The mediating role of internalized weight stigma in the relationship between pressures from health professionals to maintain a healthy weight and binge eating symptoms

Introduction: Patients with obesity often face pressures for weight loss from various societal actors. This may inadvertently lead to disordered eating patterns, specifically binge eating behaviors [1,2]. Weight stigma plays a key role, affecting the psychological well-being of those with obesity [3,4]. Health professionals can intensify these pressures, further exacerbating the issue [5,6]. This study investigates the link between professional pressures, weight stigma, and binge eating symptom severity. Materials and methods: Patients were recruited at the Integrated Experimental Service for Eating Disorders at Sapienza University of Rome. Inclusion criteria were the risk of having an eating disorder as measured by a brief screening scale (SCOFF, [7]) and a BMI of 28 or higher. Patients completed a series of questionnaires assessing: binge eating symptoms (BES, [8]), sociocultural influences toward healthy weight (namely, social exposure and pressure, SITHS, [9]), internalized weight stigma (WBIS, [10]) and psychological distress (SCL-90-R, [11]). Biomedical parameters, including weight and height, were assessed through clinical evaluation. Finally, 121 patients (71% female; age = 44.29 ± 16.18; BMI = 37.99 ± 6.93) were included in the study. Results: Results from the mediation model tested, showed that pressures by health professionals to maintain a healthy weight predicted binge eating symptoms toward the mediation of internalized weight stigma (indirect effect β = 0.26, p < 0.01; total effect β = 0.37, p < 0.01), independently of the BMI. The model was no longer significant when examining exposure to health professionals discussing a healthy weight. The mediation model is shown in Fig. 1. Discussion and conclusions: Our findings show that pressures by health professionals for weight loss can potentially amplify weight stigma in those with obesity. This stigma, in turn, intensifies binge eating behaviors. Such a cycle suggests that these pressures might exacerbate internalized weight stigma, further worsening BED symptoms, potentially leading to further weight gain and challenges in addressing weight loss. These findings stress the importance of careful weight loss communication in obesity care. Prescribing weight loss could lead to internalized weight stigma, which could therefore trigger harmful behaviors. A holistic approach to obesity requires discussions in a supportive, stigma-free environment, guided by trained professionals in eating and weight disorders.