1 Department of Health Sciences, Brock University, St. Catharines, ON, Canada.
2 Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
3 Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.
4 Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada.
5 School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.

Background: Internalized weight bias (IWB) has been identified as a correlate of higher depressive and anxiety symptoms in adolescents with higher weights. However, there has been limited investigation into how IWB relates to positive mental health and whether these associations differ across genders.

Objectives: To examine the associations between IWB and mental health (depression, anxiety, flourishing) in adolescents with higher weights, and to test the potential moderating role of gender.

Methods: Canadian adolescents with higher weights (N = 7538, 60% boys, 36% girls, 4% gender diverse, ages 12-19) from the COMPASS study completed a survey during the 2021-2022 school year. Data were analysed using generalized linear models.

Results: Highest IWB and poorest mental health were noted within gender diverse adolescents, followed by girls then boys. Gender moderated the relationship between higher IWB and higher depression, higher anxiety and lower flourishing, with the strongest relationships noted among girls.

Conclusion: IWB interventions should be tailored to gender subgroups that may be particularly vulnerable to maladaptive mental health outcomes associated with IWB. System-level changes that mitigate perpetuation of weight bias and discrimination which lead to IWB are also essential, particularly for girls.