Relationship Between Weight Bias Internalization and Health-Related Quality of Life Among Adolescents Seeking Metabolic and Bariatric Surgery.

Background: Weight bias internalization (WBI) negatively effects health outcomes in people with obesity. Little is known about how these experiences relate to quality of life and vary in racially/ethnically diverse adolescents with severe obesity. Associations between WBI and health-related quality of life (HRQOL) by race/ethnicity among a sample of adolescents seeking metabolic and bariatric surgery (MBS) were examined in this analysis.

Methods: In this single-site cross-sectional study of adolescents seeking MBS (NCT05393570, March 2022 to October 2024), WBI was measured using the 11-item weight bias internalization scale and HRQOL by the standardized HRQOL scale. Race/ethnic group differences were evaluated by univariate/multivariable linear regression analysis. Multivariable regression models were adjusted for age, sex, body mass index, and race/ethnicity.

Results: The final sample consisted of 76 adolescents (mean age 15.7 [SD 1.4] years, mean BMI 44.7 kg/m², 69.7% females, 9.2% non-Hispanic white (NHW), 32.9% non-Hispanic Black (NHB), 56.6% Hispanic/Latino, 1.3% other). Mean WBIS score (4.0; SD = 1.3) did not differ among NHW (4.5 ± 1.7), NHB (3.6 ± 1.3), and Hispanic (4.3 ± 1.1) adolescents (P > 0.05). Adolescents with high WBI experienced significantly more days with poor mental health (β = 0.03 (SE = 0.01), p = 0.03), affected by pain (β = 0.07 (SE = 0.02), p < 0.01), feeling sad/blue/depressed (β = 0.05 (SE = 0.02), p < 0.01), and feeling worried/tensed or anxious (β = 0.05 (SE = 0.02), p < 0.01). A negative association was shown for days feeling very healthy and full of energy (β = - 0.04 (SES = 0.01), p = 0.01).

Conclusion: WBI was inversely associated with feeling healthy among racially/ethnically diverse adolescents seeking MBS. Adolescent MBS programs may consider screening and targeting WBI to optimize health outcomes.