Weight bias internalization and its association with health behaviour adherence after bariatric surgery.

This study tested the hypothesis that internalized weight bias (WBI) is negatively associated with health-related quality of life, weight loss and health behaviour adherence (eg, physical activity, diet, vitamin adherence) in patients who had weight loss surgery (WLS). It also tested whether self-efficacy for exercise, barriers to being active and depression were mediators between WBI and moderate-to-vigorous physical activity (MVPA). Participants were recruited from online support forums. They completed an anonymous online survey assessing WBI, physical activity, health behaviour adherence, depression, health-related quality of life, self-efficacy for exercise and barriers to being physically active. Multiple regression analyses and a bootstrapping approach for mediation were used. The sample included 112 primarily white and female adults, who had surgery 1 month to 24 years prior. WBI was negatively associated with weight loss since surgery, MVPA, dietary adherence, vitamin adherence and mental health-related quality of life, and was not associated with walking, physical health-related quality of life or fluid intake adherence. Self-efficacy for exercise, barriers to being active and depression were partial mediators between WBI and physical activity. After WLS, WBI may signal poorer adherence to critical health behaviours. It also is associated with less weight loss. WBI should be assessed and treated by WLS providers.