“I’m only numbers on paper” – A qualitative evaluation of the Internalized Weight Bias Scale in a Swedish sample

Abstract: Weight-based stigma includes negative stereotypes and negative attitudes directed toward people with obesity or overweight. When internalized, a process also referred to as self-stigmatization, it can have detrimental effects on health. There is currently no instrument to measure internalized weight bias in a Swedish context. Developing such an instrument could be a vital step in improving obesity treatment. The purpose of this study was to perform a qualitative evaluation of the Swedish version of the Internalized Weight Bias Scale as well as to explore its utility. Twelve participants, who have or have had obesity or overweight, were interviewed about their experience of filling out the questionnaire. After transcribing interview recordings, a thematic analysis was conducted, and themes were identified. The findings show that overall, the questionnaire was received positively and perceived as relevant by the participants, with some minor changes. This indicates that self- stigma as conceptualized in the questionnaire is applicable in a Swedish context. A prominent theme was previous negative health care experiences where participants expressed a fear that if the questionnaire were to be used carelessly it could be experienced as part of weight stigma. However, when used mindfully, it was believed to have the potential to provide insight on the experience of self-stigma as well as improve treatment for people with obesity. Based on the findings, suggestions on changes of the questionnaire and recommendations for utility are proposed.