Weight Bias Internalization Scale Discriminates Obese and Overweight Patients with Different Severity Levels of Depression: the Italian Version of the WBIS

Abstract

We have investigated the psychometric properties of the Italian version of the weight bias internalization scale (WBIS) in overweight and obese patients who were attending weight loss programs. Participants were 386 overweight and obese patients admitted in two medical centers specializing in the treatment of obesity. All the patients were administered the WBIS, and measures of binge eating, depression, self-esteem, and body dissatisfaction. Confirmatory factor analysis failed to confirm the fit of the original 11-item unidimensional model. Item analysis and exploratory factor analysis indicated that 9 items included in the original measure (the items 1 and 9 were excluded because low item-total correlations) formed a reliable unidimensional measure of internalized weight bias (WBIS-9). The WBIS-9 was significantly correlated with convergent measures and was able to categorize individuals with different severity levels of depression (sensitivity of 0.72 and specificity of 0.70). The WBIS-9 may be useful in clinical practice to discriminate patients with more severe psychopathology, comorbid disordered eating patterns, and risk for poor outcomes.

Weight bias internalization and health: a systematic review

“…Similar to correlational findings for WBI and depression, the current literature showed that links between WBI and poor body image were present, and strong, for individuals of diverse body sizes. Furthermore, the consistency and strength of these associations were present in clinical samples of adults seeking treatment for weight loss , binge eating disorder (BED) or bariatric surgery , as well as community samples . Importantly, the relationship between WBI and body image remained significant even after controlling for variables such as BMI , depression and other psychological measures .…”

“…Moderate to strong correlations were consistently reported between WBI and binge eating symptoms ( r values = 0.43–0.62) . Only one study reported a correlation of less than r = 0.30 .…”

“…Links between depressive symptoms and WBI have been examined in 30 studies . WBI was significantly and positively associated with depressive symptoms in 28 of the 30 studies; only two did not find a significant association .…”

“…Correlations between WBI and depressive symptoms were present across both community and treatmentseeking samples and among individuals of different body weight categories. It is noteworthy that strong correlations were observed in both lean adults (49) and among individuals with obesity (58,59), suggesting that WBI is present and associated with emotional distress for individuals across diverse body sizes. Importantly, WBI remained significantly associated with depressive symptoms after controlling for body mass index (BMI) (40,49,52,55), and some studies found no relationship between BMI and depression (54,56,60,64).…”

“…Self-esteem has been assessed as a correlate of WBI in 11 studies (7,32,40,51,54,59,61,(67)(68)(69)(70). Across all 11 studies, WBI was significantly correlated with self-esteem, indicating that higher internalization of weight bias was related to lower self-esteem.…”