by Patrick Lejtenyi, Concordia University

Mean Weight Bias Internalization by Body Mass Index Distribution. Credit: BMC Public Health (2023). DOI: 10.1186/s12889-023-16454-5

The causes behind weight gain and obesity are complex, but many Canadians still hold negative attitudes and beliefs towards individuals who live with overweight and obesity.

Those attitudes are often held by people living with overweight and obesity themselves. These individuals have often internalized those feelings and blame their own behavior for their size—an experience called weight bias internalization (WBI).

According to a new Concordia-led study, these feelings are present in individuals across the weight spectrum. However, they are more pronounced in people with higher body mass index (BMI) scores. And females are more likely to report WBI than males.

Writing in the journal BMC Public Health, the authors note that "44 percent of Canadians believe behavioral causes are very or extremely important in causing obesity, 38% for environmental causes, 28% for physiological and 27% for psychosocial causes."

Those individuals who are more likely to believe in behavioral causes were also more likely to hold negative attitudes toward people with overweight or obesity. These negative attitudes are a concept known as explicit weight bias.

"This study looks at how the average person in Canada views not only obesity and people with obesity but also the views they have about themselves when they view themselves negatively," says lead author Vida Forouhar (MSc 22).

"Looking at this from a public health perspective helps us to better understand these attitudes to inform advocacy initiatives and weight bias reduction interventions."

Internal and external biases

The researchers used data that was previously collected from a 2018 study. The study involved 942 demographically representative English-speaking Canadian adults who completed questionnaires about attitudes towards weight-related issues.

Their secondary analysis looked at answers from three specific questionnaires that measured respondents' internalization of negative attitudes about weight, their beliefs about the different causes of obesity and their explicit weight bias.

Among their findings, the researchers noted that internalization of WBI—the extent to which a person self-stigmatizes their own weight and applies negative attitudes towards themselves—was present in every BMI category (normal/underweight, overweight, obesity).

High WBI rates were reported in 20 percent of those who were normal/underweight, in 29 percent who were overweight and in 51 percent in the group of people who had obesity.

Respondents most commonly endorsed overeating as a cause of obesity (71 percent of the sample), followed by physical inactivity (67 percent) and high-fat diets (59 percent)—all behavioral causes.

Among the least endorsed were endocrine disorders (35 percent), repeated dieting (38 percent) and metabolic factors (41 percent), which are physiological and psychosocial causes.

Beliefs in behavioral causes of obesity were directly associated with explicit weight bias, while beliefs in physiological and psychosocial causes were negatively associated.

"You tend to have more negative attitudes towards people with obesity if you really believe that obesity is mostly a behavioral issue," Forouhar says.

Forouhar works as a research coordinator in the Montreal Interdisciplinary Laboratory on Obesity and Health. Her co-author Angela Alberga, an associate professor and research chair in the Department of Health, Kinesiology and Applied Physiology, is the lab's director.

She adds that WBI has been linked to increased symptoms of depression, anxiety, psychological distress, eating disorders and exercise avoidance in many other studies.

"Our study reflects that weight bias is prevalent everywhere and among everyone, regardless of body shape and size," she says.

"It does not only affect people with obesity. We should be addressing weight bias more systematically rather than simply from a clinical perspective."

More information: Vida Forouhar et al, Weight bias internalization and beliefs about the causes of obesity among the Canadian public, BMC Public Health (2023). DOI: 10.1186/s12889-023-16454-5

Journal information: BMC Public Health 

Provided by Concordia University