A Longitudinal Study Exploring the Influence of Weight Bias Internalization and Experiences of Perceived Discrimination on Pathological Eating Among Bariatric Surgery Patients

Background: Weight bias internalization (WBI) and perceived discrimination (EPD) have been linked to pathological eating in individuals with obesity. However, few studies have explored their longitudinal effects among patients undergoing metabolic and bariatric surgery (MBS). Objective: This study examined the associations between WBI, EPD, and pathological eating behaviors (specifically binge eating and emotional eating) across the first year following MBS. Methods: Participants ( n = 392) were recruited from [redacted]. Self-report data on WBI, EPD, binge eating, and emotional eating were collected preoperatively, 6 months post-op, and 12 months post-op. Linear mixed-effects models were used to assess whether WBI and EPD predicted changes in eating behavior over time. Results: WBI emerged as a consistent predictor of binge eating and emotional eating at all time points. In contrast, EPD was only associated with disordered eating at the preoperative assessment and did not significantly predict postoperative outcomes when controlling for WBI. The strength of the relationship between WBI and pathological eating declined over time but remained significant at both 6- and 12- months postoperatively. Conclusions: These findings suggest that WBI exerts a persistent influence on maladaptive eating behaviors even after MBS, whereas EPD has a more limited and time-bound effect. Interventions targeting WBI may help reduce disordered eating and support long-term outcomes in MBS patients.