Body dissatisfaction, internalized weight bias and quality of life in young men and women

  • Terry Purton
  • Jonathan MondEmail author
  • David Cicero
  • Allison Wagner
  • Emily Stefano
  • Devin Rand-Giovannetti
  • Janet Latner



We examined the relative importance of body dissatisfaction (BD) and internalized weight bias (IWB) in accounting for variance in quality of life (QoL) impairment in an ethnically diverse sample of college students (n = 630) and potential moderation of these associations by sex.


Participants completed an online survey that included established measures of BD, IWB and QoL. Regression models were used to examine the relative contributions of BD and IWB in accounting for variance in physical and mental QoL impairment.


BD and IWB were highly correlated with bivariate analysis in both women (r = .76) and men (r = .60). In multivariable analysis, IWB was found to be associated with both physical (b = − 1.33, 95% CI − 1.93, − 0.72) and mental (b = − 2.58, 95% CI − 3.45, − 1.72) QoL impairment, whilst BD was not associated with impairment in either physical (b = − 0.29, 95% CI − 0.68, 0.09) or mental (b = − 0.48, 95% CI − 1.03, 0.07) QoL. While levels of both BD and IWB were higher for women than for men, sex did not moderate the association between either BD or IWB and either physical or mental QoL.


The findings support the view that IWB warrants greater attention in interventions seeking to reduce the adverse impact of BD in both women and men and both normal-weight and overweight individuals.


Body image Weight-related discrimination Quality of life Sex differences 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Grogan, S. (2017). Body image: Understanding body dissatisfaction in men, women and children (3rd edn.). Oxon: Routledge.Google Scholar
  2. 2.
    Griffiths, S., Hay, P., Mitchison, D., Mond, J. M., McLean, S. A., Rodgers, B., et al. (2016). Sex differences in the relationships between body dissatisfaction, quality of life and psychological distress. Australian and New Zealand Journal of Public Health. Scholar
  3. 3.
    Griffiths, S., Murray, S. B., Bentley, C., Gratwick-Sarll, K., Harrison, C., & Mond, J. (2017). Sex differences in quality of life impairment associated with body dissatisfaction in adolescents. Journal of Adolescent Health. Scholar
  4. 4.
    Mond, J., Mitchison, D., Latner, J., Hay, P., Owen, C., & Rodgers, B. (2013). Quality of life impairment associated with body dissatisfaction in a general population sample of women. BMC Public Health. Scholar
  5. 5.
    Gall, K., van Zutven, K., Lindstrom, J., Bentley, C., Gratwick-Sarll, K., Harrison, C., et al. (2016). Obesity and emotional well-being in adolescents: Roles of body dissatisfaction, loss of control eating, and self-rated health. Obesity. Scholar
  6. 6.
    van Zutven, K., Mond, J., Latner, J., & Rodgers, B. (2015). Obesity and psychosocial impairment: Mediating roles of health status, weight/shape concerns and binge eating in a community sample of women. International Journal of Obesity. Scholar
  7. 7.
    Durso, L. E., & Latner, J. D. (2008). Understanding self-directed stigma: Development of the weight bias internalization scale. Obesity. Scholar
  8. 8.
    Puhl, R. M., Himmelstein, M. S., & Quinn, D. M. (2017). Internalizing weight stigma: Prevalence and sociodemographic considerations in US adults. Obesity. Scholar
  9. 9.
    Hilbert, A., Braehler, E., Haeuser, W., & Zenger, M. (2014). Weight bias internalization, core self-evaluation, and health in overweight and obese persons. Obesity. Scholar
  10. 10.
    Latner, J. D., Durso, L. E., & Mond, J. M. (2013). Health and health-related quality of life among treatment-seeking overweight and obese adults: Associations with internalized weight bias. Journal of Eating Disorders. Scholar
  11. 11.
    Puhl, R., & Suh, Y. (2015). Health consequences of weight stigma: Implications for obesity prevention and treatment. Current Obesity Reports. Scholar
  12. 12.
    Schvey, N. A., & White, M. A. (2015). The internalization of weight bias is associated with severe eating pathology among lean individuals. Eating Behaviors. Scholar
  13. 13.
    Hilbert, A., Baldofski, S., Zenger, M., Lowe, B., Kersting, A., & Braehler, E. (2014). Weight bias internalization scale: Psychometric properties and population norms. Plos One. Scholar
  14. 14.
    Ratcliffe, D., & Ellison, N. (2015). Obesity and internalized weight stigma: A formulation model for an emerging psychological problem. Behavioural and Cognitive Psychotherapy. Scholar
  15. 15.
    Hunger, J. M., & Major, B. (2015). Weight stigma mediates the association between BMI and self-reported health. Health Psychology, 34(2), 172–175.CrossRefGoogle Scholar
  16. 16.
    Guardabassi, V., Mirisola, A., & Tomasetto, C. (2017). How is weight stigma related to children’s health-related quality of life? A model comparison approach. Quality of Life Research. Scholar
  17. 17.
    Pearl, R. L., White, M. A., & Grilo, C. M. (2014). Weight bias internalization, depression, and self-reported health among overweight binge eating disorder patients. Obesity. Scholar
  18. 18.
    Boswell, R. G., & White, M. A. (2015). Gender differences in weight bias internalisation and eating pathology in overweight individuals. Advances in Eating Disorders, 3(3), 259–268.CrossRefGoogle Scholar
  19. 19.
    Bombak, A. E. (2014). The contribution of applied social sciences to obesity stigma-related public health approaches. Journal of Obesity. Scholar
  20. 20.
    Mond, J. (2015). Optimizing prevention programs and maximizing public health impact are not the same thing. Eating Disorders. Scholar
  21. 21.
    Palmeira, L., Cunha, M., & Pinto-Gouveia, J. (2017). Processes of change in quality of life, weight self-stigma, body mass index and emotional eating after an acceptance-, mindfulness-and compassion-based group intervention (Kg-Free) for women with overweight and obesity. Journal of Health Psychology. Scholar
  22. 22.
    Mond, J. M., Hay, P. J., Rodgers, B., Owen, C., & Beumont, P. J. V. (2005). Assessing quality of life in eating disorder patients. Quality of Life Research. Scholar
  23. 23.
    Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity. Scholar
  24. 24.
    Palmeira, L., Cunha, M., & Pinto-Gouveia, J. (2017). Process of change in quality of life, weight self-stigma, body mass index and emotional eating after an acceptance-, mindfulness- and compassion-based group intervention (Kg-free) for women with overweight and obesity. Journal of Health Psychology. 1–14,
  25. 25.
    Pearl, R. L., Wadden, T., Hopkins, A., Shaw, C. M., Hayes, J. A., Bakizada, M. R., Z, M., et al (2017). Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity. Obesity, 25, 317–322. Scholar
  26. 26.
    Mond, J. M., Hay, P. J., Darby, A., Paxton, S. J., Quirk, F., Buttner, P., et al. (2009). Women with bulimic eating disorders: When do they receive treatment for an eating problem? Journal of Consulting and Clinical Psychology, 77(5), 835–844.CrossRefGoogle Scholar
  27. 27.
    Wagner, A. F., Stefano, E. C., Cicero, D. C., Latner, J. D., & Mond, J. M. (2016). Eating disorder features and quality of life: Does gender matter? Quality of Life Research. Scholar
  28. 28.
    Rand-Giovannetti, D., Cicero, D. C., Mond, J. M., & Latner, J. D. (2017). Psychometric properties of the eating disorder examination questionnaire (EDE-Q): A confirmatory factor analysis and assessment of measurement invariance by sex. Assessment. Scholar
  29. 29.
    Fairburn, C., & Beglin, S. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders.;2-%23 Google Scholar
  30. 30.
    Grilo, C. M., Reas, D. L., Hopwood, C. J., & Crosby, R. D. (2015). Factor structure and construct validity of the eating disorder examination-questionnaire in college students: Further support for a modified brief version, IJED. 48. doi: 10/1002/eat.22358.Google Scholar
  31. 31.
    Pearl, R. L., & Puhl, R. M. (2014). Measuring internalized weight attitudes across body weight categories: Vaidation of the modified weight bias internalization scale. Body Image. Scholar
  32. 32.
    Ware, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.CrossRefGoogle Scholar
  33. 33.
    Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (2nd ed.). New York: Guilford Press.Google Scholar
  34. 34.
    United States Census Bureau, 2017, QuickFacts Hawaii, Retrieved November 2017, from,>
  35. 35.
    University of Hawaii at Manoa. (2016, March). Office of student equity, excellence and diversity. Manoa’s racial and ethnic diversity profile. Honolulu: Author.Google Scholar
  36. 36.
    Mond, J. M., & Baune, B. T. (2009). Overweight, medical comorbidity and health-related quality of life in a community sample of women and men. Obesity. Scholar
  37. 37.
    Mond, J. M., Rodgers, B., Hay, P. J., Darby, A., Owen, C., Baune, B. T., et al. (2007). Obesity and impairment in psychosocial functioning in women: The mediating role of eating disorder features. Obesity. Scholar
  38. 38.
    Mond, J. M., van den Berg, P., Boutelle, K., Neumark-Sztainer, D., & Hannan, P. J. (2011). Obesity, body dissatisfaction, and emotional well-being in early and late adolescence: Findings from the Project EAT Study. Journal of Adolescent Health. Scholar
  39. 39.
    Wilson, R. E., Latner, J. D., & Hayashi, K. (2013). More than just body weight: The role of body image in psychological and physical functioning. Body Image. Scholar
  40. 40.
    Neumark-Sztainer, D., Levine, M. P., Paxton, S. J., Smolak, L., Piran, N., & Wertheim, E. H. (2006). Prevention of body dissatisfaction and disordered eating. What next? Eating Disorders, 14(4), 265–285.CrossRefGoogle Scholar
  41. 41.
    Macpherson-Sanchez, A. E. (2015). Integrating fundamental concepts of obesity and eating disorders: Implications for the obesity epidemic. American Journal of Public Health, 105, e71–e85.CrossRefGoogle Scholar
  42. 42.
    Sanchez-Carracedo, D., Neumark-Sztainer, D., & Lopez-Guimera, G. (2012). Integrated prevention of obesity and eating disorders: Barriers, developments and opportunities. Public Health Nutrition. Scholar
  43. 43.
    Weinberger, N.-A., Kersting, A., Riedel-Heller, S. G., & Luck-Sikorski, C. (2016). Body dissatisfaction in individuals with obesity compared to normal-weight individuals: A systematic review and meta-analysis. Obesity Facts. Scholar
  44. 44.
    Schaefer, J. T., & Magnuson, A. B. (2014). Review of interventions that promote eating by internal cues. Journal of the Academy of Nutrition and Dietetics. Scholar
  45. 45.
    Mitchison, D., & Mond, J. (2015). Epidemiology of eating disorders, eating disordered behaviour, and body image disturbance in males: A narrative review. Journal of Eating Disorders. Scholar
  46. 46.
    Brown, T. A., Forney, K. J., Pinner, D., & Keel, P. K. (2017). A randomized controlled trial of the body project: More than muscles for men with body dissatisfaction. International Journal of Eating Disorders. Scholar
  47. 47.
    Mitchison, D., Morin, A., Mond, J., Slew-Younan, S., & Hay, P. (2015). The bidirectional relationship between quality of life and eating disorder symptoms: A 9-year community-based study of Australian women. PlosOne. Scholar
  48. 48.
    Paxton, S. J., Neumark-Sztainer, D., Hannan, P. J., & Eisenberg, M. E. (2006). Body dissatisfaction prospectively predicts depressive mood and low self-esteem in adolescent girls and boys. Journal of Clinical Child and Adolescent Psychology. Scholar
  49. 49.
    Purton, T., Officer, C., Bullivant, B., Mitchison, D., Griffiths, S., Murray, S., et al. (2018). Body dissatisfaction, narcissism and self-esteem in young men and women: A moderated mediation analysis. Personality and Individual Differences. Scholar
  50. 50.
    Schlomer, G. L., Bauman, S., & Card, N. A. (2010). Best practices for missing data management in counseling psychology. Journal of Counseling Psychology, 57, 1–10. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Centre for Rural Health, College of Health and MedicineUniversity of TasmaniaLauncestonAustralia
  2. 2.School of MedicineWestern Sydney UniversitySydneyAustralia
  3. 3.Department of PsychologyUniversity of HawaiiHonoluluUSA

Personalised recommendations