An examination of the unique contributions of body image and internalized weight bias to psychological well-being outcomes.
Abstract
High correlations between measures of internalized weight bias (IWB) and body image (BI) have resulted in concerns that IWB is conceptually redundant with BI. This investigation examined the contribution of the unique variance of BI and IWB on three important, weight-related factors: self-esteem, depressive symptoms, and body shame. The study included 403 participants recruited through a Qualtrics research panel. Participants were required to be aged 18 + and have a BMI > 25. The sample contained three equally represented, self-identified racial/ethnic groups: Black non-Hispanic (N = 140), Hispanic (N = 133), and White non-Hispanic (N = 130). When BI was entered in the first step of the regression model, it accounted for 14-40% of the variance in various models; the addition of IWB in step two contributed 11-18% of unique variance. By contrast, when IWB was entered in the first step, it accounted for 25-56% of the variance in various models, with the addition of BI contributing between 0% and 2% unique variance. Therefore, even with a high correlation among the constructs of IWB and BI, IWB was able to contribute unique variance in predicting depressive symptoms, self-esteem, and body shame, and is not redundant with the construct of BI.
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Body shame affects well-being independently of body image.
“Repeated exposure to weight stigma can lead to internalized stereotypes and self-devaluation, resulting in body shame (Forbes & Donovan, 2019; Pearl & Puhl, 2018), impacting well-being independently of body image (Carels et al., 2024).”
From A Randomized Controlled Trial of an Acceptance and Commitment Therapy-Informed Diabetes Prevention Program Reduces Body Shame and Distress. (2025) · cites this paper as Carels et al., 2024
Cites
Weight bias internalization and health: a systematic review
Pearl, R. L., & Puhl, R. M. (2018) · Obesity Reviews · doi:10.1111/obr.12701 · Cited by 642 · see citing works
Romano, K. A., Heron, K. E., Sandoval, C. M., Howard, L. M., MacIntyre, R. I., & Mason, T. B. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102127 · Cited by 47 · see citing works
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Nutter, S., Saunders, J. F., & Waugh, R. (2024) · Journal of Eating Disorders · doi:10.1186/s40337-024-01058-0 · Cited by 28 · see citing works
“Overall, these researchers have noted that greater conceptual and measurement clarity into internalized weight stigma, as a construct distinct from body dissatisfaction, is needed [14, 33–36].”
BackgroundLipsett, M., & Berkman, E. (2025) · Health Psychology · doi:10.1037/hea0001434 · Cited by 3 · see citing works
“Repeated exposure to weight stigma can lead to internalized stereotypes and self-devaluation, resulting in bodyshame (Forbes & Donovan, 2019; Pearl & Puhl, 2018), impacting well-being independently of body image (Carels et al., 2024).”
Weight self-stigma, but not body dissatisfaction, predicts binge eating across one academic year
Patarinski, A. G. G., Athanasaw, K., Garban, A. L., Hahn, S. L., & Davis, H. A. (2025) · Body Image · doi:10.1016/j.bodyim.2025.101902 · Cited by 4 · see citing works
The hidden pathways to internalized weight bias: from insecure attachment to depressive self-schemas
Bianciardi, E., Quinto, R. M., Longo, E., Angelis, F. D., Siracusano, A., Niolu, C., & Lorenzo, G. D. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1703650 · Cited by 2 · see citing works
"There Are Healthier Ways": Perspectives of Emerging Adults on Weight Loss Medications.
Rogers, C. B., Gangel, M. J., & Schorr, M. (2026) · Family & Community Health · doi:10.1097/fch.0000000000000457 · Cited by 1 · see citing works
Carels, R. A., Jansen, E., Mansour, L., Byrd, R., Shonrock, A. T., Force, J. C., & Metzler, A. L. (2026) · Obesities · doi:10.3390/obesities6030031
“However, IWB has been shown to predict unique variance above and beyond body image in past research [29] and there is significant precedent for treating body shame and IWB as independent constructs in eating disorder research [40,41].”
Self-citationAusten, E., Hunger, J., Bonell, S., & Griffiths, S. (2025) · Social & Personality Psychology Compass · doi:10.1111/spc3.70057
- Authors
- Carels, R. A., Jansen, E., Mansour, L., Byrd, R., & Metzler, A. L.
- Affiliations
- East Carolina University (US)
- Corresponding author
- Carels, Robert A.
- Venue
- Body Image
- Publisher
- Elsevier BV
- Published
- 2024-03
- Volume
- 48
- Pages
- 101668
- ISSN
- 1740-1445 (ISSN-L)
- OpenAlex
- W4389636112
- Cited by
- 7
- References
- 0
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2
- FWCI
- 2.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Body Image (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Keywords
- weight bias internalization, self-esteem, depressive symptoms, body shame, psychological well-being, overweight and obesity, construct redundancy, unique variance, racial and ethnic differences
- MeSH terms
- Weight Prejudice, Psychological Well-Being, Body Image, Body Weight, Humans, Self Concept, Shame
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