Recognizing the Fundamental Right to be Fat: A Weight-Inclusive Approach to Size Acceptance and Healing From Sizeism

The present study developed the Weight Bias Internalization Scale (WBIS), an 11-item measure assessing internalized weight bias among the overweight and obese. An Internet sample was recruited through online community discussion groups and snowball sampling via e-mail. Women (n = 164) and men (n = 34) with a BMI > 25 kg/m2 completed the WBIS and the Antifat Attitudes Questionnaire (AAQ), as well as measures of self-esteem, body image, mood disturbance, drive for thinness, and binge eating. Results indicate that the WBIS had high internal consistency (Cronbach's alpha = 0.90) and correlated significantly with antifat attitudes but was not a completely overlapping construct (r = 0.31). The scale showed strong partial correlations with self-esteem (r = -0.67), drive for thinness (r = 0.47), and body image concern (r = 0.75), controlling for BMI. Internalized weight bias was also significantly correlated with measures of mood and eating disturbance. Multiple regression analyses were conducted using WBIS scores, antifat attitudes, and BMI as predictor variables of body image, mood, self-esteem, and binge eating. WBIS scores were found to significantly predict scores on each of these measures. The WBIS showed excellent psychometric properties and construct validity. The study highlights the importance of distinguishing antifat attitudes toward others from internalized weight bias, a construct that may be closely linked with psychopathology.

Weight stigma is highly pervasive, but its consequences are understudied. This review draws from theory in social psychology, health psychology, and neuroendocrinology to construct an original, generative model called the cyclic obesity/weight-based stigma (COBWEBS) model. This model characterizes weight stigma as a "vicious cycle" - a positive feedback loop wherein weight stigma begets weight gain. This happens through increased eating behavior and increased cortisol secretion governed by behavioral, emotional, and physiological mechanisms, which are theorized to ultimately result in weight gain and difficulty of weight loss. The purpose of this review is to evaluate the existing literature for evidence supporting such a model, propose ways in which individuals enter, fight against, and exit the cycle, and conclude by outlining fruitful future directions in this nascent yet important area of research.