It's Interpersonal: Internalized Weight Bias and Suicidality Are Associated Indirectly via Perceived Burdensomeness and Thwarted Belongingness

Suicide prevention is a public health priority because suicide is a serious public health issue in the United States and globally. In this study, we test whether weight bias internalization is associated with suicidal thoughts and behaviors from the perspective of the interpersonal theory of suicide. Utilizing a community sample of American adults (N = 433), participants completed measures of weight bias internalization, perceived burdensomeness, thwarted belongingness, and suicidality. As expected, weight bias internalization was positively associated with perceived burdensomeness, thwarted belongingness, and suicidality. Weight bias internalization was associated with suicidality indirectly through perceived burdensomeness and thwarted belongingness, in line with the theoretical predictions of the interpersonal theory of suicide. The indirect associations of perceived burdensomeness and thwarted belongingness were of equivalent strength. This parallel mediation model remained significant when participant body mass index, self-perceived weight status, gender, age, and race were included as covariates. These findings contribute to better understanding the consequences of weight bias internalization and point to the need for longitudinal and intervention studies to further examine the association between weight bias internalization and suicidality. It is advisable for health professionals to be aware of the association between weight bias internalization and suicidal thoughts and behaviors, particularly in conjunction with levels of perceived burdensomeness and thwarted belongingness when assessing for suicide risk.