The relationship between weight bias internalization and psychological distress and health behaviors among obese high school students in Maha Sarakham Province, Thailand

Adolescents with obesity are vulnerable to weight bias internalization (WBI) and may face its psychological and behavioral health consequences. However, little is known about WBI and its effects on psychological distress and poor health behaviors among obese Thai students. Thus, this study aimed to examine the association of WBI with psychological distress and health behaviors among obese Thai high school students. A cross-sectional study was carried out from August 2023 to March 2024 among 785 obese high school students in Mahasarakham, Thailand, with a multistage sampling method. The data were collected using a self-administered questionnaire. Hierarchical linear regression analyses and multiple logistic regression analyses were used to examine the association of WBI with psychological distress and health behaviors. Most students were girls (47.1%), with a mean age of 14.7 years (SD = 1.2) and a mean body mass index of 29.8 kg/m2 (SD = 1.6). The mean WBI, depression, and self-esteem scores were 38.9 (SD = 8.4), 20.1 (SD = 4.5), and 25.0 (SD = 5.0), respectively. Most participants reported unhealthy eating habits (52.2%) and inadequate physical activity (51.3%). WBI was associated with severe depressive symptoms (β = 0.292; P < 0.01), low self-esteem (β = -0.221; P < 0.01), unhealthy eating behaviors (adjusted OR = 1.15; 95% CI: 1.13, 1.18), and inadequate physical activity (adjusted OR = 1.14; 95% CI: 1.12, 1.17). WBI was associated with adverse psychological and behavioral health among these obese students. Thus, future interventions to prevent or reduce WBI are needed, such as individual- or school-based interventions or school anti-stigma campaign strategies.