Psychological distress and quality of life in Iranian adolescents with overweight/obesity: mediating roles of weight bias internalization and insomnia

  • Chung-Ying Lin
  • Vida Imani
  • Anders Broström
  • Karina Huus
  • Maria Björk
  • Eric A. Hodges
  • Amir H. PakpourEmail author
Original Article
Part of the following topical collections:
  1. Sleep and Eating and Weight disorders



To examine whether weight-related self-stigma (aka weight bias internalization) and insomnia are potential predictors of psychological distress and quality of life (QoL) among Iranian adolescents with overweight (OW)/obesity (OB). To examine whether weight-related self-stigma and insomnia are potential mediators in the relationship between excess weight and health outcomes of distress and QoL.


All participants (n = 934; 444 males; mean age = 15.7 ± 1.2 years; zBMI = 2.8 ± 1.0) completed questionnaires on weight-related self-stigma and insomnia at baseline. Six months later, they completed questionnaires on psychological distress and QoL to assess health outcomes. Relationships among variables were tested using mediation analyses with bootstrapping method.


Weight-related self-stigma significantly mediated the effects of zBMI on psychological distress (effect = 0.22; bootstrapping SE = 0.09; 95% CI = 0.08, 0.45), psychosocial QoL (effect = − 0.64; bootstrapping SE = 0.19; 95% CI = − 1.10, − 0.32), and physical QoL (effect = − 1.35; bootstrapping SE = 0.54; 95% CI = − 2.43, − 0.26). Insomnia also significantly mediated the effects of zBMI on psychological distress (effect = 2.18; bootstrapping SE = 0.31; 95% CI = 1.61, 2.81), psychosocial QoL (effect = − 0.89; bootstrapping SE = 0.33; 95% CI = − 1.60, − 0.28), and physical QoL (effect = − 0.83; bootstrapping SE = 0.42; 95% CI = − 1.69, − 0.02). Full mediations were found in psychosocial QoL; partial mediations were found in psychological distress and physical QoL.


Weight-related self-stigma and insomnia were significant mediators in the effects of excess weight on health outcomes. Therefore, it is important to identify and treat weight-related self-stigma and insomnia for adolescents with OW/OB.

Level of evidence

Level V, cross-sectional descriptive study.


Insomnia Mental health Obese Quality of life Stigma 



The authors have no financial relationships relevant to this article to disclose.

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.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHung HomHong Kong
  2. 2.Pediatric Health Research CenterTabriz University of Medical SciencesTabrizIran
  3. 3.Department of Nursing, School of Health and WelfareJönköping UniversityJönköpingSweden
  4. 4.School of NursingThe University of North Carolina at Chapel HillChapel HillUSA
  5. 5.Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable DiseasesQazvin University of Medical SciencesQazvinIran

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