Psychosocial determinants of food cravings in women with overweight and obesity: self-stigmatisation, weight bias and self-esteem

Abstract

Background

Weight-related self-stigma and internalised weight bias may intensify food cravings and undermine psychological resources such as self-esteem, yet their combined contribution to food cravings among women with overweight and obesity is not well characterized. This study compared these psychosocial factors between women with overweight and those with obesity and examined their independent associations with food craving.

Methods

The sample included 179 women with BMI ≥ 25 who completed a sociodemographic questionnaire and validated measures of weight-related self-stigma, internalised weight bias, food craving, and self-esteem. Group differences were examined, and hierarchical multiple regression was used to identify psychosocial predictors of food craving.

Results

Compared with women with overweight, women with obesity reported higher levels of weight-related self-stigma (p = 0.001), internalised weight bias (p = 0.001), and food craving (p = 0.003). Self-esteem did not differ by weight status but was significantly negatively associated with weight-related self-stigma, internalised weight bias, and food craving. Hierarchical regression analysis showed that greater weight-related self-stigma (β = 0.260) and internalised weight bias (β = 0.222), along with lower self-esteem (β = 0.184), independently predicted higher food craving, explaining 38.9% of the variance (R²=0.389). Age remained a significant negative predictor of food craving. Importantly, aside from age, BMI category and other sociodemographic variables were included as covariates in the hierarchical model but did not emerge as significant predictors.

Conclusions

Food craving in women with overweight and obesity appears to be significantly associated with modifiable psychosocial mechanisms, particularly weight-related self-stigma, internalised weight bias, and self-esteem. Integrating stigma-reduction and self-esteem-supportive components into obesity management may help improve psychological and behavioral outcomes beyond standard dietary advice.

Introduction

Obesity is defined as one of the major public health concerns worldwide and is associated not only with metabolic disorders but also with negative psychosocial consequences [1, 2]. Overweight and obesity are also highly prevalent in Türkiye, with recent data indicating that approximately 61% of the adult population is overweight and 32.1% lives with obesity, placing Türkiye among the countries with the highest obesity prevalence in the European region [3]. In individuals with overweight and obesity, due in part to widespread societal prejudices regarding body weight, social stigma, low self-esteem, and impaired eating behaviours are observed in addition to physical health problems [4, 5]. Therefore, psychosocial factors, such as social stigma, low self-esteem, and impaired eating behaviours, may also be important to consider in relation to overweight and obesity.

Self-stigmatisation refers to the internalisation of stereotypes associated with societal stigma and the application of these negative beliefs to oneself [6]. Weight-related self-stigma (WSS) is characterised by the development of negative self-judgments resulting from the belief that one will be excluded because of their body weight [7], which may lead to psychological distress, social withdrawal, and decreased quality of life [8]. Studies suggest that weight-related self-stigma may negatively affect eating behaviours and psychological health [9, 10]. Similarly, internalised weight bias (IWB) is defined as the tendency of individuals to adopt societal prejudices and develop weight-related stress and self-devaluation [11]. Internalised weight bias has been associated with mood disorders, psychological distress, social isolation, low self-esteem, poorer health-related quality of life, metabolic dysfunction, and disordered eating habits [12, 13]. Within this framework weight-related self-stigma refers to the process by which individuals develop negative emotions and judgments toward themselves as a result of perceiving weight-based devaluation [6, 14], whereas internalised weight bias represents a deeper process in which societal weight-based stereotypes and prejudices are accepted, adopted, and integrated into one’s self-concept [15, 16]. Self-esteem is an individual’s evaluation of oneself and is a fundamental aspect of mental health. Self-esteem has been reported to be associated with obesity and stigmatisation processes [17, 18]. Low self-esteem may be associated with higher levels of internalised weight bias and greater eating-related psychopathology among individuals with obesity [19]. In the literature, low self-esteem has been reported to contribute to obesity by influencing eating behaviours both directly and indirectly [20–22].

Food craving is a trait-level, dimensional construct characterised by a tendency to experience intense desires to consume certain foods, and it is considered an important factor in complicating weight management [23, 24]. The theoretical basis linking these psychosocial constructs to eating behaviors is well-supported. For instance, Tomiyama’s Cyclic Obesity/Weight-Based Stigma Model proposes that exposure to weight-based stigma induces psychological stress, which in turn promotes emotional eating and exacerbates food cravings [25]. Furthermore, experiences of stigma can trigger feelings of shame and guilt, increasing psychological distress and predisposing individuals to maladaptive eating patterns [26]. Crucially, past research highlights that the internalisation of such weight bias is directly associated with overeating, emotional eating, binge eating, and heightened food cravings [27–30]. Additionally, reduced psychological resources, particularly low self-esteem, have been frequently linked to emotional eating, increased food cravings, and a tendency toward unhealthy food choices [31–33]. This theoretical framework underscores that food cravings in individuals with overweight and obesity are significantly shaped by modifiable psychosocial mechanisms, rather than solely physiological factors. In the literature, food craving has generally been examined in relation to obesity, eating disorders, and food addiction [34, 35]. However, to the best of current knowledge, there are no studies that have directly evaluated the relationship between weight-related stigma or internalised weight bias and food craving.

Overweight and obesity differ not only in terms of physical health risks but also in their psychological and behavioural correlates. Previous studies have shown that individuals with higher body mass index (BMI) tend to experience greater weight-related self-stigma, including both self-devaluation and fear of stigma, likely due to increased exposure to weight-based discrimination [36, 37]. Similarly, internalised weight bias has been reported to be more pronounced in individuals with higher BMI, as repeated stigmatising experiences may lead individuals to adopt negative societal beliefs about body weight into their self-concept [7, 38, 39]. Food craving has also been found to be positively associated with obesity, potentially through both physiological mechanisms and psychosocial pathways such as stress and emotional eating [27, 40, 41]. However, findings regarding self-esteem are less consistent; while some studies report lower self-esteem with increasing BMI [42, 43], others suggest no significant differences between individuals with overweight and obesity [44]. Therefore, examining differences in these psychosocial variables across weight status groups may help clarify whether psychological burden increases progressively with BMI and address inconsistencies in the existing literature. According to previous studies, weight-related stigma has been associated with higher body weight and BMI [8, 45]. Individuals with overweight and obesity experience greater feelings of self-devaluation and fear of stigma compared to individuals with normal weight [45]. These findings also indicate that weight-related self-stigma is associated with negative outcomes such as stress, overeating, and low self-esteem [8]. Accordingly, the present study aimed (i) to compare levels of weight-related self-stigma, internalised weight bias, self-esteem, and food craving between women with overweight and obesity, and (ii) to examine the relationships among these variables and determine the extent to which they explain food craving.

Based on the existing literature, it was hypothesised that women with obesity would report higher levels of weight-related self-stigma, internalised weight bias and food craving compared to women with overweight, and lower levels of self-esteem. Additionally, it was hypothesised that weight-related self-stigma and internalised weight bias would be positively associated with food craving, and that lower self-esteem would be associated with higher levels of weight-related self-stigma, internalised weight bias, and food craving.

Materials and methods

Study group and design

This cross-sectional study was conducted between June and December 2024 with voluntary female participants aged 19–65 who applied to a private Healthy Life Center located in Kayseri. A total of 179 female participants were included in the study. The inclusion criteria for participation in the study were as follows: aged 19–65 years, BMI ≥ 25 and < 45 kg/m², female, and willing to participate voluntarily. Exclusion criteria were determined based on participants’ self-reports and included having a current or past history of an eating disorder diagnosis, undergoing active chemotherapy treatment, the presence of cognitive or psychiatric impairments that could prevent completion of the questionnaires, and participation in restrictive diet programmes not recommended by a dietitian.

Ethical approval

Ethical approval for the study was obtained from the Non-Interventional Clinical Research Ethics Committee of Ankara Medipol University on May 6, 2024, with decision number 52. Participants who volunteered to take part in the study were asked to complete an informed consent form before participating.

Data collection process

Data were collected through face-to-face administration of a questionnaire form prepared by the researchers. Sociodemographic information, including age, marital status, education level, employment status, and income status, was collected through researcher-administered questioning and recorded on the questionnaire form. Anthropometric measurements were obtained according to standard procedures and documented on the questionnaire form. Participants’ height and body weight were measured using calibrated instruments.

Body Mass Index (BMI) classification

BMI was calculated as body weight in kilograms divided by the square of height in meters (kg/m²). BMI classification was performed according to the World Health Organization (WHO) criteria [46]. Participants with a BMI of 25.0–29.9 kg/m² were classified as overweight, and those with a BMI of 30.0–44.9 kg/m² were classified as obese.

After the assessment of anthropometric measurements and BMI classification, the following validated scales were used to evaluate the study variables.

Weight Self-Stigma Questionnaire (WSSQ) [47, 48]: The WSSQ is a 12-item questionnaire that assesses levels of weight-related self-stigmatisation across two subscales (self-devaluation and fear of enacted stigma). The version used in this study was adapted into Turkish. Higher scores indicate greater levels of self-stigmatising behaviour. In the Turkish adaptation study, internal consistency was reported as good (Cronbach’s alpha = 0.83). In the current study, internal consistency for the overall scale was also good (Cronbach’s alpha = 0.82).

Two-Factor Weight Bias Internalization Scale (WBIS-2F) [49, 50]: The WBIS-2F comprises 13 items across two subscales and measures internalised weight bias through the dimensions of weight-related stress and weight-related self-devaluation. The version used in this study was adapted into Turkish. Higher scores indicate greater levels of internalised weight bias. In the Turkish adaptation study, internal consistency was reported as good (Cronbach’s alpha = 0.80). In the current study, internal consistency was also good (Cronbach’s alpha = 0.81).

Rosenberg Self-Esteem Scale (RSES) [51, 52]: The RSES is a 10-item instrument that assesses self-esteem. The version used in this study was adapted into Turkish. Lower scores indicate higher self-esteem, whereas higher scores indicate lower self-esteem. In the Turkish adaptation study, internal consistency was reported as good (Cronbach’s alpha = 0.75). In the current study, internal consistency was also good (Cronbach’s alpha = 0.80).

Food Craving Questionnaire–Trait (FCQ-T) [53, 54]: The FCQ-T consists of 39 items and assesses individuals’ levels of intense desire and craving for specific foods. The version used in this study was adapted into Turkish. Higher scores indicate more frequent and intense food cravings. In the Turkish adaptation study, internal consistency was reported as excellent (Cronbach’s alpha = 0.97). In the current study, internal consistency was also excellent (Cronbach’s alpha = 0.97).

Statistical analysis

The sample size for the study was calculated using G*Power 3.1 software based on data from a similar previous study [55]. The analysis conducted with an alpha (α) of 0.05, an effect size (d) of 0.39, and a power (1-β) of 0.95 determined that a minimum of 85 participants was required. A total of 179 female participants were included in the study, exceeding the number needed for sufficient power. Statistical analyses were performed using IBM SPSS Statistics 28.0 (IBM Corp., Armonk, NY, USA). For categorical variables, frequencies and percentages were reported, while for numerical variables, mean, standard deviation, median, minimum, and maximum values were calculated. The normality of continuous variables was assessed using the Kolmogorov–Smirnov test. No missing data were observed in the dataset; therefore, all 179 participants were included in the analyses. Comparisons of sociodemographic and other categorical variables between groups were conducted using the Chi-square test or Fisher’s exact test, as appropriate. To address the first aim of the study, group comparisons between women with overweight and obesity were performed for weight-related self-stigma, internalised weight bias, self-esteem, and food craving scores using the Mann–Whitney U test or Independent Samples t-test according to data distribution. To address the second aim of the study, Spearman’s correlations were used to assess the relationships among weight-related self-stigma, internalised weight bias, self-esteem and food craving. To further examine the explanatory value of psychosocial variables on food craving, hierarchical regression analysis was performed. Food craving was entered as the dependent variable. In the first step of the model, sociodemographic variables (BMI category, age, marital status, and employment status) were included. In the second step, self-esteem was added to the model. In the final step, internalised weight bias and weight-related self-stigma were included. The level of statistical significance was set at p < 0.05. To account for multiple comparisons and reduce the risk of Type I error, p-values were adjusted using the Benjamini–Hochberg procedure with a false discovery rate (FDR) threshold of 5% [56].

Results

Sample characteristics

A total of 179 women participated in the study and were divided into two groups based on their BMI values. The first group consisted of women with overweight (n = 101), while the second group comprised women with obesity (n = 78). The analysis results for the participants’ sociodemographic characteristics are presented in Table 1. The mean age of the participants was 37.42 ± 10.76 years. Age was significantly higher in women with obesity compared to those with overweight (p = 0.001). Additionally, marital status (p = 0.037), education level (p = 0.023), and employment status (p = 0.030) differed significantly between the groups, with a higher proportion of married women, lower educational attainment and unemployed in the obesity group. In contrast, women with overweight had higher proportions of university graduates and employed participants. No significant difference was observed between the groups in terms of income status (p > 0.05).

Table 1.

Sociodemographic characteristics of participants and according to weight status

	Overweight (n = 101)		Obese (n = 78)		Total (n = 179)
	n	%	n	%	n	%	p
Age (years)
(±SD)	34.88 ± 10.23		40.71 ± 10.59		37.42 ± 10.76		0.001ᵃ
Marital Status
Married	69	68.3	64	82.1	133	74.3	0.037b
Single	32	31.7	14	17.9	46	25.7
Education Level
Primary school	3	3.0	11	14.1	14	7.8
Secondary school	2	2.0	5	6.4	7	3,9
High school	17	16.8	15	19.2	32	17.9	0.023b
University	70	69.3	42	53.8	112	62.6
Postgraduate	9	8.9	5	6.4	14	7.8
Employment Status
Employed	58	57.4	32	41.0	90	50.3	0.030b
Unemployed	43	42.6	46	59.0	89	49.7
Income Status
Income< Expenses	18	17.8	17	21.8	35	19.6
Income=Expenses	58	57.4	45	57.7	103	57.5	0.704b
Income> Expenses	25	24.8	16	20.5	41	22.9

Uncorrected p-values are reported. Significance testing was adjusted for multiple comparisons using the Benjamini–Hochberg method. The B-H critical value for the highest significant comparison was 0.040, and all statistically significant results remained significant

^aIndependent Samples t-test, ^bChi-square test and Fisher’s Exact test, p < 0.05

Comparison of psychosocial variables and food craving by BMI category

The findings related to weight-related self-stigma, internalised weight bias, food craving, and self-esteem are presented in Table 2. Women with obesity exhibited significantly higher levels of weight-related self-stigma (p = 0.001) and internalised weight bias (p = 0.001) (including both total and subscale scores), as well as higher levels of food craving (p = 0.003), compared to women with overweight. No significant difference was observed between the groups in terms of self-esteem (p > 0.05).

Table 2.

Comparison of scale scores between participants with overweight and obesity

	Overweight (n = 101)		Obese (n = 78)		Total (n = 179)
	x̄±SD	Median (Min-Max)	x̄±SD	Median (Min-Max)	x̄±SD	Median (Min-Max)	p
WSSQ Total	25.32 ± 7.76	24 (12–48)	30.36 ± 9.10	31 (13–59)	27.51 ± 8.71	27 (12–59)	0.001
Self-Devaluation	16.71 ± 6.02	15 (6–30)	19.04 ± 6.20	19 (6–30)	17.73 ± 6.19	17 (6–30)	0.008
Fear of Enacted Stigma	8.60 ± 4.00	7 (6–26)	11.32 ± 5.08	10 (6–30)	9.79 ± 4.69	8 (6–30)	0.001
WBIS-2F Total	44.23 ± 12.34	43 (16–74)	51.63 ± 12.50	51,5 (22–83)	47.45 ± 12.91	47 (16–83)	0.001ᵃ
Weight-Related Stress	22.92 ± 9.11	22 (7–43)	28.06 ± 8.86	28,5 (12–49)	25.16 ± 9.34	25 (7–49)	0.001ᵇ
Weight-Related Self-Devaluation	21.31 ± 4.85	22 (6–31)	23.56 ± 5.19	24 (7–39)	22.29 ± 5.11	23 (6–39)	0.003ᵇ
FCQ-T Total	130.37 ± 43.85	126 (46–223)	150.60 ± 45.92	161 (44–229)	139.18 ± 45.76	138 (44–229)	0.003
RSES Total	1.52 ± 1.45	1 (0–5)	1.94 ± 1.89	1 (0–6)	1.70 ± 1.66	1 (0–6)	0.326ᵃ

Uncorrected p-values are reported. Significance testing was adjusted using the Benjamini–Hochberg procedure. The B-H critical value for the highest significant comparison was 0.037, and all statistically significant results remained significant

WSSQ Weight Self-Stigma Questionnaire, WBIS-2F Two-Factor Weight Bias Internalization Scale, FCQ-T Food Craving Questionnaire-Trait, RSES Rosenberg Self-Esteem Scale

^aIndependent Samples t-test, ᵇMann–Whitney U test, p<0.05

Correlations among psychosocial variables and food craving

Table 3 presents the correlations among weight-related self-stigma, internalised weight bias, self-esteem, and food craving. Significant positive correlations were observed among all variables and their subdimensions (p < 0.001). Specifically, higher levels of weight-related self-stigma and internalised weight bias were associated with higher levels of food craving. In addition, lower self-esteem (i.e., higher RSES scores) was associated with higher levels of weight-related self-stigma, internalised weight bias, and food craving.

Table 3.

Correlations among participants’ scale scores

	WSSQ Total		Self-Devaluation		Fear of Enacted Stigma		WBIS-2F Total		Weight-Related Stress		Weight-Related Self-Devaluation		RSES Total
	r	p	r	p	r	p	r	p	r	p	r	p	r	p
WSSQ Total	-	-
Self-Devaluation	0.890	0.001*	-	-
Fear of Enacted Stigma	0.693	0.001*	0.335	0.001*	-	-
WBIS-2F Total	0.712	0.001*	0.599	0.001*	0.536	0.001*	-	-
Weight-Related Stress	0.716	0.001*	0.596	0.001*	0.566	0.001*	0.951	0.001*	-	-
Weight-Related Self- Devaluation	0.466	0.001*	0.385	0.001*	0.316	0.001*	0.757	0.001*	0.538	0.001*	-	-
RSES Total	0.482	0.001*	0.463	0.001*	0.265	0.001*	0.526	0.001*	0.536	0.001*	0.304	0.001*	-	-
FCQ-T Total	0.541	0.001*	0.554	0.001*	0.234	0.002*	0.534	0.001*	0.542	0.001*	0.363	0.001*	0.393	0.001*

Uncorrected p-values are reported. Significance testing was adjusted using the Benjamini–Hochberg procedure. The B-H critical value for the highest significant comparison was 0.050, and all statistically significant results remained significant

WSSQ Weight Self-Stigma Questionnaire, WBIS-2F Two-Factor Weight Bias Internalization Scale, RSES Rosenberg Self-Esteem Scale, FCQ-T Food Craving Questionnaire–Trait

*p<0.001; Spearman correlation analysis; r=correlation coefficient

Predictors of food craving

According to the hierarchical multiple linear regression analysis (Table 4), when BMI category, age, marital status, and employment status were included in Model 1, only age was found to be significantly and negatively associated with food craving (β=−0.154; p = 0.024), explaining a small proportion of the variance (R²=0.094). The inclusion of self-esteem in Model 2 significantly increased the explanatory power of the model (ΔR²=0.165; p < 0.001), with self-esteem emerging as a significant positive predictor of food craving (β = 0.184; p = 0.011). In Model 3, the addition of internalised weight bias and weight-related self-stigma further increased the explained variance to 38.9% (R²=0.389; ΔR²=0.130; p < 0.001). In the final model, higher weight-related self-stigma (β = 0.260; p = 0.004), higher internalised weight bias (β = 0.222; p = 0.016), and lower self-esteem (β = 0.184; p = 0.011) were significant predictors of food craving, while age remained negatively associated (β=−0.154; p = 0.024). BMI category, marital status, and employment status were not significant predictors in the final model.

Table 4.

Hierarchical regression analysis of variables predicting FCQ-T scores

	Variables	Unstandardized B	SE	β	t	p	95% CI	VIF
Model 1	Overweight (ref.)	-	-	-	-	-	-	-
	Obese	9.141	6.092	0.099	1.500	0.135	-2.886-21.167	1.226
	Age	-0.655	0.288	-0.154	-2.277	0.024	-1.223- -0.087	1.281
	Marital Status	10.927	6.875	0.105	1.589	0.114	-2.644-24.498	1.212
	Employment Status	8.524	5.636	0.093	1.513	0.132	-2.600-19.649	1.067
Model 2	RSES Total	5.071	1.970	0.184	2.574	0.011	1.182–8.960	1.437
Model 3	WBIS-2F Total	0.778	0.323	0.222	2.437	0.016	0.150–1.426	2.328
	WSSQ Total	1.367	0.472	0.260	2.894	0.004	0.435-2.300	2.264
Model 1		R²=0.094 (Adj.=0.073)
Model 2 vs. Model 1		R²=0.259, ΔR²=0.165, F = 38.396, p<0.001
Model 3 vs. Model 2		R²=0.389, ΔR²=0.130, F = 18.150, p<0.001
Model 3		Adj. R²=0.364

Assumption checks were met; multicollinearity was within acceptable limits (VIF < 3)

Model 1: BMI category, age, marital status, employment status;

Model 2: BMI category, age, marital status, employment status, RSES;

Model 3: BMI category, age, marital status, employment status, RSES, WBIS-2 F, WSSQ

WSSQ Weight Self-Stigma Questionnaire, WBIS-2F Two-Factor Weight Bias Internalization Scale, RSES Rosenberg Self-Esteem Scale, FCQ-T Food Craving Questionnaire–Trait

Discussion

This study aimed to examine the relationships among weight-related self-stigma, internalised weight bias, self-esteem, and food cravings among women with overweight and obesity and to determine the extent to which these psychosocial variables explain trait food cravings. The findings indicate that women with obesity had significantly higher scores for weight-related self-stigma, internalised weight bias, and food cravings compared to women with overweight.

Along with this, weight-related self-stigma, internalised weight bias, and low self-esteem emerged as the strongest determinants of food cravings. One of the most notable findings of the study was that food cravings were strongly related to weight-related self-stigma, internalised weight bias, and lower self-esteem, whereas having obesity or overweight alone was not a primary associated factor. These findings highlight the importance of psychosocial mechanisms, such as weight-related self-stigma, internalised weight bias, and self-esteem, in understanding food craving beyond weight status alone.

In the present study, women with obesity had significantly greater total scores on the weight-related-self-stigma, as well as greater weight-related self-devaluation and fear of enacted stigma, compared to women with overweight. This finding is consistent with research indicating that individuals with higher BMI are more likely to experience obesity-related stigma and discrimination [36, 37]. For example, one systematic review reported that perceived weight discrimination was more prevalent among individuals with obesity, particularly those with higher BMI values, and highlighted the relevance of its negative consequences [37]. Consistent with the literature, the findings of this study indicate that women with obesity had higher levels of both negative self-evaluation and concern about being stigmatised, when compared to their overweight counterparts.

In addition, the significantly greater overall internalised weight bias and greater weight-related stress and weight-related self-devaluation observed among women with obesity compared to women with overweight suggests that these women more strongly internalise the negative stereotypes prevalent in society. Consistent with this finding, the literature indicates that internalised weight bias is common across body weight categories, with approximately 52% of adults with obesity and about one in five adults in general population samples reporting high levels of weight bias internalisation [57]. In addition, evidence indicates that individuals with higher BMI more strongly internalise negative weight-related beliefs [7, 38]. A systematic review also highlighted that internalised weight bias is positively associated with higher BMI and female gender [39]. The high degree of internalised weight bias observed among women with obesity in the present study are consistent with previous literature.

No significant difference was found between the overweight and obesity groups in self-esteem levels. This finding suggests that self-esteem may not be directly related to obesity or that individuals with overweight may have similar self-esteem levels as those with obesity. The literature presents mixed results on this issue. For instance, some studies have reported that individuals with Class III obesity (BMI ≥ 40 kg/m²) exhibit lower levels of self-esteem compared to healthy controls, and that higher BMI is generally associated with lower self-esteem in adult populations [42, 43]. However, other studies have reported no difference in self-esteem between adults with overweight and obesity and found no significant association between BMI and self-esteem [44, 58]. The findings of the present study are consistent with past research, suggesting that the relationship between obesity and self-esteem may vary depending on age and other psychosocial factors [44].

When the correlations between the study variables were examined, a significant positive relationship was found between weight-related self-stigma and internalised weight bias. Although these constructs are closely related, they represent distinct psychosocial processes. Specifically, internalised weight bias reflects the extent to which individuals adopt and apply societal weight-based stereotypes and prejudices to themselves, whereas weight-related self-stigma reflects negative self-evaluations and emotional responses arising from perceived or experienced weight-related stigma. Consistent with this finding, previous studies have reported that individuals with higher BMI encounter stigmatising situations more frequently, which in turn increases the degree of internalisation of weight bias [59]. Similarly, another study reported a significant positive association between weight-related self-stigma and internalised weight bias [60]. These findings of past research suggest that the stigma experienced by individuals with obesity may negatively affect their body perception and lead to the internalisation of weight-related biases. Furthermore, significant positive correlations were found between both higher self-stigma and internalised weight bias scores and lower self-esteem. Similarly, previous studies have shown that as stigma and bias levels increase, self-esteem decreases [60–62]. In particular, internalised weight bias in women has been shown to heighten negative body image and reduce self-esteem [40]. These findings from both the present study and previous research suggest that negative perceptions of body weight and the internalisation of weight-related bias may be associated with lower self-esteem and poorer perceived self-worth.

The results showed that women with obesity had significantly higher levels of food craving compared to women with overweight. This finding suggests an association in which women with obesity report a stronger desire for food and greater difficulty in controlling their cravings. Similarly, the literature has reported a positive association between the frequency and intensity of food cravings and higher BMI [10]. In addition, psychological distress and negative weight-related experiences among individuals with obesity may contribute to emotional eating behaviours and increased food cravings [27]. This literature suggests that the greater trait food craving observed among women with obesity may be associated not only with biological mechanisms (e.g., leptin resistance, impaired satiety signalling) but also with psychosocial stress-related factors and weight-related experiences [63]. In the current study, a significant relationship was also found between higher weight-related self-stigma and higher food cravings. The literature likewise suggests that internalised weight bias is associated with a range of psychological and health-related outcomes, including eating-related outcomes [64]. Similarly, the positive association that we observed between internalised weight bias and food cravings is noteworthy. The literature has shown that internalised weight bias is associated with maladaptive eating behaviours such as overeating, emotional eating, and binge eating [28, 29]. It has also been reported that exposure to weight bias and the internalisation of such experiences may contribute to maladaptive eating behaviours and increased food cravings [27, 30]. These findings are consistent with the results of the present study. A significant relationship was found between higher food cravings and lower self-esteem. Previous studies have frequently reported that low self-esteem is associated with emotional eating, increased food cravings, and a tendency toward unhealthy food choices [31–33]. In line with these findings, the present study demonstrates low self-esteem corresponds with higher food craving, highlighting the significant role of psychological factors in eating behaviours. The findings obtained from the correlation analysis further reveal that weight-related self-stigma, internalised weight bias, low self-esteem, and increased food craving are closely interrelated, reinforcing the notion that obesity is likely perpetuated by psychosocial dynamics.

The results of the hierarchical regression analysis also support these relationships. Weight-related self-stigma, internalised weight bias, and low self-esteem were identified as significant predictors of food cravings. This finding is consistent with previous studies indicating that weight-related self-stigma and bias exert an indirect yet powerful influence on individuals’ eating behaviours. Tomiyama’s [25] Cyclic Obesity/Weight-Based Stigma Model highlights that weight-based stigma induces stress in individuals, which in turn promotes emotional eating and increases food cravings. Similarly, Kemeny et al. [26] demonstrated that feelings of shame and guilt arising from stigma may increase depression and anxiety, thereby predisposing individuals to unhealthy eating behaviours. The finding in the present study that higher levels of weight-related self-stigma and internalised weight bias are associated with increased food cravings is consistent with this model.

However, the regression analysis indicated that psychosocial variables were more strongly associated with higher food cravings, while BMI was not a significant predictor. It is noteworthy that weight-related self-stigma, internalised weight bias, and low self-esteem were significantly associated with higher food cravings, whereas BMI category was not a significant predictor of food cravings. This finding indicates that obesity is not merely associated with physical health problems but also associated with psychosocial factors such as weight-related stigma, weight bias and disturbances in self-perception. The literature similarly reports that exposure to weight-based stigma from external sources may induce stress, which is associated with emotional eating and more frequent food cravings [25], and that emotions such as shame and guilt may further contribute to unhealthy eating behaviours [26]. Consistent with these findings, the present study demonstrates that weight-related self-stigma and internalised bias were associated with greater trait food craving.

Limitations

This study has several limitations. Its cross-sectional design does not allow for causal inference among variables. Although data were collected through face-to-face administration, self-reported responses may have been subject to recall bias and social desirability bias. The inclusion of only women in the sample limits the generalisability of the findings. In addition, the inclusion of only women with overweight and obesity (BMI 25–45 kg/m²) limits the generalisability of the findings across the full BMI spectrum, as comparisons with women with normal BMI or with BMI values above 45 kg/m² were not possible. Despite these limitations, the study also has notable strengths. The inclusion of only women results in a sample homogeneous in terms of sex, which reduces variability related to sex differences and allows a more focused examination of the study variables. Examining weight-related self-stigma, internalised weight bias, food craving, and self-esteem simultaneously offers a contribution to the literature by considering these variables together. Moreover, the adequate sample size enhances the statistical reliability of the findings.

Conclusion

This study revealed that there are significant differences between women with overweight and obesity in relation to psychological processes. The higher levels of weight-related self-stigma, internalised weight bias, and food cravings observed among women with obesity indicate that obesity is related to not only biological factors but also with psychosocial mechanisms.

The finding that weight-related self-stigma, internalised weight bias, and low self-esteem are significant determinants of higher food cravings suggests that these psychological factors are associated with increased food cravings. In this study population, perhaps the more frequent and intense experience of weight-based stigma may be associated with a greater psychological burden of obesity (e.g., lower self-esteem, greater weight-related self-stigma and internalised bias) and increased difficulty in coping. Therefore, interventions targeting obesity would likely benefit from not solely focusing on weight reduction but should also prioritising holistic approaches that strengthen individuals’ self-esteem, mitigate the negative effects of weight-related stigma, and enhance psychological resilience. It is crucial for dietitians and other health professionals to develop personalised interventions that address not only physiological but also psychosocial needs. Furthermore, community-based anti-stigma programmes and awareness initiatives may play a complementary role to these individual-level interventions, perhaps contributing to more sustainable outcomes.

In future research, examining psychosocial variables such as weight-related self-stigma, internalised weight bias, self-esteem, and food cravings across different age groups, genders, and socioeconomic levels may enhance the generalizability of the findings. Additionally, future intervention-based studies may explore approaches aimed at reducing weight-related self-stigma and internalised weight bias and their potential effects on food cravings. Given our findings that weight-related self-stigma and lower self-esteem significantly explain food cravings, such approaches may help address the psychological factors associated with food cravings. Such research could contribute to the development of more holistic strategies that address not only physiological but also psychosocial processes related to obesity.

Abbreviations

BMI

Body mass index

WSS

Weight-related self-stigma

IWB

Internalised weight bias

WHO

World Health Organization

WSSQ

Weight Self-Stigma Questionnaire

WBIS-2F

Two-Factor Weight Bias Internalization Scale

RSES

Rosenberg Self-Esteem Scale

FCQ-T

Food Craving Questionnaire–Trait

IBM SPSS Statistics 28

IBM Statistical Package for the Social Sciences, version 28

Authors’ contributions

BY contributed to conceptualization, study design, data collection, statistical analysis, interpretation of findings, literature review, and manuscript writing. PG contributed to conceptualization, supervision, methodological guidance, and critical revision of the manuscript. KT contributed to conceptualization, supervision, methodological guidance, and critical revision of the manuscript. All authors read and approved the final manuscript.

Funding

The authors received no financial support for this research.

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was approved by the Ankara Medipol University Non-Interventional Clinical Research Ethics Committee on May 6, 2024 (Approval No: 52). All procedures were carried out in accordance with the ethical standards of the institutional research committee and the Declaration of Helsinki. Written informed consent was obtained from all participants prior to data collection.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.