Shame and Self-Compassion as Risk and Protective Mechanisms of the Internalized Weight Bias and Emotional Eating Link in Individuals Seeking Bariatric Surgery

Braun, Tosca D.; Gorin, Amy A.; Puhl, Rebecca M.; Stone, Andrea; Quinn, Diane M.; Ferrand, Jennifer; Abrantes, Ana M.; Unick, Jessica; Tishler, Darren; Papasavas, Pavlos

doi:10.1007/s11695-021-05392-z

Cited by 29Obesity and Health PracticesEating Disorders and BehaviorsBariatric Surgery and Outcomes

Shame and Self-Compassion as Risk and Protective Mechanisms of the Internalized Weight Bias and Emotional Eating Link in Individuals Seeking Bariatric Surgery

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Braun, Tosca D., Gorin, Amy A., Puhl, Rebecca M., Stone, Andrea, Quinn, Diane M., Ferrand, Jennifer, Abrantes, Ana M., Unick, Jessica +2 more·2021·Obesity Surgery

DOI 10.1007/s11695-021-05392-zPMC PMC8493808

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Abstract

Background Emotional eating in bariatric surgery patients is inconsistently linked with poor post-operative weight loss and eating behaviors, and much research to date is atheoretical. To examine theory-informed correlates of pre-operative emotional eating, the present cross-sectional analysis examined paths through which experienced weight bias and internalized weight bias (IWB) may associate with emotional eating among individuals seeking bariatric surgery.Methods We examined associations of experienced weight bias, IWB, shame, self-compassion, and emotional eating in patients from a surgical weight loss clinic (N = 229, 82.1% female, M. BMI: 48 ± 9). Participants completed a survey of validated self-report measures that were linked to BMI from the patient medical record. Multiple regression models tested associations between study constructs while PROCESS bootstrapping estimates tested the following hypothesized mediation model: IWB ➔ internalized shame ➔ self-compassion ➔ emotional eating. Primary analyses controlled for adverse childhood experiences (ACE), a common confound in weight bias research. Secondary analyses controlled for depressive/anxiety symptoms from the patient medical record (n = 196).Results After covariates and ACE, each construct accounted for significant unique variance in emotional eating. However, experienced weight bias was no longer significant and internalized shame marginal, after controlling for depressive/anxiety symptoms. In a mediation model, IWB was linked to greater emotional eating through heightened internalized shame and low self-compassion, including after controlling for depressive/anxiety symptoms.Conclusions Pre-bariatric surgery, IWB may signal risk of emotional eating, with potential implications for post-operative trajectories. Self-compassion may be a useful treatment target to reduce IWB, internalized shame, and related emotional eating in bariatric surgery patients. Further longitudinal research is needed.

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Patients who have a high degree of internalized shame about having obesity may have the lowest levels of self-compassion.
“Indeed, patients who have a high degree of internalized shame (e.g., feelings of inadequacy, inferiority) about having obesity may have the lowest levels of self-compassion (25).”
From Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery (2022) · cites this paper as [25]
In the Results (Serial mediation model; page unavailable), the paper reports a pathway through greater internalized shame followed by greater self-compassion, contrary to the claimed pattern of the lowest self-compassion among patients with high shame. The Discussion also describes patients reporting internalized shame alongside self-compassion, rather than characterizing high shame as linked to the lowest self-compassion. (LLM, conf=0.82)
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Emotion-based eating is associated with emotion dysregulation, poor emotion regulation skills, low distress tolerance, dietary restraint, loss of control of eating, poor awareness of hunger/fullness signals, body image dissatisfaction, internalized shame, and low self-compassion.
“In addition to depression, emotion-based eating is associated with many other factors, including emotion dysregulation, poor emotion regulation skills, low distress tolerance, dietary restraint, loss of control of eating, poor awareness of hunger/fullness signals, body image dissatisfaction, internalized shame, and low self-compassion (24–29).”
From Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery (2022) · cites this paper as [25]
The Introduction and Discussion (page unavailable) link emotional eating with emotion dysregulation, internalized shame, and lower self-compassion in people seeking bariatric surgery. The paper does not establish the full list of associations in the citing sentence, including low distress tolerance, dietary restraint, loss of control of eating, or poor awareness of hunger and fullness signals. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Patients seeking bariatric surgery who have high levels of internalized shame and low levels of self-compassion also report high levels of emotion-based eating.
“Specifically, a recent study found that patients seeking bariatric surgery who have high levels of internalized shame (e.g., feelings of inferiority, inadequacy, insignificance) and low levels of self-compassion (e.g., disapproving of perceived personal inadequacies, feeling alone in perceived failures) also report high levels of emotion-based eating (25).”
From Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery (2022) · cites this paper as [25]

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Lier, H. Ø., Biringer, E., & Bjørkvik, J. (2011) · Journal of Obesity & Weight loss Therapy · doi:10.4172/2165-7904.1000113 · Cited by 6 · see citing works

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Translation of the Chinese version of the modified Yale Food Addiction Scale 2.0 and its validation among college students
Zhang, H., Tong, T., Gao, Y., Liang, C., Yu, H., Li, S., Yan, X., & Wang, L. (2021) · Journal of Eating Disorders · doi:10.1186/s40337-021-00471-z · Cited by 33 · see citing works
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“org 2 inadequacies, feeling alone in perceived failures) also report high levels of emotion-based eating (25).”
Background
Childhood traumas and emotional eating: The mediating role of self-esteem, and emotion dysregulation
Koçak, Z., & Çağatay, S. E. (2024) · Current Psychology · doi:10.1007/s12144-024-05953-2 · Cited by 27 · see citing works
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Self-citation
Internalised Weight Stigma Mediates Relationships Between Perceived Weight Stigma and Psychosocial Correlates in Individuals Seeking Bariatric Surgery: a Cross-sectional Study
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“Improvement in mindfulness and self-compassion did not correlate with reduced IWS, despite strong theoretical rationale and negative associations between self-compassion and IWS in prior cross-sectional research (Braun et al., 2021; Hilbert et al., 2015; Webb & Hardin, 2015).”
BackgroundResultInfluentialSelf-citation
Brief Self-Compassion Intervention for Women of Higher Weight and Internalized Weight Bias: A Randomized Pilot Study
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Adverse Childhood Experiences Associated with Greater Internalization of Weight Stigma in Women with Excess Weight
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Associations between internalized weight stigma and visceral adipose tissue status are observed in women but not men.
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Mobile applications and improving the quality of life in people with obesity
Mustač, F., Tomašić, L., Peček, M., Galijašević, T., Grkinic, A., Medić, F., Matovinović, M., & Marčinko, D. (2022) · International Conference on Smart and Sustainable Technologies (SpliTech) · doi:10.23919/splitech55088.2022.9854214 · Cited by 3 · see citing works
The Application of Cohen’s Stress-Buffering Model for Weight Bias Internalization in Prebariatric Patients
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RECONSTRUÇÃO DA IMAGEM CORPORAL E AUTOACEITAÇÃO EM PACIENTES BARIÁTRICOS: UMA REVISÃO INTEGRATIVA
Rodrigues, G. D. S. M., & Mendonça, M. A. (2023) · Revista Ibero-Americana de Humanidades, Ciências e Educação · doi:10.51891/rease.v9i5.9838
Piloting “From the Inside Out” - a toolkit addressing tuberculosis-related self-stigma: A feasibility studyPreprint
Macdonald, S. H.-F., France, N. F., Hodgson, I. J., Ali, F., Dewi, C., Abdurrakhman, I., Runtu, Y. M., Juan, A., Sugiharto, J., Byrne, E., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-3181385/v1
Do Individuals With Overweight and Obesity Have Reduced Affective and Cognitive Empathy? A Systematic Review and Meta‐Analysis
Maupin, C., Gérain, P., Dassonneville, C., & Grynberg, D. (2025) · Obesity Reviews · doi:10.1111/obr.13948
Additional file 2 of Translation of the Chinese version of the modified Yale Food Addiction Scale 2.0 and its validation among college students
Zhang, H., Tong, T., Gao, Y., Liang, C., Yu, H., Li, S., Yan, X., & Wang, L. (2021) · Figshare · doi:10.6084/m9.figshare.16633463
Additional file 1 of Translation of the Chinese version of the modified Yale Food Addiction Scale 2.0 and its validation among college students
Zhang, H., Tong, T., Gao, Y., Liang, C., Yu, H., Li, S., Yan, X., & Wang, L. (2021) · Figshare · doi:10.6084/m9.figshare.16633460
Obesity: Bias, Stigma, Discrimination, and Your Patient
Manning, L. S., Pashby, R. O., Nece, P., Kyle, T. K., Zervios, J., & Nadglowski, J. F. (2026) · Springer eBooks · doi:10.1007/978-3-032-24278-5_4
The Development of Internalized Weight Stigma and the Process of Healing: A Critical-Constructivist Grounded Theory Analysis
Kelly, D. A. (2026) · doi:10.56902/etdcrp.2026.164

Testing risk and protective pathways between weight bias and mental health symptoms in a bariatric sample: Internalized weight bias, shame, and self-compassion
Braun, T. D., Quinn, D. M., Stone, A. L., Ferrand, J. L., Gorin, A. A., Sierra, J., Puhl, R. M., Sensale, G., Tishler, D. S., & Papasavas, P. K. (2018) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2018.09.319 · Cited by 1 · see citing works
Testing Risk and Protective Pathways between Weight Bias and Psycho-Behavioral Health in Bariatric Surgery Patients: Internalized Weight Bias, Shame, and Self-Compassion
Braun, T. D. (2019) · OpenCommons - UConn (University of Connecticut)
Examining Weight Bias and Loss-of-Control Eating among Individuals Seeking Bariatric Surgery
Lawson, J. L., Schuh, L. M., Creel, D. B., Blackinton, R. M., Giambrone, S. A., Grilo, C. M., & Ivezaj, V. (2021) · Obesity Surgery · doi:10.1007/s11695-021-05418-6 · Cited by 18 · see citing works
Self-compassion as a protective pathway in the link between mental health symptoms and emotional eating in a pre-bariatric sample
Braun, T. D., Stone, A. M., Ferrand, J. L., Gorin, A. A., Quinn, D. M., Puhl, R. M., Sensale, G., Tishler, D. S., & Papasavas, P. K. (2018) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2018.09.229
Disinhibition and Subjective Hunger as Mediators Between Weight Bias Internalization and Binge Eating Among Pre-Surgical Bariatric Patients
Soulliard, Z. A., Brode, C. S., Tabone, L. E., Szoka, N. L., Abunnaja, S., & Cox, S. J. (2020) · Obesity Surgery · doi:10.1007/s11695-020-05023-z · Cited by 14 · see citing works

Authors: Braun, T. D., Gorin, A. A., Puhl, R. M., Stone, A., Quinn, D. M., Ferrand, J., Abrantes, A. M., Unick, J., Tishler, D., & Papasavas, P.
Affiliations: University of Connecticut (US)
Hartford Hospital (US)
Brown University (US)
Corresponding author: Braun, Tosca D.
Gorin, Amy A.
Puhl, Rebecca M.
Stone, Andrea
Quinn, Diane M.
Ferrand, Jennifer
Abrantes, Ana M.
Unick, Jessica
Tishler, Darren
Papasavas, Pavlos
ORCID: Braun, Tosca D.
Gorin, Amy A.
Puhl, Rebecca M.
Stone, Andrea
Quinn, Diane M.
Abrantes, Ana M.
Unick, Jessica
Papasavas, Pavlos
Venue: Obesity Surgery
Publisher: Springer Science and Business Media LLC
Published: 2021-04-27
Volume: 31
Issue: 7
Pages: 3177-3187
ISSN: 0960-8923 (ISSN-L)
1708-0428
DOI: 10.1007/s11695-021-05392-z
PMC: PMC8493808
OpenAlex: W3157668372
Cited by: 29
References: 81
Citations by year: 2026: 2 · 2025: 4 · 2024: 8 · 2023: 2 · 2022: 7 · 2021: 6
FWCI: 8.97
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.springer.com/tdm (tdm)
www.springer.com/tdm (vor)
Locations: Obesity Surgery (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Heart, Lung, and Blood Institute (T32HL076134)
Topics: Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
Keywords: weight bias internalization, emotional eating
MeSH terms: Body Image, Cross-Sectional Studies, Empathy, Female, Humans, Male, Obesity, Morbid, Shame, Bariatric Surgery

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Shame and Self-Compassion as Risk and Protective Mechanisms of the Internalized Weight Bias and Emotional Eating Link in Individuals Seeking Bariatric Surgery

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