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.     

Gender differences in coping responses and bulimic symptoms among undergraduate students

This prospective study examined the predictive role of three types of coping responses (i.e., voluntary disengagement, involuntary engagement, and involuntary disengagement) in response to social stress on bulimic symptoms among undergraduate women and men. A total of 883 (308 men; 35%) participants completed the Response to Stress Questionnaire, the Beck Depression Inventory, and the Eating Disorder Inventory (EDI) at baseline assessment and the EDI at follow-up assessment 8–12 weeks later. After controlling for baseline bulimic symptoms, depression, and body dissatisfaction, involuntary disengagement predicted bulimic symptoms at follow-up among men (b = .21, p < .001), but not among women (b = .06, p > .05). Results indicated that men who responded to social stress through involuntary disengagement (e.g., emotional numbing, inaction) had higher risk for increased bulimic symptoms. Future studies are needed to replicate these findings and to further understand the role of these coping responses on bulimic symptoms.     

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.     

Perfectionistic cognitions and eating disturbance: Distinct mediational models for males and females

ObjectivePerfectionism has long been known to correlate with eating disturbance (ED). One mechanism through which this personality tendency may lead to ED is through increasing one's daily perfectionistic thoughts. This study examined the mediating role of perfectionistic thinking in the personality perfectionism–ED relationship among both male and female college students, and included measures assessing both typically-male and typically-female ED symptoms.MethodA majority-White sample of 140 males and 329 females completed online versions of the Multidimensional Perfectionism Scale (Hewitt & Flett, 1991), Perfectionism Cognitions Inventory (Flett, Hewitt, Blankstein, & Gray, 1998), Drive for Muscularity Scale (McCreary, Sasse, Saucier, & Dorsch, 2004), items from the Eating Disorder Examination Questionnaire (Fairburn, 2008), and other measures. Regression tests examined the hypothesized role of perfectionistic cognitions as a mediator, including participant age, BMI, and positive and negative affect as covariates.ResultsAmong women, relationships between both self-oriented (Sobel's statistic = − 4.63, p < .001) and socially prescribed perfectionism (Sobel's statistic = − 5.77, p < .001) and dieting behavior were fully mediated by increased perfectionistic thinking. Among men, however, the relationship between only self-oriented perfectionism and bulimic (but not dieting) behavior, was fully mediated by increased perfectionistic thinking (Sobel's statistic = − 2.53, p = .01).ConclusionsPerfectionistic cognitions play an important linking role between personality perfectionism and ED, and can illuminate important differences by gender in eating disturbance. Such findings can improve validity of ED assessment in both genders, and provide a clear pathway to interventions to decrease ED in both genders.     

Social anxiety and disordered overeating: An association among overweight and obese individuals

ObjectiveThe study objectives were to evaluate the relationship between social anxiety, binge eating, and emotional eating in overweight and obese individuals and to evaluate the relationship between weight and social anxiety.MethodsUsing an internet based survey, overweight and obese men and women (n = 231; mean age = 36.0 ± 12.8; mean BMI = 33.7 kg/m² ± 6.7) completed several self-report measures including: social anxiety, social physique anxiety, binge eating, and emotional eating. The relationships among variables were evaluated using Spearman's correlations, ANOVAs, and linear and logistic regression equations.ResultsClinically significant levels of social anxiety were reported in 59% of participants, and binge eating disorder criteria were met by 13%. Social anxiety was significantly associated with binge eating (r = .36; OR = 1.06, CI = 1.02–1.10) and emotional eating (r = .46; β = 0.36), but was not associated with restrained eating. The association between social physique anxiety and emotional and binge eating did not remain significant in regression equations. BMI was associated with binge eating (r = .19) but not emotional eating. Level of social anxiety was not significantly higher among extremely obese participants, compared to overweight and obese participants.ConclusionsIn this study, social anxiety was associated with binge eating and emotional eating in overweight and obese men and women. When appropriate, interventions could address social anxiety as a barrier to normative eating patterns and weight loss.     

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.     

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.     

The presence of maladaptive eating behaviors after bariatric surgery in a cross sectional study: Importance of picking or nibbling on weight regain

BackgroundMaladaptive eating behaviors after bariatric surgery are thought to compromise weight outcomes, but little is known about their frequency over time.ObjectiveThis study investigates the presence of subjective binge eating (SBE), objective binge eating (OBE) and picking and nibbling (P&N) before surgery and at different time periods postoperative, and their association with weight outcomes.MethodsThis cross-sectional study assessed a group of patients before surgery (n = 61), and three post-operative groups: 1) 90 patients (27 with laparoscopic adjustable gastric band (LAGB) and 63 with Laparoscopic Roux-en-Y Gastric Bypass (LRYGB)) assessed during their 6 month follow-up medical appointment; 2) 96 patients (34 LAGB and 62 LRYGB) assessed during their one year follow-up medical appointment; and 3) 127 patients (62 LAGB and 55 LRYGB) assessed during their second year follow-up medical appointment. Assessment included the Eating Disorders Examination and a set of self-report measures.ResultsIn the first ten months after surgery fewer participants reported maladaptive eating behaviors. No OBEs were reported at 6 months. SBE episodes were present in all groups. P&N was the most frequently reported eating behavior. Eating behavior (P&N) was significantly associated with weight regain, and non-behavioral variables were associated with weight loss.ConclusionsThis study is cross-sectional study which greatly limits the interpretation of outcomes and no causal association can be made. However, a subgroup of postoperative patients report eating behaviors that are associated with greater weight regain. The early detection of these eating behaviors might be important in the prevention of problematic outcomes after bariatric surgery.     

Unique relationships between facets of mindfulness and eating pathology among female smokers

Female smokers often have higher levels of eating disorder symptoms than non-smokers, and concerns about eating and weight might interfere with smoking cessation. Thus, it is critical to identify factors to promote healthier eating and body image in this population. Initial research suggests that specific aspects of trait mindfulness predict lower body dissatisfaction and eating disorder symptoms among non-smokers. However, these relationships are unknown among smokers. The current study examined associations between facets of trait mindfulness and eating disorder symptoms in 112 college female smokers (83% Caucasian; mean age 20 years, SD = 1.69). After controlling for relevant sociodemographic variables, Describing and Nonjudging facets of mindfulness predicted lower bulimic symptoms and body dissatisfaction (ps < .05), while Acting with Awareness predicted lower bulimic and anorexic symptoms, ps < .05. Observing predicted higher anorexic symptoms, p < .05. These results suggest that specific mindfulness facets are related to lower eating disorder symptoms among smokers, whereas other facets are not associated or have a positive relationship with these symptoms. Mindfulness-based interventions focusing on Describing, Nonjudging, and Acting with Awareness may help to reduce eating pathology among female smokers, which could potentially improve smoking cessation rates in this population.     

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.     

Cigarette smoking is associated with body shape concerns and bulimia symptoms among young adult females

Elevated rates of cigarette smoking have been reported among individuals with Bulimia Nervosa. However, little is known about eating disorder symptoms within non-clinical samples of smokers. The purpose of the present study was to compare the eating disorder symptoms of young adult female smokers (n = 184) and non-smokers (n = 56), to determine whether smokers were more likely to endorse bulimic symptoms and report greater body shape concern than non-smokers. Analyses indicated that smokers scored significantly higher than non-smokers on the Body Shape Questionnaire, p = .03, and the Bulimia Test-Revised, p = .006. In addition, a higher proportion of smokers than non-smokers scored ≥ 85 on the Bulimia Test-Revised, p = .05, suggesting the possibility that Bulimia Nervosa diagnoses were more prevalent among smokers. No differences were found between smokers and non-smokers on other measures of eating behavior. Overall, findings suggest that smoking is specifically associated with symptoms of Bulimia Nervosa and body shape concern among young adult females.     

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.     

Screening for Binge Eating Disorder in people with obesity

The Risk factors for Binge Eating Disorder in Overweight (REO) questionnaire is a screening tool for nutritionists to discriminate between individuals with obesity with and without Binge Eating Disorder (BED). The first study tested the discriminative ability of the REO and identified an optimal cut-off value. In the second study this cut-off value was used to identify individuals with and without BED from a sample of individuals with obesity visiting a nutritionist and compared clinical and personality characteristics with a group of individuals officially diagnosed with BED. Results showed that the REO has a sensitivity of 95.1%, specificity of 81.5%, a good internal consistency of α = .96, and an exploratory factor analysis showed four underlying factors of the REO that explained a total variance of 63.7%. Characteristics of individuals with BED symptoms identified by the REO and those officially diagnosed with BED were comparable and differed from individuals with obesity without BED symptoms. By screening individuals with obesity with the REO those presenting with BED symptoms are more easily identified, and can be referred to psychological treatment facilities for further assessment and appropriate treatment.     

Different methods for assessing the features of eating disorders in patients with binge eating disorder: a replication.

OBJECTIVE: To compare different methods for assessing the features of eating disorders in patients with binge eating disorder (BED). RESEARCH METHODS AND PROCEDURES: A total of 47 participants with BED were administered the Eating Disorder Examination (EDE) Interview and completed the EDE-Questionnaire (EDE-Q) at baseline. A total of 37 participants prospectively self-monitored their eating behaviors daily for 4 weeks and then completed another EDE-Q. RESULTS: At baseline, the EDE and the EDE-Q were significantly correlated on frequencies of objective bulimic episodes (binge eating), overeating episodes, and on the dietary restraint, eating concern, weight concern, and shape concern subscales. Mean differences in the EDE and EDE-Q frequencies of objective bulimic episodes and overeating were not significant but scores on the four subscales differed significantly, with the EDE-Q yielding higher scores. At the 4-week point, the EDE-Q retrospective 28-day assessment was significantly correlated with the prospective daily self-monitoring records for frequency of objective bulimic episodes and the mean difference between the methods was not significant. The EDE-Q and self-monitoring findings for subjective bulimic episodes and objective overeating differed significantly. DISCUSSION: In patients with BED, the three assessment methods showed some areas of acceptable convergence.     

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.     

Reliability of the Eating Disorder Examination in patients with binge eating disorder

OBJECTIVE: This study examined the interrater and test-retest reliabilities of the Eating Disorder Examination (EDE) in patients with binge eating disorder (BED). METHOD: Interrater reliability and short-term (6-14 days) test-retest reliability of the EDE were examined in two study groups of 18 patients with BED. RESULTS: Interrater reliability was excellent for objective bulimic episodes and days (correlations above .98) and very good for the EDE scales, albeit somewhat variable (correlations range from .65 to .96). Test-retest reliabilities were very good for objective bulimic episodes (.70) and days (.71) and were good (significant) for the EDE scales, albeit somewhat variable (correlations range from .50 to .88). Interrater reliability was excellent for subjective bulimic episodes and days but test-retest reliabilities were unacceptable. CONCLUSIONS: These findings support the reliability of the EDE for patients with BED. The EDE has utility for assessing the number of large binge episodes (objective bulimic episodes), as well as the number of days during which large binge episodes occurred. The EDE also demonstrates very good interrater and test-retest reliabilities for assessing the associated features of eating disorders in patients with BED. The results for subjective bulimic episodes are consistent with previous studies, suggesting that these eating behaviors may not be reliable indicators of eating disorders.     

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.     

Obesity stigmatization as the status quo: Structural considerations and prevalence among young adults in the U.S.

ObjectiveAlthough obesity stigmatization contributes to significant health, economic, and quality-of-life challenges for U.S. adults, the prevalence and nature of stigmatizing attitudes requires an update and clarification. The present study sought to examine the prevalence and major dimensions of negative attitudes toward obesity through assessment of young U.S. adults' responses to the Attitudes Toward Obese Persons Scale.MethodParticipants were women (n = 578) and men (n = 233) who completed self-report questionnaires assessing obesity stigmatization and eating disorder features.ResultsResults indicate that at least one stigmatizing attitude was endorsed by 92.5% of respondents, with an average endorsement rate of 32.8% across items. Eating disorder features, body size, and gender were not related to one's likelihood of endorsing negative attitudes toward obesity. Distinct clusters of negative attitudes were identified involving beliefs that “obese people suffer” and “obese people are inferior.”DiscussionData suggest that large proportions of young U.S. adults harbor negative attitudes toward obese persons and these attitudes are pervasive across individuals with different characteristics. Although such negative attitudes have traditionally been conceptualized as relatively unidimensional, results suggest that future research would benefit from deconstructing negative attitudes into those related to pitying the obese and those related to perceiving the obese with harsh judgment.     

Course and moderators of emotional eating in anorectic and bulimic patients: A follow-up study

Emotion dysregulation has been found to be associated with specific eating attitudes and behavior in Eating Disorder (ED) patients. The present study evaluated whether emotional eating profile of ED patients changes over time and the possible effects of a psychotherapeutic intervention on the emotional eating dimension. One hundred and two ED patients (28 with Anorexia Nervosa restricting type [AN-R], 35 with Anorexia Nervosa binge/purging subtype [AN-B/P] and 39 with Bulimia Nervosa [BN]) were evaluated at baseline, at the end of a Cognitive Behavioral Therapy, at 3 and 6 year follow-up. The Structured Clinical Interview for DSM IV Axis I Disorders, the Emotional Eating Scale (EES) and several self-reported questionnaires for eating specific and general psychopathology were applied. A control group of 86 healthy subjects was also studied, in order to compare psychopathological variables at baseline. A significant EES total score reduction was observed among AN-B/P and BN patients, whereas no significant change was found in the AN-R group. Mixed Models analyses showed that a significant effect on EES total score variation was found for cocaine or amphetamine abuse (b = .25; p < .01). Patients who assumed these substances reported no significant EES reduction across time, unlike other patients. The present results suggest that ED patients with a history of cocaine or amphetamine abuse represent a sub-population of patients with lasting dysfunctional mood modulatory mechanisms.     

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.