Nearly Half of Adults Seeking Obesity Treatment in Italy Internalize Weight Stigma

Almost half of adults seeking treatment for obesity at clinical centers across Italy report high levels of internalized weight stigma, the tendency to adopt negative societal attitudes about weight and turn them against oneself, according to a new multicenter study published in Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity.

At baseline, each participant completed a clinical interview along with a battery of validated self-report questionnaires: the Weight Bias Internalization Scale (WBIS) to measure internalized stigma, the Eating Disorder Examination Questionnaire (EDE-Q) for eating disorder psychopathology, the Brief Symptom Inventory (BSI) for general psychological distress, and the 36-Item Short Form Health Survey (SF-36) for quality of life.

Using a cutoff of a WBIS score of 4 or higher to define high internalized weight stigma, the researchers found that 211 of the 438 participants, or 48.2 percent, fell into this category. In other words, nearly one in every two patients arriving for obesity treatment carried the burden of self-directed weight stigma, a finding the authors describe as both common and clinically relevant.

The pattern of associations the study uncovered is striking. WBIS scores were significantly higher in women and were negatively associated with age, meaning younger patients tended to report more internalized stigma than older ones. Higher scores were also linked to greater eating disorder psychopathology, more general psychological distress, and higher 12-month weight-loss expectations.

Equally important is what the study did not find. Internalized weight stigma was not associated with body mass index, and it showed no consistent association with cardiometabolic parameters. This dissociation suggests that the psychological burden of self-stigma is not simply a reflection of how much a person weighs or of their physical health measures, but a distinct clinical phenomenon in its own right.

When the team turned to multivariable linear regression, three variables emerged as independently associated with WBIS scores: age, the EDE-Q global score, and the SF-36 mental component score. The independent link with the mental component of quality of life reinforces the conclusion that internalized stigma tracks closely with impaired mental well-being, independent of body mass index.

The authors note that internalized weight stigma arises when negative attitudes about weight that circulate in society are taken on by individuals and directed at themselves, producing feelings of shame, self-blame, and low self-worth. In the plain-language summary accompanying the paper, they report that participants with higher levels of self-directed stigma were more likely to experience emotional difficulties, poorer mental well-being, and greater concerns about eating, weight, and body shape.

Because the study was cross-sectional, it captures associations at a single point in time and cannot establish causal direction. It is possible that internalized stigma contributes to psychological distress and disordered eating concerns, or that pre-existing distress makes individuals more likely to absorb and internalize weight-based prejudice, or both. The sample consisted exclusively of treatment-seeking adults with obesity in Italy, so the findings may not generalize to people with obesity who are not in care or to other populations.

The study is being shared early as a peer-reviewed, accepted manuscript with a permanent DOI, and the final version of record may still undergo further edits. The authors conclude that internalized weight stigma should be systematically assessed in obesity care and addressed through tailored psychological strategies within multidisciplinary treatment teams, arguing that tackling self-stigma may help improve mental well-being as part of comprehensive obesity care.

Subject of Research: Internalized weight stigma and its clinical correlates in treatment-seeking adults with obesity in Italy

Article Title: Internalized weight stigma and associated clinical features in treatment-seeking adults with obesity: a multicenter Italian study

Article References: Calugi, S., Colangeli, L., Ciammariconi, A., Capoccia, D., Mariani, S., Russo, B., Tuccinardi, D., Milani, I., Coccaro, F., Dalle Grave, A., Cattaneo, G., Chimini, M., Dalle Grave, R., & Guglielmi, V. (2026). Internalized weight stigma and associated clinical features in treatment-seeking adults with obesity: a multicenter Italian study. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity. https://doi.org/10.1007/s40519-026-01910-z

Image Credits: AI Generated

DOI: 10.1007/s40519-026-01910-z

Keywords: internalized weight stigma, obesity, weight bias, mental health, eating disorder psychopathology, quality of life, WBIS, multicenter study, psychological distress, BMI, Italy, Internalized