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Weight bias internalization and health: a systematic review
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Summary: A robust literature has documented the negative health effects of being the target of weight bias. Weight bias internalization (WBI) occurs when individuals apply negative weight stereotypes to themselves and self‐derogate because of their body weight. Compared with experiences of weight bias, less is known about the relationship between WBI and mental and physical health, although more literature on this topic has emerged in recent years. The current systematic review identified 74 studies assessing the relationship between WBI and health and interventions designed to reduce WBI and improve health. Over half of identified studies were published from 2016 to 2017. Results showed strong, negative relationships between WBI and mental health outcomes. Fewer studies have examined the relationship between WBI and physical health, and results were less consistent. Key directions for future research are highlighted, including the need for prospective and experimental studies with greater sample diversity.
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“Repeated exposure to weight stigma can lead to internalized stereotypes and self-devaluation, resulting in body shame (Forbes & Donovan, 2019; Pearl & Puhl, 2018)”
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 Pearl & Puhl, 2018
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“Internalized stigma is broadly defined as (i) awareness of negative stereotypes about one’s social identity; (ii) agreement with these stereotypes; (iii) application of these stereotypes to oneself; and (iv) self-devaluation due to one’s social identity (9).”
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Items 301–400 of 545
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“Weight stigma can be described as ‘societal devaluation and derogation’ on the basis of bodily fatness (Pearl & Puhl, 2018, p. 1141), and informs our analysis.”
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Longitudinal associations of binge eating with internalized weight stigma and eating self-efficacy
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Self-citationBevan, N., O'Brien, C. K. S., Latner, J. D., Vandenberg, B., Jeanes, R., & Lin, C. (2023) · American Journal of Health Behavior · doi:10.5993/ajhb.47.2.15 · Cited by 8
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de Oliveira, L. C., Soares, A. R. D. S., Sabatini, F., Ulian, M. D., Unsain, R. F., & Scagliusi, F. B. (2023) · Interface - Comunicação Saúde Educação · doi:10.1590/interface.230360 · Cited by 4
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“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).”
Sex and Gender Differences in Weight Bias Internalization: A Systematic Review and Meta‐Analysis
Cui, T., Xi, J., Barnhart, W. R., Sun, H., Cui, S.-Q., Li, W., Lu, Y., Nagata, J. M., & He, J.-B. (2026) · Obesity Reviews · doi:10.1111/obr.70089 · Cited by 3
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“Data from the World Health Organization (WHO) reveals that since 1975, the negative weight evaluations of others and thus generate self-deprecation (Pearl & Puhl, 2018).”
Gu, C., Long, Z., Fang, Z., Wu, L., Yang, F., & Luo, W. (2026) · BMC Geriatrics · doi:10.1186/s12877-026-07029-1 · Cited by 3
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The integration of oppression related variables into eating disorder research
Kapadia, A., Hooper, S. C., Crumby, E. K., Mekawi, Y., & Levinson, C. A. (2025) · Body Image · doi:10.1016/j.bodyim.2025.101999 · Cited by 2
Dieting Practices of Adolescents Seeking Obesity Treatment
Jebeile, H., House, E. T., Baur, L. A., Kwok, C., Collins, C. E., Garnett, S. P., & Lister, N. B. (2025) · Nutrients · doi:10.3390/nu17193100 · Cited by 3
“Additionally, internalisation of negative societal attitudes and stigma towards higher weight is associated with disordered eating [12] and may lead to dieting attempts to lose weight.”
“Thin & waif-like”: body image and body ideals in gender-expansive adults
Biefeld, S. D., Mays, K., & Brown, C. S. (2025) · Journal of Gender Studies · doi:10.1080/09589236.2025.2552808 · Cited by 3
Beyond dietary therapy: addressing weight stigma awareness in medical students
Annunziata, G., Zonzini, G. B., Frías-Toral, E., Zambrano-Villacres, R., Bertuccioli, A., Sisti, D., Verde, L., Pauli, D. D., Colao, A. A. L., Muscogiuri, G., et al. (2025) · Journal of Translational Medicine · doi:10.1186/s12967-025-06981-7 · Cited by 3
Weight bias among undergraduate women with health-related majors: a systematic review
Pacanowski, C. R., Vizthum, D., Katz, S. E., & Skubisz, C. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-025-01275-1 · Cited by 3
“Internalized weight bias is a type of explicit bias that occurs when individuals apply negative stereotypes about weight to themselves [2].”
Weight bias: relationships with physical activity and sedentary behaviour
Forouhar, V., Edache, I. Y., & Alberga, A. S. (2025) · Journal of Behavioral Medicine · doi:10.1007/s10865-025-00570-1 · Cited by 3
“…and reduced stress, anxiety, risk of type 2 diabetes, cardiovascular disease, and risk of premature mortality (Reiner et al., 2013 ; Ruegsegger & Booth, 2018; A growing body of research has investigated the role of weight bias as a potential barrier to physical activity (Pearl & Puhl, 2018 ).”
InfluentialWeight 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
Mebarek, H., Toumi, H., & Nimeri, A. A. (2025) · Obesity Surgery · doi:10.1007/s11695-025-07882-w · Cited by 3
“Similarly, metabolic/ bariatric surgery (MBS) stigma, where MBS is perceived as an “easy solution” or a failure of self-control, further discourages patients and providers from pursuing effective treatment [4].”
Wheelington, A., Ernest, D. K., Xie, L., Atem, F., Neti, S., Braxton, R., Misserian, M., Francis, J., Mathew, M. S., Allicock, M. A., et al. (2025) · Obesity Surgery · doi:10.1007/s11695-025-07731-w · Cited by 2
“Finally, while both the WBIS [6] and HRQOL [26] measures have demonstrated reliability and validity across diverse populations, cultural adaptations and further validation are critical to ensure accuracy as cultural factors such as societal norms about weight and health perceptions may influence…”
Kane, R. M., Williams, S. B., Reynolds, K. L., Kincanon, A., Hager, M. R., McDougall, C., Purnell, J. Q., & Carney, P. A. (2025) · PLoS ONE · doi:10.1371/journal.pone.0314269 · Cited by 5
Richmond, B. S., Zaidan, A. C. V., Araiza, A. M., Beam, A. J., Lee, A. A., & Wellman, J. D. (2024) · Journal of Health Psychology · doi:10.1177/13591053241302285 · Cited by 3
“While some studies have found a stronger relationship between weight discrimination and depression in women, other research suggests consistent effects across demographic variables (Gerend et al., 2023; Pearl and Puhl, 2018).”
Butryn, M. L., Miller, N. A., Hagerman, C. J., Arigo, D., LaFata, E. M., Zhang, F., Spring, B. J., & Forman, E. M. (2024) · Obesity · doi:10.1002/oby.24138 · Cited by 3
“Given that weight stigma is ubiquitous and commonly internalized among people with overweight and obesity [23], this study also provided an important opportunity to determine whether data sharing might inadvertently damage the relationship between the participant and coach, perhaps making the…”
Pedersen, Z. O., Ewers, B., Wimmelmann, C. L., Kofoed‐Enevoldsen, A., Køster‐Rasmussen, R., Couppé, C., Simonsen, E. H., & Dammeyer, J. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21091231 · Cited by 4
“Beyond this, studies have shown a negative relationship between weight stigma and mental health, such as depression and anxiety [75], and a high degree of serological stress biomarkers, which may be related to the social construct of BMI [76].”
BackgroundTesting the validity of the Norwegian translation of the modified weight bias internalization scale
Lussier, T., Tangen, J., Eik-Nes, T., Karlsen, H. R., Berg, K. H., & Fiskum, C. (2024) · Journal of Eating Disorders · doi:10.1186/s40337-024-01067-z · Cited by 3
“To date, associations between WBI and reduced health and worse outcomes have been found, including studies showing that depression, anxiety, and disordered eating are associated with higher WBI [7–9].”
BackgroundResultInfluentialYangyuen, S., Somdee, T., Yin, M.-H., & Chaichan, A. (2024) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_1480_23 · Cited by 3
“Consistent with previous studies, [6,7,27] reported that WBI has been linked to increased stress and may contribute to individual variation in stress response; thus, people who deal with WBI have more stress.”
BackgroundMethodResultInfluentialDeveloping a Weight-Neutral Health Intervention in Denmark: Protocol for a Co-Design Process
Meyer, L. B., Køster‐Rasmussen, R., Christiansen, A.-K. L., Heitmann, B. L., Vesterlund, G. K., Larsen, S. C., Specht, I. O., Þorsteinsdóttir, F., Steinbo, E. K. F., Appel, C. L., et al. (2024) · JMIR Public Health and Surveillance · doi:10.2196/59455 · Cited by 3
Nagpal, T. S., Pearce, N., & Adamo, K. B. (2024) · Obesity Pillars · doi:10.1016/j.obpill.2024.100107 · Cited by 2
“This tool has consistently shown high reliability, and strong correlations with several biopsychological and behavioural outcomes including exercise avoidance, body image disturbances, depression, and weight gain [12 – 14].”
BackgroundInfluentialBarriers to metabolic surgery and how to address them
Laville, M., Robert, M., & Segrestin, B. (2023) · Metabolism · doi:10.1016/j.metabol.2023.155764 · Cited by 3
Weight Bias in Reproductive Medicine: A Curiously Unexplored Frontier
Evans, A. T., & Vitek, W. (2023) · Seminars in Reproductive Medicine · doi:10.1055/s-0043-1777016 · Cited by 6
“14,15,28,29 It is also important to understand the concept of implicit bias when analyzing and exploring weight stigma.”
BackgroundDeveloping and validating a Japanese version of the Weight Self-Stigma Questionnaire
Nakamura, Y., & Asano, M. (2023) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-023-01573-0 · Cited by 5
“To assess WBI, two self-reported questionnaires, the Weight Bias Internalization Scale (WBIS) and the Weight Self-Stigma Questionnaire (WSSQ), were mostly used in previous studies [5].”
BackgroundMethodInfluentialCorrelates of Weight Bias in Adults From the NutriNet-Santé Study
Branche, O., Buscail, C., Péneau, S., Baudry, J., Poitou, C., Oppert, J., Czernichow, S., Kesse‐Guyot, E., Touvier, M., Julia, C., et al. (2023) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2023.02.012 · Cited by 6
“35 Thus, although these results are encouraging and suggest overall positive attitudes towards people with obesity, they should be interpreted with caution since participants may be particularly prone to social desirability bias in this domain and may refrain from explicit endorsements of negative…”
Checketts, T. R., & Miyairi, M. (2022) · Cogent Psychology · doi:10.1080/23311908.2022.2080317 · Cited by 3
Jongenelis, M. I., Dixon, H., Scully, M. L., & Morley, B. (2022) · Health Education & Behavior · doi:10.1177/10901981221104727 · Cited by 9
“Internalized weight bias is associated with low selfesteem, eating disorder psychopathology, depressive symptoms, and body dissatisfaction (Pearl & Puhl, 2018; Wu & Berry, 2018).”
BackgroundBrenton-Peters, J., Consedine, N. S., Cavadino, A., Roy, R., & Serlachius, A. S. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-056174 · Cited by 2
Baur, J., Schmitz, F., Naumann, E., & Svaldi, J. (2021) · Cognitive Therapy and Research · doi:10.1007/s10608-021-10271-z · Cited by 5
“Furthermore, given the relationship between self-stigmatizing attitudes and eating pathology using explicit measures (Brauhardt et al., 2014; Pearl & Puhl, 2018; Rudolph & Hilbert, 2014), we were interested in the implicit association of one’s own body and high-calorie food in overweight and…”
BackgroundKushner, R., & Hammond, M. M. (2021) · Obesity Science & Practice · doi:10.1002/osp4.555 · Cited by 3
“Body image issues and body dissatisfaction brought about by negative weight stereotypes to themselves can lead to disordered eating patterns, depression, lower self‐esteem, and social withdrawal, often referred to as weight bias internalization.(11) Lastly, the All‐or‐Nothing Doer is synonymous with dichotomous thinki…”
BackgroundPsychosocial and Diet-Related Lifestyle Clusters in Overweight and Obesity
Godoy‐Izquierdo, D., Moreno, R. L., Ogallar, A., Rodríguez‐Tadeo, A., Ramírez, M. J., Navarrón, E., & Arbinaga, F. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18126461 · Cited by 8
Residual Stigma and Internalized Weight Bias following Metabolic Bariatric Surgery
Puhl, R. M., Papasavas, K., Michalak, I., Wu, Y., McLaughlin, T., Esu, A., Tishler, D. S., Papasavas, P. K., Bond, D. S., & Umashanker, D. (2026) · Obesity Surgery · doi:10.1007/s11695-026-08691-5 · Cited by 3
Self-citationRamsamy, G., Albouy-Llaty, M., & Esnard, C. (2026) · Scandinavian Journal of Psychology · doi:10.1111/sjop.70093 · Cited by 2
“Coping through self-blame or internalization also contributes to anxiety and depressive symptoms (Pearl and Puhl 2018).”
InfluentialObesity‐Related Beliefs, Concerns, and Stigmatizing Perceptions Among Adults Living With Obesity
Viola, L. F., Valério, C. M., Muniz, R. B. G., Allgayer, R. M. C. M., Trujilho, T. D. G., Hohl, A., Lamounier, R. N., Bernardini, M. A., Brito, R., Halpern, B., et al. (2026) · Obesity Science & Practice · doi:10.1002/osp4.70133 · Cited by 2
Côté, M., Forouhar, V., Sacco, S., González-González, M., Baillot, A., Himmelstein, M. S., Hussey, B., Rodriguez, A. C. I., Nagpal, T. S., Nutter, S., et al. (2025) · International Journal of Obesity · doi:10.1038/s41366-025-01975-3 · Cited by 2
“Although weight bias research has increased in the past two decades [15, 16], weight bias and stigma continue to be pervasive social justice and human rights issues, [17 – 19] affecting millions of adults living in larger bodies around the world.”
Self-citationThe 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
“These associations appear to be stronger among individuals under 18 (60), a developmental stage in which personal identity is still being formed (61).”
Gaggiano, C. M., Wang, S., Barnhart, W. R., Ji, F., & He, J. (2025) · Body Image · doi:10.1016/j.bodyim.2025.101993 · Cited by 3
Tingle, E., Groen, J., Russell‐Mayhew, S., Nutter, S., & Saunders, J. F. (2025) · Studies in the Education of Adults · doi:10.1080/02660830.2025.2578879 · Cited by 2
Sancho, M. E., Ramírez‐Manent, J. I., López, P. J. T., Campayo, I. C., Herrero, M. T. V., & López‐González, Á. A. (2025) · Gastroenterología y Hepatología (English Edition) · doi:10.1016/j.gastrohep.2025.502560 · Cited by 2
Ethical reflexivity: A critical examination of ethics in public health intervention research
Broholm-Jørgensen, M., & Tjørnhøj‐Thomsen, T. (2025) · Evaluation · doi:10.1177/13563890251367001 · Cited by 1
“Studies suggest that the intense focus on weight and body mass index (BMI) may be accompanied by depression, low self-esteem, and overeating, which may result in several other health problems (Davidsen et al., 2022; Hilbert et al., 2014; Meyer et al., 2019; Pearl and Puhl, 2018).”
Dunford, A., Metzler, A. L., Pittman, B. P., Alperovich, M. A., Price, G. J., & Ivezaj, V. (2025) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2025.06.020 · Cited by 2
Mixed Methods to Assess Sex Differences in Weight Bias Internalization Among Patients With Obesity
Olaniran, M. O., Francis, J., Neti, S., Polavarapu, D., Kapti, E. G., Mathew, M. S., Schellinger, J. N., Allicock, M. A., Messiah, S. E., & Almandoz, J. P. (2025) · Obesity Science & Practice · doi:10.1002/osp4.70084 · Cited by 4
Weight stigma and mental health in a racially and ethnically diverse sample of US adults
Gerend, M. A., Lu, A. W., & Teets, E. L. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1593145 · Cited by 2
“Research consistently demonstrates a negative association between weight stigma and mental health outcomes (11 – 13).”
Hammad, N. M., Sonneville, K. R., Shanab, B. M., Khosla, P., Austin, S. B., & Leung, C. W. (2025) · Eating Behaviors · doi:10.1016/j.eatbeh.2025.102010 · Cited by 2
Les soignants et la stigmatisation de l’obésité
Caillet, R., & Epin, A. (2025) · Soins · doi:10.1016/j.soin.2025.05.011 · Cited by 2
Dahl-Larsen, R., Jakobsen, P. R., Søndergaard, J., Henriksen, J. E., & Hvidt, E. A. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-093357 · Cited by 3
“It is also important to explore how different set-ups affect peer support and confidentiality in a GC.”
Gaspar, M. C. D. M. P., Verthein, Ú., & Sato, P. D. M. (2025) · Sociology of Health & Illness · doi:10.1111/1467-9566.70062 · Cited by 4
“As shown by previous studies, internalized stigma often discourages fat individuals from seeking medical care (Pearl and Puhl 2018; Puhl, Lessard, Himmelstein, et al. 2021; Wetzel and Himmelstein 2023).”
Brochu, P. M., Georgia, E. J., Jubran, M., Robbins, M., West, K., Crocker, J., Schmidt, A. M., Rinaldi, K., Joseph, E., & Roddy, M. K. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1576406 · Cited by 2
“The negative association between weight stigma internalization, or self-derogation based on body weight, and mental well-being is consistent with existing research ’ s aggregated strong negative association between weight bias internalization and mental health more broadly (54).”
InfluentialYangyuen, S., Phattharaphakinworakun, A., Thongjit, S., Yin, M., & Yang, H. (2025) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_1297_24 · Cited by 2
“[2,5] Although WBI and its negative impacts on psychological health have been found across genders, the evidence of differences in WBI across genders is mixed, [2,3] as some studies note that girls endorse higher WBI than boys, [5,6] whereas others find no difference across genders.”
“MRI and stigma: Qualitative insights from fat individuals in Norway”
Granbo, T., Reidunsdatter, R. J., Carlsen, C. E., & Eik‐Nes, T. T. (2025) · Fat Studies · doi:10.1080/21604851.2025.2542640 · Cited by 2
“Weight bias refers to negative attitudes, beliefs, or assumptions about individuals based on their body size, often held implicitly by health-care providers (Alberga et al. 2019; Pearl and Puhl 2018).”
Morales, J. C., Smith, K. E., & Mason, T. B. (2025) · Body Image · doi:10.1016/j.bodyim.2025.101891 · Cited by 2
Jenkins, P. E., & Baysen, L. (2025) · Eating and Weight Disorders · doi:10.1007/s40519-025-01741-4 · Cited by 2
“Further, negative attitudes towards weight can impair individuals of different weight statuses, with the potential for stigma to be both received from others and directed towards oneself (e.g., [2]).”
InfluentialJordan, E. (2025) · Journal of Social and Personal Relationships · doi:10.1177/02654075251328485 · Cited by 2
“Given that weight-stigmatizing beliefs have been linked with reduced well-being (Forbes & Donovan, 2019; Pearl & Puhl, 2018), it is important to investigate the transmission of such beliefs and their impact on children ’ s disordered eating behaviors and body image.”
Vasilevski, V., Mekonnen, A. B., Peeters, A., Chapman, A., Naughton, S., Yuen, E. Y. N., Ananthapavan, J., Holmes‐Truscott, E., Willcox, J. C., Graham, K. P., et al. (2025) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-025-07262-3 · Cited by 6
“In turn, these implicit biases against people living with overweight or obesity may lead to suboptimal communication, engagement, and care provision [67].”
Luo, P., Alruwaili, O. M., Zhou, H., & Lian, Y. (2025) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2025.103018 · Cited by 2
“…stigma, and internalized biases can lead to heightened stress, adverse behavioral shifts, reduced healthcare engagement, and feelings of social isolation, all of which may contribute to an increased risk of suicidal ideation (Brochu et al., 2018; Hunger et al., 2020; Pearl and Puhl, 2018).”
Goff, A. J., Ng, C. L. W., Lim, C. J., Jones, L. E., Lee, Y., & Tham, K. W. (2024) · Obesity Research & Clinical Practice · doi:10.1016/j.orcp.2024.10.001 · Cited by 2
D'Adamo, L., Shonrock, A. T., Monocello, L. T., Goldberg, J., Yaeger, L. H., Jebeile, H., Pearl, R. L., & Wilfley, D. (2024) · Research Square · doi:10.21203/rs.3.rs-4844880/v1 · Cited by 2
“This review served as an important �rst step to demonstrate that psychological interventions can produce meaningful reductions in IWS, a critical direction given the harmful effects of IWS on physical health, mental health, and healthcare services use (15, 17).”
MethodSelf-citationElshaikh, U. A. M., Elashie, S., Alhussaini, N. W. Z., Yaseen, M., Mohamed, H. A., Syed, M. A., & Zainel, A. A. (2024) · Discover Health Systems · doi:10.1007/s44250-024-00134-1 · Cited by 2
“Weight stigma can lead to various detrimental health outcomes, including an elevated prevalence of cardiometabolic risk factors that significantly contribute to the development of T2DM [63].”
Wang, K., Brownstone, L. M., & Kivlighan, D. M. (2024) · Psychotherapy Research · doi:10.1080/10503307.2024.2385399 · Cited by 2
“Internalized weight stigma is defined as “the awareness, agreement, and self-appli-cation of negative weight stereotypes, along with consequent self-devaluation or decrements in self-worth due to weight” (Pearl & Puhl, 2018, p. 1141).”
Kaden, J., Hübner, C., Mansfeld, T., Sander, J., Seyfried, F., Kaiser, S., Dietrich, A., & Hilbert, A. (2024) · Obesity Facts · doi:10.1159/000539857 · Cited by 3
Meneguzzo, P., Behrens, S. C., Pavan, C., Toffanin, T., Quirós-Ramírez, M. A., Black, M. J., Giel, K. E., Tenconi, E., & Favaro, A. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1407474 · Cited by 2
Schraven, S., Hübner, C., Eichler, J., Mansfeld, T., Sander, J., Seyfried, F., Kaiser, S., Dietrich, A., Schmidt, R., & Hilbert, A. (2024) · Obesity Facts · doi:10.1159/000537689 · Cited by 2
“Possibly, the new 10-item version of WBIS-M could help detect WBI during bariatric surgery, which could be approached psychotherapeuti-cally, e.g., by cognitive-behavioral therapy [45], and in turn improve bariatric surgery outcomes [5].”
BackgroundVosoughi, A. R., Pandya, B. U., Mezey, N., Tao, B. K., & Micieli, J. (2023) · Journal of neuro-ophthalmology · doi:10.1097/wno.0000000000002047 · Cited by 2
“21 Weight stigma has been shown to promote weight gain, 22,23 and the use of perceived stigmatizing language is deemed by patients as an important barrier to losing weight.”
Health Consequences of Familial Negative Weight Talk Across the Spectrum of Gender Diversity
Rancaño, K. M., & Lawrence, S. E. (2023) · Current Nutrition Reports · doi:10.1007/s13668-023-00501-z · Cited by 2
Ra, J. S. (2023) · The Journal of Early Adolescence · doi:10.1177/02724316231174562 · Cited by 2
“For example, a person with a higher weight may engage in self-devaluation by applying negative stereotypes to themselves (Durso & Latner, 2008; Pearl & Puhl, 2018; Zuba & Warschburger, 2017).”
BackgroundWeight Bias and Healthism: An Integrative Health Perspective
Walsh, E. G., Rogalski, K., & Hibbler, L. (2023) · Journal of Integrative and Complementary Medicine · doi:10.1089/jicm.2023.0157 · Cited by 3
“12 Anti-fat bias assumes three things: (1) There exists an ideal weight range for all people and weight outside this range is unhealthy, (2) it is fat people’s fault that they are fat, and (3) attaining weight loss is simple and should be prioritized in all cases.”
Pickett, A. C., Brown, K., Damon, Z. J., & Brison, N. T. (2023) · Health Behavior Research · doi:10.4148/2572-1836.1177 · Cited by 1
“Importantly, body dissatisfaction and weight bias internalization are related to negative physical and mental health outcomes (Pearl & Puhl, 2018), as well as risky health behaviors (Wu & Berry, 2018).”
Validation of a Greek adaptation of the Anti‐Fat Attitudes Questionnaire
Argyrides, M., Anastasiades, E., Charalambous, Z., & Michael, K. (2022) · Clinical Obesity · doi:10.1111/cob.12565 · Cited by 4
Reliability and validity of the Japanese version of the weight bias internalization scale
Endo, S., Kasuga, H., Yusuke, M., Hidaka, T., Kakamu, T., & Fukushima, T. (2022) · BMC Research Notes · doi:10.1186/s13104-022-06221-x · Cited by 2
“Weight stigma internalization refers to “internalization of negative weight stereotypes and subsequent selfdisparagement” [3].”
BackgroundMoran, C., & Terrasa, S. (2022) · Evidencia actualizacion en la práctica ambulatoria · doi:10.51987/evidencia.v25i4.7033 · Cited by 2
“Help curb the hunger pangs”: news media frames of weight loss during the COVID- 19 lockdown
Prohaska, A. (2022) · Critical Public Health · doi:10.1080/09581596.2022.2104155 · Cited by 2
“…and controllable increases fat stigma, does not lead to weight loss (Bacon,), can result in negative mental health outcomes (Evans & Colls, 2009; Pearl & Puhl, 2018), and undermines the discrimination of fat people by medical professionals, who consistently reinforce that fat people must lose…”
BackgroundObesidad: factor de riesgo para psoriasis y COVID-19
Llamas‐Velasco, M., Ovejero‐Merino, E., & Salgado‐Boquete, L. (2020) · Actas Dermo-Sifiliográficas · doi:10.1016/j.ad.2020.12.001 · Cited by 15
“…otro individuo, los obesos han tenido que estar confinados y esto les ha hecho más vulne-rables al exceso de ingesta alimentaria y al sedentarismo 43 dado que son capaces de mejorar la 13 44 psicoló-gico como las presentes en una pandemia 45 Por otro lado, en psoriasis se han evaluado las…”
Editorial: The Implications of Weight Bias Internalization
Flint, S., Raisborough, J., & Hudson, J. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.03019 · Cited by 2
Obesity: The Post Mortem: Reviving History and Dehumanizing Fatness via Televised Dissection
Fox, R. (2019) · Women's Studies · doi:10.1080/00497878.2019.1594812 · Cited by 2
Obesity — A Risk Factor for Psoriasis and COVID-19
Llamas‐Velasco, M., Ovejero‐Merino, E., & Salgado‐Boquete, L. (2021) · Actas Dermo-Sifiliográficas · doi:10.1016/j.adengl.2021.03.013 · Cited by 7
“Overweight people, like everyone else, have been confined to home, a situation that has made them more vulnerable to excess food consumption and a sedentary lifestyle, predisposing them to additional weight gain.(43) Consequently, weight control strategies are particularly important in the current context since weight…”
Jebeile, H., Brennan, L., Burrows, T. W., Garcia, X. D. L. P., Ralph, A. F., Saluja, S., Atlantis, E. E., Garnett, S. P., Harrison, C. J., House, E. T., et al. (2026) · The Medical Journal of Australia · doi:10.5694/mja2.70235
Dever, M., Hill, B., Skouteris, H., & Rodriguez, A. C. I. (2026) · Journal of Health Psychology · doi:10.1177/13591053261462432 · Cited by 1
Stigmatizing attitudes and misconceptions about obesity among Spanish healthcare professionals
Sánchez‐Carracedo, D., Fornieles-Deu, A., Anastasiadou, D. T., & Flint, S. W. (2026) · PLoS ONE · doi:10.1371/journal.pone.0351868 · Cited by 2
“Weight stigma is now widely recognized as both a global health challenge and a human rights issue [7,8] and is associated with adverse psychological outcomes, disordered eating, reduced engagement in health behaviors, and poorer weight-related outcomes [9–15].”
Manzoni, G. M., Tomba, E., Gardini, V., Cena, H., Schumann, R., Ballardini, D., Donini, L. M., Manzato, E., Gravina, G., Pauli, D. D., et al. (2026) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-026-01818-8 · Cited by 1
“These results are consistent with previous research showing that IWS and depressive symptomatology tend to increase with higher body weight, rather than being uniquely associated with being in clinical care [24, 27].”
Barnhart, W. R., Pasquariello, K., Xiao, Y., Xu, Y., & He, J. (2026) · Appetite · doi:10.1016/j.appet.2026.108611 · Cited by 1
Psychosocial Outcomes of the Fast Track to Health Clinical Trial in Adolescents with Obesity
Lister, N., Baur, L., Gow, M., House, E., Kwok, C., Varady, K., & Jebeile, H. (2026) · Obesity Facts · doi:10.1159/000551890 · Cited by 1
“This is consistent with literature from adult studies showing weight bias internalization is unrelated to weight loss [16].”
Park, K. E., Reid, R., Cassin, S. E., Sockalingam, S., & Wnuk, S. (2026) · Obesity Surgery · doi:10.1007/s11695-026-08651-z · Cited by 1
“A systematic review conducted by Pearl and Puhl [30 ] identified 74 studies that explored the relationship between WBI and health outcomes and found that WBI was associated with increased risk of depression, anxiety, reduced self-esteem, worsened body image, disordered eating, and poorer…”
Wu, H., Huang, Y.-S., Lu, H., Wang, L., & Zhang, M. (2026) · Preventive medicine reports · doi:10.1016/j.pmedr.2026.103483 · Cited by 1
“Additionally, it can cause psychological disorders, such as anxiety, depression, and loneliness, exacerbating the degree of obesity and even endangering patients' lives (Prunty et al., 2023; Pearl and Puhl, 2018).”
Kee, C., & Neshteruk, C. D. (2026) · Advances in Nursing Science · doi:10.1097/ans.0000000000000637 · Cited by 1
Griffiths, K., Markarian, T., Meurice, V., Muzellec, M., Lannoy, F., Beneton, F., & Michelet, P. (2026) · PLoS ONE · doi:10.1371/journal.pone.0345784
“The internalization of this bias, or self-stigma (WBI, weight bias internalisation) is strongly associated with negative health outcomes [5].”
It is a matter of size—manipulating body size with virtual reality modulates reward sensitivity
Pia, L., Freedberg, M., Pyasik, M. M., Boarini, R., Holcomb, A. N., Lanza, C. M., Zampini, M., & Schintu, S. (2026) · Scientific Reports · doi:10.1038/s41598-026-45811-8 · Cited by 1
“The WB-IAT (https://implicit.harvard.edu/ ) was used to quantify illusion-induced changes in the implicit attitude towards large people 49 , following the embodiment of a slim and large avatar (Fig.”
Ross, J. M., Holland, M. C., Collins, A., Badejoh, O. O., & Volpe, V. V. (2026) · Journal of Health Psychology · doi:10.1177/13591053261430429 · Cited by 1
“…study, greater internalization of negative thoughts about weight was associated with skipping meals for Black young adult women, aligning with previous theories on the negative impact of IWS on health behaviors (Tylka et al., 2014) and eating behaviors (Levy et al., 2022; Pearl and Puhl, 2018).”
Risi, R., Pauletto, D., Buffi, V. Z., Berna, V., Carafa, A., Barbaro, F., Vita, F. D., D’Onofrio, L., Amendolara, R., Pantano, A. L., et al. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.70629 · Cited by 1
Dimitriou, M., Chatzaki, N., Kostara, D., Tsialta, M.-E., Miliou, A., Mpanti, S., Stalidi, L., Grammatikopoulou, M. G., & Poulimeneas, D. (2026) · Nutrients · doi:10.3390/nu18050866
“A growing body of literature has linked internalized weight bias to adverse mental health outcomes and maladaptive eating-related behaviors, including emotional eating, binge eating, disinhibited eating, rigid dietary restraint, and lower intuitive eating [13–15].”
State of the Science: Body Image and Mental Health
Wilfred, S. A., Okyere, M., Lopez, S., Kilpela, L. S., & Becker, C. B. (2026) · Behavior Therapy · doi:10.1016/j.beth.2026.03.003 · Cited by 1
Koçak, T., Koçyiğit, E., Özbek, Y. D., & Çelik, İ. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1772302 · Cited by 1
Le stigma lié au poids au sein du couple et la compulsion alimentaire
Légaré-Baribeau, M.-P., Talbot, M.-È., Côté, M., & Bégin, C. (2025) · Canadian Journal of Community Mental Health · doi:10.7870/cjcmh-2025-022 · Cited by 1
CYRANKA, K. M., Snoek, F. J., Hermanns, N., Ehrmann, D., & Klupa, T. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.70549 · Cited by 1
Metadata
- Authors
- Pearl, R. L., & Puhl, R. M.
- Affiliations
- University of Pennsylvania (US)
- University of Connecticut (US)
- Corresponding author
- Pearl, R. L.
- Venue
- Obesity Reviews
- Publisher
- Wiley
- Published
- 2018-05-22
- Volume
- 19
- Issue
- 8
- Pages
- 1141-1163
- ISSN
- 1467-7881 (ISSN-L)
- 1467-789X
- PMC
- PMC6103811
- OpenAlex
- W2803711470
- Cited by
- 642
- References
- 110
- Citations by year
- 2026: 96 · 2025: 110 · 2024: 90 · 2023: 79 · 2022: 85 · 2021: 99 · 2020: 55 · 2019: 23 · 2018: 4
- FWCI
- 11.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Obesity Reviews (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Rudd Foundation
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity and Health Practices
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- weight bias internalization, weight stigma, self-derogation, mental health, physical health, body weight
- MeSH terms
- Body Weight, Humans, Obesity, Self Concept, Social Stigma
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