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In a landmark study from India involving 142 patients, it has been found that in over 70% of the study participants, the emotional weight of obesity far exceeded the physical—shaped by silent, deeply negative self-beliefs. It was also seen that younger individuals carried a heavier emotional burden, while those with higher BMI experienced stronger levels of self-stigma
The study revealed striking levels of self-stigma, 74.6% felt depressed about their weight, over half felt less attractive, more than one-third doubted their competence, and many reported self-hate and judged their self-worth by their weight. Social confidence was also deeply affected, with 45.8% doubted anyone attractive would want to be in a relationship with them. Almost half believed that they did not deserve a fulfilling social life due to their high weight.
Mumbai: For the first time in India, a new study conducted by MetaHeal Laparoscopy and Bariatric Surgery Center has uncovered a significant burden of internalized weight bias (negative beliefs about self, due to weight) among individuals with obesity seeking metabolic and bariatric surgery.
Internalized weight bias (when individuals absorb negative societal attitudes about weight and turn them inward) is linked to depression, anxiety, sadness, low self-esteem, negative body image, disordered eating behaviours, and decline in mental health-related quality of life (HRQOL).
Internalization of weight bias has also been associated with a higher degree of obesity, lesser motivation to engage in physical activity, poorer adherence to dietary modification, and weight-regain post any weight loss program. These findings highlight the urgent need for targeted interventions that tackle internalized bias and stigma in patients with obesity. By addressing these issues early, it is possible to strengthen psychological well-being, boost confidence, and encourage healthier, timely health-seeking behaviours among people living with obesity.
The Burden from Within—An Indian Pilot Study on Weight Bias Internalization was published in the international journal of IFSO- “Obesity Surgery”. Link: https://rdcu.be/eQAoL
Weight bias is defined as negative attitudes toward individuals with obesity. These prejudicial attitudes are often rooted in negative stereotypes, including beliefs that individuals with obesity are lazy, incompetent, and lack willpower. There is a persistent belief that obesity results from personal failure, fostering the perception that people with obesity (PWO) are responsible for their condition. Weight bias can lead to obesity stigma. Obesity stigma involves actions against individuals with obesity that can lead to exclusion, marginalization, and inequality.
To understand the impact of obesity on an individual’s mental and emotional health, the study assessed 142 participants, of whom 78.9% were women, using the validated Weight Bias Internalization Scale (WBIS). All patients with a body mass index ≥ 27.5 Kg/m2 were included in the study. Researchers analysed overall scores, age correlation, and BMI association to understand how stigma affects patients preparing for metabolic and bariatric surgery.
The findings from the survey revealed that more than 71.1% of participants scored above the neutral point, clearly showing that internalized weight bias is highly prevalent in people with obesity. An overwhelming 74.6% participants felt depressed about their weight. More than half of the study participants felt less attractive, and more than one-third questioned their own competence. More than half of the participants expressed strong feelings like hating themselves due to their weight and saw weight as a major way of judging their value as a person. When it came to their social life, about 45.8% of participants questioned how anyone attractive would want to date them, and half of them believed they were not deserving of a fulfilling social life until they were overweight. This shows that obesity status and internalization of weight bias affect social interactions, connections, and relationships, which can have a long-lasting impact on the life course of an individual’s personal, emotional, occupational, and financial trajectory. Both depression and internalized weight bias often act as major barriers to seeking timely care.
The individual responses echoed deep dissatisfaction with body weight, feelings of low self-worth, and emotional distress linked to obesity. A clear pattern was observed across age and BMI. Younger individuals experienced stronger internalized bias, while those with higher BMI showed stronger levels of self-directed stigma. These insights remind us how important it is to address weight bias with empathy, early support, and evidence-based care.
Dr. Aparna Govil Bhasker a Bariatric Surgeon at MetaHeal in Mumbai and the lead author of the study said, “Weight-related bullying often begins in childhood and can persist throughout adulthood. People living with obesity are frequently judged as lazy or lacking willpower. Negative media portrayals, especially weight-based memes and stigmatizing content, only deepen these harmful beliefs. Post-pandemic trends show that online negativity toward obesity has grown even stronger.”
Dr. Vishakha Jain, Professor of medicine at AIIMS Bibi Nagar said that, “this constant stigma seeps into everyday life, affecting physical health, mental well-being, work performance, and relationships. It fuels poor mental health, unhealthy eating patterns, and even biological stress responses like higher inflammation. Together, these pressures create a cycle of self-blame and prejudice, often making individuals feel undeserving of care. Increasing evidence now shows that weight stigma can also worsen treatment outcomes, underscoring the urgent need for a more compassionate and supportive approach.”
“Internalized weight bias is not just an emotional burden; it affects every part of a patient’s health journey. Internalized weight bias is consistently linked to increased depression, anxiety, sadness, low self-esteem, negative body image, disordered eating behaviours, and decline in mental health-related quality of life (HRQOL)”, said Dr. Tejal Lathia, an endocrinologist at Apollo hospital, Navi Mumbai.
Dr. Shehla Shaikh an endocrinologist at Saifee and HN Reliance hospital added that, “internalization of weight bias has also been associated with a higher degree of obesity, lower motivation to engage in physical activity, and poorer adherence to dietary modification. Consequently, this leads to a vicious cycle of obesity and further stigma. Many patients begin to feel that they are at fault or that they do not deserve treatment, and this emotional pressure makes it harder for them to follow dietary advice or stay physically active”.
What we also see in this study is that younger patients and patients with higher BMI, carry a much heavier psychological burden. Addressing this bias early can help patients feel more supported, more hopeful, and more ready to take charge of their health, said Dr. Chitra Selvan, HOD Endocrinology at M.S. Ramaiah Medical College in Bengaluru.
Dr. Aparna Govil Bhasker highlighted, “These findings highlight how deeply weight stigma is rooted in our society. Patients often feel ashamed, guilty, and discouraged. They endure years of negative comments, judgment, and misinformation, and over time, these negative experiences become internalized. This affects their self-worth and mental health and can delay their decision to seek proper treatment. Obesity is a chronic disease, not a personal failure, and supporting patients emotionally is just as important as helping them medically. When it comes to women, increasing exposure to global beauty standards, pressurizes many Indian women to conform to ideals—such as slimness and fair skin—that often don’t match natural Indian body types. When these expectations collide with cultural pressures around marriage and family approval, women may internalize stigma and experience deep shame and distress”.
She further explained that understanding internalized weight bias allows us to offer better, more compassionate care. When patients feel judged or blame themselves, it becomes difficult for them to accept long-term treatment. By acknowledging the psychological struggles they face, we can create a safe space that helps them heal both emotionally and physically. This study is an important step toward building a more supportive and stigma-free environment for all individuals living with obesity.”
This is the first study in India to highlight the burden of internalized weight bias among individuals with obesity seeking treatment. Researchers emphasize that addressing internalized stigma is essential to improving psychological well-being, encouraging timely health-seeking behaviour, and supporting better long-term outcomes for people living with obesity.
