Gender differences in the relationship between weight bias internalization and psychological health outcomes among overweight and obese high school students in Thailand.

Background: Weight bias internalization (WBI) has been related with adverse psychological health outcomes. However, little is known about the gender differences in the associations among Thai high school students. Hence, we examined such relationships with a focus on gender differences.

Materials and methods: A cross-sectional study was conducted with 1012 Thai overweight and obese high school students, selected by the multistage sampling method. A self-reported questionnaire was used for data collection. Hierarchical linear regression analyses were used to examine the association between WBI and psychological health outcomes.

Results: Most students were girls (52.6%), with a mean body mass index (BMI) of 25.7 kg/m² (SD = 1.6). We found that girls reported significantly greater WBI and body dissatisfaction (BD) than boys (P < 0.001). For both genders, WBI had a significant association with low self-esteem (β = -0.330, P < 0.001 in girls; β = -0.358, P < 0.001 in boys). However, only girls showed a significant relationship between WBI and severe depressive symptoms (β =0.466, P < 0.001 in girls; β =0.516, P = 0.108 in boys) and higher perceived stress (β =0.347, P < 0.001 in girls; β =0.389, P = 0.095 in boys), after controlling for age, BD, and BMI.

Conclusion: Gender differences were observed in WBI and its association with depression and perceived stress among overweight and obese students. Thus, gender-specific individual- or school-based interventions or school strategies for an antistigma campaign to reduce WBI are needed in these groups, particularly among girls.