy weight loss behavior (e.g., fasting, purging) over the last 30 days, with no differences by gender. Self-report of at least one unhealthy weight loss behavior was associated with report of symptoms of depression (e^B = 1.14 [confidence interval, CI: 1.08–1.20]), adjusting for potential confounders. Interactions between gender and depression were not significant (e^B = 1.04 [CI: 0.93–1.16]).ConclusionAmong an overweight or obese sample of college students, unhealthy weight loss practices were equally common in both genders, and students with depressive symptomatology were at greatest risk. Obesity interventions targeting overweight or obese college students should educate both men and women about the dangers of unhealthy weight loss practices. In addition, screening for depression can help identify students who would benefit from additional supportive and coping strategies and resources.     

Melanocortin-3 receptor gene variants: Association with childhood obesity and eating behavior in Chilean families

ObjectiveTo evaluate the association between melanocortin-3 receptor common genetic polymorphisms with childhood obesity and eating behavior in Chilean families.MethodsTwo hundred twenty-nine obese children (6–12 y old, body mass index >95th percentile of Centers for Disease Control and Prevention/National Center for Health Statistics, 2000) and 270 parents were selected. Genotypes for MC3R genetic markers ?239A > G, 17C > A (Thr6Lys), 241 G > A (Val81Ile), +2138InsCAGACC, and microsatellite D20s32e were determined. Eating behavior scores were computed using the Child Eating Behavior Questionnaire and a shorter version of the Three Factor Eating Questionnaire adapted for evaluating eating inclinations in children. Genotype-obesity associations were assessed by the Transmission Disequilibrium Test. Non-parametric tests were used to compare eating behavior scores across study groups.ResultsAllelic frequencies of ?239 G, 17A, 241A, and +2138InsCAGACC were estimated as 4.5%, 5.9%, 5.6%, and 17.6%, respectively, in obese children. The Transmission Disequilibrium Test in case–parent trios revealed no significant associations between childhood obesity and genetic markers, including the microsatellite D20s32e. In girls, we found significantly higher scores of the emotional eating subscale in carriers of the +2138InsCAGACC compared with non-carriers (P = 0.04). In boys, carriers of 17A and 241A showed lower scores for the emotional eating subscale (P = 0.01), whereas carriers of +2138InsCAGACC showed significantly lower scores for the enjoyment of food subscale compared with non-carriers (P = 0.04).ConclusionsThere is not sufficient evidence to support the contribution for common melanocortin-3 receptor variants in childhood obesity. However, our results are concordant for a role of melanocortin-3 receptor variants in some dimensions of eating behavior such as emotional eating and enjoyment of food.     

Weight parameters and pathological eating as predictors of obesity treatment outcome in children and adolescents

ObjectiveThe current study investigated weight parameters and pathological eating as predictors of treatment outcome in obese youngsters.MethodObese youngsters (N = 132) were examined before participating in an obesity treatment program. Weight loss was measured during and at the end of treatment.ResultsBaseline adjusted BMI, restrained eating style and weight loss after 4 months of treatment positively predicted weight loss at the end, whereas larger weight loss after 1 month of treatment predicted less total weight loss. Lower baseline adjusted BMI was associated with more drop-out whereas subjective binge eating was positively related to program completion.ConclusionSpecific weight and eating pathology parameters affected positive as well as negative obesity treatment outcome. Identifying more pre-treatment predictors for drop-out can ameliorate our treatment approach.     

Television use and binge eating in adults seeking weight loss treatment

ObjectiveBinge eating has a complex etiology and is likely influenced by a wide range of biological, psychological, social, and environmental factors. Among the environmental and behavioral contributors, television use has been strongly linked to obesity and unhealthy eating behaviors. The current study tested whether television use predicts binge eating symptomatology in adults seeking behavioral weight loss treatment.MethodParticipants (N = 116) were adults seeking weight loss treatment in group-based behavioral weight loss programs. Average body mass index was 38.5; average age was 45.3. They completed measures of binge eating symptomatology, television use, internalized weight stigma, depression, body satisfaction, and habitual physical activity.ResultsThe amount of television participants watched per week was associated with binge eating symptomatology even after controlling for relevant covariates. Binge eating symptomatology was positively associated with television use, internalized weight stigma, depression, and decreased body satisfaction.DiscussionThe findings of the current study support the hypothesis that television use is a significant predictor of binge eating symptomatology for adults attempting weight loss. Determining the causal nature of the relationship and whether binge eating is occurring during television viewing will be important areas of future inquiry.     

Nibbling and picking in obese patients with Binge Eating Disorder

ObjectiveThe goal of this study was to examine the clinical utility of nibbling behavior, defined as eating in an unplanned and repetitious manner between meals and snacks without a sense of loss of control, in obese patients with Binge Eating Disorder (BED).MethodsTwo-hundred seventeen (N = 217) consecutive, treatment-seeking, obese patients with BED were assessed with the Eating Disorder Examination (EDE). Nibbling frequency was examined in relation to current weight, eating disorder psychopathology and eating patterns.ResultsResults found that nibbling/picking was not related to body mass index, objective bulimic, subjective bulimic, or overeating episodes, food avoidance, sensitivity to weight gain, or any subscales of the EDE. However, nibbling/picking was significantly related to frequency of morning and afternoon snacking (r = .21, p = .002; r = .27, p < .001).DiscussionThe assessment of nibbling/picking behaviors among individuals with BED might not provide clinically significant information.     

Emotion recognition and alexithymia in females with non-clinical disordered eating

ObjectivesThe aims were to determine if emotion recognition deficits observed in eating disorders generalise to non-clinical disordered eating and to establish if other psychopathological and personality factors contributed to, or accounted for, these deficits.DesignFemales with high (n = 23) and low (n = 22) scores on the Eating Disorder Inventory (EDI) were assessed on their ability to recognise emotion from videotaped social interactions. Participants also completed a face memory task, a Stroop task, and self-report measures of alexithymia, depression and anxiety.ResultsRelative to the low EDI group, high EDI participants exhibited a general deficit in recognition of emotion, which was related to their scores on the alexithymia measure and the bulimia subscale of the EDI. They also exhibited a specific deficit in the recognition of anger, which was related to their scores on the body dissatisfaction subscale of the EDI.ConclusionsIn line with clinical eating disorders, non-clinical disordered eating is associated with emotion recognition deficits. However, the nature of these deficits appears to be dependent upon the type of eating psychopathology and the degree of co-morbid alexithymia.     

Sex differences in the association between dietary restraint,insulin resistance and obesity

Background & aimsRestrained food consumption may alter metabolic function and contribute to eventual weight gain; however, sex differences in these relationships have not been assessed. The objective of this study was to examine the relationship between restrained eating and insulin resistance and the influence of body mass index and sex on this relationship in a large community sample of both men and women. We hypothesized that restrained eating would be related to insulin resistance and this relationship would be influenced by sex and body mass index.MethodsIn this cross-sectional, observational study, we studied 487 individuals from the community (men N = 222, women N = 265), who ranged from lean (body mass index 18.5–24.9 kg/m², N = 173), overweight (body mass index 25–29.9 kg/m², N = 159) to obese (body mass index > 30 kg/m², N = 155) weight categories. We assessed restrained eating using the Dutch Eating Behavior Questionnaire and obtained fasting morning plasma insulin and glucose on all subjects.ResultsIn men, but not in women, restrained eating was related to homeostatic model assessment of insulin resistance (HOMA-IR) (p < 0.0001). Furthermore, HOMA-IR was significantly higher in men who were high- versus low-restrained eaters (p = 0.0006).ConclusionsThis study is the first to report sex differences with regard to the relationship between restrained eating and insulin resistance. Our results suggest that high restrained eating is associated with insulin resistance in men but not in women.     

COVID- 19 outbreak: Does confinement have any impact on weight change perception?

PurposeThis study aimed to evaluate the relationship between factors related to COVID-19 confinement (i.e., fear of COVID-19, anxiety, anger, boredom, eating disorders, and duration of confinement) and weight perception in a sample of the Lebanese population.MethodsA cross-sectional web-based survey carried out at a one-time point between April 3 and 18, 2020, enrolled 407 participants. Due to the imposed lockdown, respondents self-reported their weight and height. One dichotomized question (positive/negative) assessed the perception of weight change (yes = change perception, and no = no change perception). The variation in BMI was calculated by subtracting the estimated weight during confinement from the estimated weight before.ResultsNo significant variation in BMI was detected before and during the confinement (p = 0.40), while a perceived weight change was found in 212 (52.1%) participants. The regression analysis showed that higher fear of COVID-19 score (ORa = 0.96) and higher self-reported weight change (ORa = 0.47) were associated with lower weight change perception. However, longer confinement duration (ORa = 1.07), higher anxiety (ORa = 1.05), and high eating concerns (ORa = 1.81) were associated with higher weight change perception.ConclusionOur results revealed that both the fear of COVID-19 and self-reported weight change were negatively associated with weight change perception, while higher anxiety and a longer duration of confinement correlated with a higher weight change perception. Further studies are necessary to confirm our findings.     

Recognizing disordered eating in primary care patients with obesity

ObjectiveIn clinical practice, behavioral approaches to obesity treatment focus heavily on diet and exercise recommendations. However, these approaches may not be effective for patients with disordered eating behaviors. Little is known about the prevalence of disordered eating behaviors in primary care patients with obesity or whether they affect difficulty making dietary changes.MethodsWe conducted a telephone interview of 337 primary care patients aged 18–65 years with BMI ≥ 35 kg/m² in Greater Boston, 2009–2011 (58% response rate, 69% women). We administered the Three-Factor Eating Questionnaire R-18 (scores 0–100) and the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) (scores 0–100). We measured difficulty making dietary changes using four questions regarding perceived difficulty changing diet (Scores 0–10).Results50% of the patients reported high emotional eating (score > 50) and 28% reported high uncontrolled eating (score > 50). Women were more likely to report emotional [OR = 4.14 (2.90, 5.92)] and uncontrolled eating [OR = 2.11 (1.44, 3.08)] than men. African-Americans were less likely than Caucasians to report emotional [OR = 0.29 (95% CI: 0.19, 0.44)] and uncontrolled eating [OR = 0.11 (0.07, 0.19)]. For every 10-point reduction in QOL score (IWQOL-lite), emotional and uncontrolled eating scores rose significantly by 7.82 and 5.48, respectively. Furthermore, participants who reported emotional and uncontrolled eating reported greater difficulty making dietary changes.SummaryDisordered eating behaviors are prevalent among obese primary care patients and disproportionately affect women, Caucasians, and patients with poor QOL. These eating behaviors may impair patients' ability to make clinically recommended dietary changes. Clinicians should consider screening for disordered eating behaviors and tailoring obesity treatment accordingly.     

Anxiety mediates the relationship between sleep onset latency and emotional eating in minority children

This study examined associations between sleep onset latency and emotional eating in a minority sample of children. A cross-sectional school-based study of sleep, psychological constructs, diet and physical activity was conducted in 6 public and private schools in Los Angeles County. An ethnically diverse sample of 356 third through fifth graders completed confidential self-report surveys. Multilevel regression (MLM) analyses were conducted to study associations while controlling for gender, ethnicity, and the random effect of school. Girls made up 57% of the total sample, which was predominantly Latino (42.6%), followed by African Americans (21.6%) and Asians (19.2%). MLM revealed that there were significant associations between sleep onset latency and emotional eating (p = .030), depressive symptomology (p < .0001) and trait anxiety (p < .0001). Sobel's test for mediation showed that trait anxiety (p = .011) but not depressive symptomology (p = .141) was a mediator of the relationship between sleep onset latency and emotional eating. Thereby providing a mechanism through which sleep onset latency is related to emotional eating. These findings suggest that sleep onset latency is associated with increased anxiety, depressive symptoms, and emotional eating. Although causal inferences cannot be drawn from this cross-sectional data, future studies should examine the possibility that problems falling asleep could lead to emotional dysregulation that in turn leads to emotional eating. Emotional eating may be one avenue by which sleep disturbances lead to overweight and obesity.     

A preliminary evaluation of BMI status in moderating changes in body composition and eating behavior in ethnically-diverse first-year college women

The present pilot investigation explored whether BMI status at college entry moderated changes in body composition and eating behavior in a sample of 134 first-time, first-year undergraduate females (40% Black/African American). Participants had their body measurements [i.e. weight, BMI, hip and waist circumference (WC), percent body fat (PBF)] assessed and completed self-report measures of binge eating, night eating, and intuitive eating at both the beginning of the fall and the beginning of the spring semesters of their first year. Results for the 83 completers revealed that overweight/obese students (N = 28) experienced greater gains in weight (p < 0.05), BMI (p < 0.05), and a trend towards increased WCs (p < 0.06) across the first college semester relative to their underweight/normal weight peers (N = 55). Night eating increased (p < 0.05) and intuitive eating declined (p < 0.05) over time in the full sample. Overweight/obese participants indexed greater binge eating scores (p < 0.001) and lower intuitive eating scores (p < 0.01) irrespective of time. Most anthropometric findings were diminished while all eating behavior estimates were retained in subsequent models adjusted for parental income. Preliminary results call attention to the need for continued elucidation of the roles of socioeconomic and regional diversity in affecting both the prevalence of overweight/obesity and the relationship between higher weight and body composition changes among first-year college women. Findings also provide tentative behavioral targets for college wellness programming that may prove useful in promoting healthy weight management while acclimating to the college environment.     

An exploratory investigation of purging disorder

ObjectivePurging Disorder (PD) is an understudied pattern of behaviors within the Eating Disorder Not Otherwise Specified (EDNOS) category. Such categorization may suggest that PD is not clinically significant as other eating disorders. However, evidence has suggested that PD is associated with significant impairments in psychosocial functioning and well-being. Despite the apparent clinical significance of PD, it remains to be determined if PD is distinct from other clinically significant eating disorders. The present study sought to assess the phenomenology, clinical significance, and distinctiveness of PD.MethodGroup scores on measures of eating pathology, body image disturbance, and psychological correlates were compared using MANOVA among a female undergraduate sample (N = 94) meeting diagnostic criteria for PD (n = 20), Bulimia Nervosa (BN; n = 35), restrained eating (n = 18), and healthy controls (n = 21).ResultsOverall, results indicated the PD group reported less severe symptoms than BN but more severe symptoms than controls. The PD and restraint groups were similar on most variables (including subjective binge behavior), with the exception of perfectionism and hunger.DiscussionFindings support the conceptualization of PD as existing along a spectrum of bulimic spectrum disorders rather than as a distinct diagnostic category.     

Weight and health-related quality of life: The moderating role of weight discrimination and internalized weight bias

ObjectivesObesity is an increasingly prevalent public health concern, with associated medical comorbidities and impairment in health-related quality of life (HRQoL). Obese women are frequently victims of weight-related discrimination. The HRQoL impairments among obese people could be related to this discrimination and to internalized weight bias.DesignWe examined the potential moderating role of discrimination (from others) and self-directed (internalized) weight-based discrimination in the association between body mass index (BMI) and HRQoL.MethodsEighty-one women (mean age = 41.1 years; mean BMI = 43.40 kg/m², 97% Caucasian) completed valid and reliable measures of weight bias internalization (weight bias internalization scale), perceived discrimination by others (everyday discrimination scale) and both physical and mental HRQoL (SF-36 Health Survey). Multiple regression analysis was used to test whether internalized weight bias or discrimination moderated the association between BMI and the summary scores for physical and mental HRQoL, controlling for age.ResultsSignificant associations were found between BMI and discrimination (r = .36, p = .002), between internalized weight bias and both mental (r = .61, p < .001) and physical HRQoL (r = .45, p < .001), and between discrimination and physical HRQoL (r = .29, p = .014). A statistically significant interaction was found between BMI and internalized weight bias (b = − .21, SE = .10, p < 0.05) in accounting for the variance in physical HRQoL.ConclusionsThe association between higher BMI and poorer physical HRQoL was found only in individuals reporting high levels of internalized weight bias. Self-discrimination among overweight individuals may be a critical factor in their physical health impairment.