Validity Evidence Based on Internal Structure and Related Constructs of the Brazilian Version of the Weight Self-Stigma Questionnaire (WSSQ-BR)

Validity Evidence Based on Internal Structure and Related Constructs of the Brazilian Version of the Weight Self-Stigma Questionnaire (WSSQ-BR) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Validity Evidence Based on Internal Structure and Related Constructs of the Brazilian Version of the Weight Self-Stigma Questionnaire (WSSQ-BR) Luciana Pacheco Miranda Rochael, Sônia Maria Mello Neves, Daniela Sacramento Zanini, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9204777/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Obesity is a complex biopsychosocial condition that involves biological, behavioral, and sociocultural determinants, and growing evidence highlights the role of weight-related stigma in shaping emotional distress, health behaviors, and clinical outcomes. This study investigated the validity evidence of the Brazilian version of the Weight Self-Stigma Questionnaire (WSSQ), examining its internal structure and its associations with self-esteem, psychological distress, and body image. Methods A sample of 262 adults residing in the Central-West Brazil, aged between 18 and 72 years (M = 33.0; SD = 13.4), was predominantly female (72.9%). Among the participants, 58% self-identified as White, 52.5% were classified as overweight, and 47.5% as obese. Participants completed the WSSQ, BSQ, K10, RSES, and a sociodemographic questionnaire. Results Confirmatory factor analyses supported the two-factor model originally proposed, demonstrating superior fit, theoretical coherence, and satisfactory reliability indices. The bifactor model also presented adequate fit but showed weaker item representativeness. Convergent validity analyses revealed moderate to strong negative correlations with self-esteem and moderate to strong positive correlations with distress, anxiety, depression, and body dissatisfaction, replicating international findings and reinforcing the relevance of internalized self-stigma for psychological functioning. Conclusions The results provide robust evidence of validity and reliability for the Brazilian WSSQ and support its use in clinical and research contexts. The instrument may contribute to culturally sensitive assessments and to interventions that address the emotional and social dimensions of obesity, a phenomenon still understudied in the Brazilian context. weight self-stigma validity evidence WSSQ obesity psychological distress body image self-esteem Introduction Obesity is a multifactorial condition, determined by biological, environmental, behavioral, and sociocultural factors, and associated with a wide range of clinical outcomes and functional limitations. Reports from the World Health Organization (WHO, 2022) indicate that the global rise in obesity is related to metabolic and cardiovascular diseases, as well as functional limitations such as reduced mobility, lower cardiorespiratory capacity, limitations in activities of daily living, and reduced social participation. In 2022, an estimated 43% of the world’s adult population were overweight and 16% were obese, with a continuous increase since 1990 (WHO, 2022). In Brazil, data from a recently launched national obesity panel, based on integrated information from official national health data sources, indicate patterns consistent with previous epidemiological findings, including higher prevalence among women and individuals in socioeconomically disadvantaged conditions (Ministério da Saúde, 2024 ). Scientific evidence has also demonstrated that obesity frequently co-occurs with depressive and anxiety disorders, forming, alongside these conditions, one of the most prevalent and disabling clusters of global disease burden (Global Burden of Disease Collaborative Network [GBD], 2020; Milaneschi et al., 2019 ; Wang et al., 2019 ). Consistent findings reveal bidirectional associations between obesity and depression, with longitudinal studies and meta-analyses showing that inflammatory processes, social stressors, adverse environments, and experiences of stigma contribute to this interrelation (Luppino et al., 2010 ; Milaneschi et al., 2019 ; Tomiyama et al., 2018 ). This scenario underscores the importance of developing care approaches that simultaneously address the physical, emotional, and social dimensions of illness. Current studies indicate that Body Mass Index (BMI), although widely used, is insufficient as a standalone diagnostic criterion ( Associação Brasileira para o Estudo da Obesidade e da Síndrome Metabólica [Brazilian Association for the Study of Obesity and Metabolic Syndrome, ABESO], 2022; Kyle et al., 2016 ; WHO, 2022). International and national guidelines have emphasized that obesity is a complex condition that involves more than the weight-to-height ratio and requires an integrated assessment of metabolic parameters, clinical history, eating patterns, mental health conditions, social context, and experiences of stigmatization (ABESO, 2022; Kyle et al., 2016 ; WHO, 2022). Evidence also shows that weight-related stigma acts as a relevant social determinant, shaping emotional responses, health behaviors, and clinical outcomes across the lifespan (Puhl & Suh, 2015 ; Tomiyama et al., 2018 ). In the Brazilian context, despite the recognition of obesity as a public health issue, the care provided remains limited in scope. The literature indicates a predominance of interventions centered on bariatric surgery and traditional dietary prescriptions, with low implementation of guidelines recommending interdisciplinary care and psychosocial management of the condition (ABESO, 2022; Ministério da Saúde, 2022 ). This psychosocial management encompasses clinical and educational practices that consider emotional, behavioral, and social determinants, including variables that influence engagement and maintenance of health behaviors, such as coping repertoires, avoidance patterns, self-care contingencies, social support, and stigma-related contexts (National Institute for Health and Care Excellence [NICE], 2025; Puhl & Heuer, 2009 ; Tomiyama et al., 2018 ; WHO, 2022). Although such approaches are well established in international guidelines, their implementation in Brazil remains limited (Grilo, 2024 ; Wadden & Bray, 2018 ). Recent national policies have begun to emphasize the need for intersectoral and socially informed approaches to obesity, recognizing its complex and socially determined nature, including the role of stigma and structural inequalities ( Ministério do Desenvolvimento e Assistência Social , 2026). Within this broader framework, weight-related stigma emerges as a key phenomenon for understanding how social and institutional practices shape illness trajectories and inform the development of public policies sensitive to inequalities. The concept of stigma, originally described by Erving Goffman ( 1963 ), refers to social processes that mark certain bodies as deviant and generate material and symbolic disadvantages. Applied to body weight, stigma manifests when cultural norms associate thinness with discipline, success, and personal worth, while attributing characteristics such as laziness, lack of self-control, or moral failure to higher body weight (Brewis et al., 2018 ; Puhl & Heuer, 2009 ; Tomiyama et al., 2018 ). These social contingencies do not operate solely from the outside in. They may be transformed into self-directed behavioral patterns when stigmatizing messages in the environment become verbal rules that guide negative self-evaluations, accompanied by shame, self-censorship, avoidance of social situations, emotional suppression, and behavioral withdrawal (Durso & Latner, 2008 ; Lillis et al., 2010 ; Puhl & Heuer, 2009 ). In the literature, this phenomenon is referred to as self-stigma or internalized weight bias and describes the process by which individuals treat themselves according to the negative stereotypes embedded in cultural norms. This process affects everyday functioning by restricting behavioral repertoires, decreasing the likelihood of engagement in valued activities, impairing relationships, and influencing self-esteem, understood as the set of evaluative self-concepts that guide public and private responses (Meadows & Higgs, 2019 ; Pearl & Puhl, 2018 ). Empirical evidence indicates that internalized weight bias is associated with negative self-evaluation processes and poorer health outcomes (Hilbert et al., 2014 ). Consistent with this pattern, weight self-stigma has also been consistently associated with relevant indicators of psychological distress. The systematic review conducted by Pearl and Puhl ( 2018 ), encompassing 74 studies, identified significant and moderate correlations between self-stigma and depressive symptoms (r = .47, p < .001), anxiety (r = .39, p < .001), body dissatisfaction (r = .54, p < .001), disordered eating behaviors (r = .38, p < .001), poorer quality of life (r = –.44, p < .001), and lower self-efficacy for health behaviors (r = .32, p < .001). Collectively, these findings indicate that self-stigma functions as a psychological variable linked to increased experiential avoidance—a pattern characterized by attempts to avoid or control aversive internal events—and to reduced likelihood of engaging in self-care behaviors, contributing to cycles of avoidance and heightened distress (Donahue et al., 2023 ; Hayes et al., 1996 ; Hayes et al., 2012 ; Levin et al., 2012 ). Several measures have been developed to assess components related to stigma and weight self-stigma. The systematic review by Lacroix et al. ( 2017 ) identified more than ten instruments evaluating explicit attitudes, implicit attitudes, prejudice, shame, discriminatory behaviors, and self-stigma. Among these instruments, few present robust psychometric properties specifically for assessing self-stigma. The most established measures are the Weight Bias Internalization Scale (WBIS; Durso & Latner, 2008 ) and the Weight Self-Stigma Questionnaire (WSSQ; Lillis et al., 2010 ). Whereas the WBIS assesses the general internalization of negative weight-related beliefs, the WSSQ was developed to capture the multifaceted nature of weight self-stigma, comprising the factors self-devaluation and fear of enacted stigma . This distinction enables the assessment of both self-referential devaluation and perceived vulnerability to stigmatization, an aspect relevant for clinical interventions and studies on social processes of prejudice. Since its development, the WSSQ has been translated and adapted across various cultural contexts. The review by Lacroix et al. ( 2017 ) identified at least 15 cross-cultural adaptation and validation studies up to that point, with the number increasing substantially in subsequent years. Countries with consistent psychometric evidence include Portugal, Germany, Italy, Spain, China, Japan, Turkey, and Malaysia, with replicated two-factor structures, factor loadings typically above .50, alpha coefficients ranging from .80 to .92, and correlations aligned with variables such as self-esteem, psychological distress, body image, and disordered eating (Hain et al., 2015 ; Lin & Lee, 2017 ; Sevincer et al., 2017 ). The selection of these countries in this introduction reflects methodological proximity and the similarity of external variables examined, which directly parallel the analyses conducted in the present study. In Brazil, Rodrigues et al. ( 2024 ) conducted the first translation and cultural adaptation of the WSSQ into Brazilian Portuguese, following established guidelines in the cross-cultural adaptation literature, such as those proposed by Beaton et al. ( 2000 ) and Borsa et al. ( 2012 ). The study presented initial evidence of semantic equivalence and satisfactory internal consistency for the total scale (α = .83). Exploratory analyses identified two factors, but three items originally belonging to the self-devaluation factor showed cross-loadings—an expected finding given the small sample size, reinforcing the need for analyses with greater statistical power. As a preliminary step, the study did not assess confirmatory factor structure, validity based on relations with external variables, or factor-specific precision, all of which are essential for psychometric consolidation. The authors also underscored the need for larger samples in subsequent phases, highlighting the relevance of additional validation studies in the Brazilian context. Given that weight self-stigma remains scarcely assessed in Brazil, despite its relevance for public health, there is a need for instruments capable of measuring this process with precision. Recent evidence indicates that everyday experiences of stigma and stigmatizing practices by healthcare professionals are associated with reduced help-seeking and poorer clinical outcomes (Puhl et al., 2021 ). Research in the field shows that devaluing social messages may be internalized and expressed through negative self-descriptions, avoidance patterns, and other responses consistent with self-stigma. The availability of validated measures contributes to clinical interventions sensitive to self-stigma and may support public policies aimed at reducing bias and improving the quality of healthcare. The study aimed to examine the validity evidence of the Brazilian version of the Weight Self-Stigma Questionnaire (WSSQ). The internal structure of the measure and its associations with self-esteem, psychological distress, and body image were examined, in alignment with evidence reported in previously published adaptations. Method Participants A total of 262 individuals participated in this study, aged between 18 and 72 years (M = 33.0, SD = 13.4), all residing in the Central-West region of Brazil. The sample was composed of cisgender women (72.9%) and cisgender men (27.1%). Regarding race/color, 58% identified as White, 29.4% as Brown, 8.8% as Black, and 3.8% as Yellow. With respect to Body Mass Index (BMI), 52.5% presented overweight, 29.3% obesity class I, 12% obesity class II, and 6.2% obesity class III. Concerning educational level, 1.9% had incomplete elementary school, 1.5% completed elementary school, 1.5% incomplete high school, 13.7% completed high school, 43.5% incomplete higher education, 13.4% completed higher education, and 24.4% postgraduate education. Instruments To meet the objectives of this study, the following instruments were administered: Weight Self-Stigma Questionnaire (WSSQ; Lillis et al., 2010 ). Used as a measure of weight self-stigma among individuals with overweight and obesity, the WSSQ comprises 12 items forming two correlated subscales: self-devaluation (items 7–12) and fear of enacted stigma (items 1–6). Items are rated on a 5-point Likert scale ranging from 1 ( strongly disagree ) to 5 ( strongly agree ), with total scores ranging from 12 to 60; higher scores reflect greater internalized weight stigma. The original version of the WSSQ presents good internal consistency, as does the Brazilian adaptation (α = .79; Rodrigues et al., 2024 ). Body Shape Questionnaire (BSQ; Cooper et al., 1987 ). Translated and adapted to Brazilian Portuguese by Di Pietro and Silveira ( 2009 ), the BSQ assesses body image dissatisfaction. It comprises 34 items rated on a 6-point Likert scale from never to always , yielding total scores ranging from 34 to 204. Classification categories include: no body image distortion (≤ 110), mild (111–138), moderate (139–167), and severe distortion (> 167). The Brazilian version demonstrated excellent internal consistency (α = .97). Kessler Psychological Distress Scale (K10; Kessler et al., 2002 ). Adapted to Portuguese by Peixoto et al. ( 2021 ) for use with individuals aged 14 years or older, the K10 includes 10 self-report items that assess emotional distress over the past 30 days, rated on a 5-point Likert scale (1 = never to 5 = always ). Total scores indicate overall psychological distress; higher scores denote higher distress levels. Based on its factorial structure, separate indices of anxiety (items 2, 3, 5, and 6) and depression (items 1, 4, 7, 8, 9, and 10) may also be computed. The original study reported adequate reliability (α = .87). Rosenberg Self-Esteem Scale (RSES; Rosenberg, 1965 ). Adapted for Brazil by Hutz ( 2000 ) and validated by Hutz and Zanon ( 2011 ), the scale includes ten items, six assessing positive self-evaluation and four assessing negative self-evaluation. Items are rated on a 3-point Likert scale ( disagree , neither agree nor disagree , agree ). Higher scores indicate higher self-esteem. Internal consistency coefficients in Brazilian studies range from .68 (Avanci et al., 2007 ) to .86 (Hutz, 2000 ; Santos & Maia, 2003 ). Procedure The study was conducted in accordance with the ethical guidelines of the Brazilian National Health Council (Resolution No. 510/2016) for research involving human subjects and was approved under protocol No. 5.729.640. Participants were recruited through physical media (flyers) and digital platforms (WhatsApp, Instagram, X [formerly Twitter]), as well as through active search at a higher education institution where data collection took place in a reserved room. Initially, voluntary participation was confirmed through the signing of the Free and Informed Consent Form (FICF), which ensured anonymity, the possibility of withdrawing at any stage of the study without penalty, and availability of researcher contact for additional information or in case of complications arising from participation. Subsequently, participants had their weight and height measured using an anthropometric scale and completed the questionnaires either in paper-and-pencil format or online via Google Forms. All responses were collected between May 2022 and June 2024. Data Analysis To examine the factorial structure of the WSSQ, a Confirmatory Factor Analysis (CFA) was conducted. Three models were compared: a one-factor model, a two-factor model, and a bifactor model. For the hierarchical model, parameter estimation was not feasible, preventing identification. Analyses were performed in Mplus using the Weighted Least Squares Mean and Variance adjusted estimator (WLSMV). Interpretation was based on the following fit indices: χ², degrees of freedom (df), RMSEA (Root Mean Square Error of Approximation), CFI (Comparative Fit Index), and TLI (Tucker–Lewis Index). The reference values adopted were CFI and TLI ≥ .90, RMSEA ≤ .08, and χ²/df ≤ 5 (Muthén & Muthén, 2017 ; Tabachnick & Fidell, 2019 ). The adequacy of the bifactor model was assessed through global fit indices and item factor loadings, and auxiliary indices were calculated to evaluate the degree of unidimensionality, including the Percentage of Uncontaminated Correlations (PUC) and the Explained Common Variance (ECV) of the general factor (Reise et al., 2013 ; Rodriguez et al., 2016 ). Internal consistency was estimated using McDonald’s omega and Cronbach’s alpha (both computed in Jamovi, Version 2.3; The Jamovi Project, 2022 ), as well as composite reliability calculated using the Composite Reliability Calculator (Colwell, 2016 ). Values ≥ .70 were interpreted as adequate indicators of reliability (Tabachnick & Fidell, 2019 ). Validity evidence based on relations with external variables was examined using Spearman correlations. Coefficients were interpreted according to Cohen ( 1988 ): values between − 0.09 and 0.09 were considered negligible; between 0.10 and 0.29, small; between 0.30 and 0.49, moderate; and between 0.50 and 1.00, strong. These analyses were also conducted in Jamovi. Results Table 1 presents the fit indices for the models examined. The one-factor model did not yield adequate fit indices. Although the bifactor model showed superior global fit, its item loadings were unsatisfactory, indicating low representativeness of items in their respective factors. This compromises the interpretability and practical utility of the model, as factor meaning becomes unstable. Additionally, the combination of weak factor loadings, a low PUC (0.545), and an ECV for the general factor below recommended thresholds (0.586) suggests that, despite acceptable global fit, the bifactor model lacks sufficient psychometric support for robust interpretation (Reise et al., 2013 ; Rodriguez et al., 2016 ). In contrast, the two-factor model demonstrated adequate fit indices and substantial factor loadings. Accordingly, the two-factor model appears more appropriate for representing the latent structure of the construct assessed. Table 1 Fit indices for the three models compared. Modelo χ 2 df χ 2 /df CFI TLI RMSEA (IC − 90%) Unidimensional 443.225 54 8.207 0.845 0.811 0.166 (0.152–0.180) Two-factor 206.016 53 3.887 0.939 0.924 0.105 (0.090–0.120) Bifactor 107.399 42 2.557 0.974 0.959 0.077 (0.059–0.095) Table 2 presents the item loadings on the two factors of the instrument (Self and Fear). Items 1 through 6 loaded on the Self factor, with loadings ranging from 0.465 to 0.878, whereas items 7 through 12 loaded on the Fear factor, with loadings between 0.705 and 0.826. All items showed moderate to high factor loadings, indicating adequate representativeness within their respective factors. Regarding internal consistency indices, both factors showed good reliability indicators. The Self factor presented coefficients ranging from 0.78 to 0.84, and the Fear factor presented coefficients between 0.83 and 0.89. Table 2 Factor loadings and reliability indicators. Items Self Fear 1. I will always gain weight again. 0.544 2. I caused my own weight problems. 0.465 3. I feel guilty about my weight problems. 0.739 4. I became overweight because I am a weak person. 0.878 5. I would never have weight problems if I were a stronger person. 0.793 6. I do not have enough self-control to maintain a healthy weight. 0.677 7. I feel insecure about how others view me. 0.755 8. People discriminate against me because of my weight problems. 0.705 9. It is difficult for people who have never had weight problems to understand me. 0.761 10. Others will think I lack self-control because of my weight problems. 0.826 11. People think I am to blame for my weight problems. 0.804 12. People feel ashamed to be around me because of my weight. 0.722 Cronbach’s α 0.78 0.83 McDonald’s ω 0.78 0.83 Composite reliability 0.84 0.89 Table 3 presents the correlations between the Self and Fear factors and the variables self-esteem, distress, anxiety, depression, and body image. A strong positive correlation was observed between the Self and Fear factors. Regarding self-esteem, negative correlations of moderate magnitude (Self) and strong magnitude (Fear) were identified, indicating that higher levels of self-esteem are associated with lower scores on both factors. Psychological distress variables exhibited positive correlations of moderate to strong magnitude with the Self and Fear factors. Distress showed a moderate correlation with Self and a strong correlation with Fear. Anxiety showed moderate correlations with both factors, whereas depression showed strong positive correlations with Self and Fear. Finally, the BSQ demonstrated strong positive correlations with both factors, suggesting that body image dissatisfaction is consistently related to the two dimensions. These findings indicate that the Self and Fear factors are associated with lower levels of self-esteem and higher levels of psychological distress. Table 3 Correlations between self-stigma (Self and Fear), self-esteem, psychological distress, and body image. Fear Self Fear SE DIS ANX DEP 0.52* SE -0.49* -0.55* DIS 0.40* 0.54* -0.63* ANX 0.33* 0.42* -0.41* 0.85* DEP 0.40* 0.54* -0.68* 0.95* 0.66* BSQ 0.58* 0.67* -0.58* 0.52* 0.43* 0.52* Note: SE = Self-esteem; DIS = Distress; ANX = Anxiety; DEP = Depression; BSQ = Body Image. Discussion The aim of this study was to investigate the validity evidence of the Brazilian version of the Weight Self-Stigma Questionnaire (WSSQ), examining its internal structure and its associations with self-esteem, psychological distress, and body image. The results provide consistent support for the psychometric adequacy of the instrument in the Brazilian context and reinforce the relevance of weight-related self-stigma as a central variable in understanding illness processes, as widely discussed in the international literature. The confirmatory factor analysis demonstrated that the two-factor model presented a better fit and greater theoretical coherence, replicating the structure originally proposed by Lillis et al. ( 2010 ) and observed in international adaptations conducted in countries such as Germany, Italy, Spain, Portugal, China, Turkey, and Malaysia (Hain et al., 2015 ; Lin & Lee, 2017 ; Sevincer et al., 2017 ). The bifactor structure, comprising the self-devaluation and fear of stigma factors, also showed adequate performance in the present sample, reinforcing the robustness of the construct and indicating cross-cultural stability. Internal consistency indices for both factors were satisfactory, consistent with those reported in international studies and higher than the preliminary parameters identified in the initial Brazilian adaptation (Rodrigues et al., 2024 ), possibly due to the increased sample size and greater heterogeneity of the participants. Validity evidence based on relations with external variables was also strong. The negative correlations between WSSQ scores and self-esteem, ranging from moderate to strong magnitude, align with the understanding that internalized stigma affects how individuals evaluate their own worth, shaping self-referential processes that may reduce engagement in health-related behaviors, as described by Durso and Latner ( 2008 ), Puhl and Heuer ( 2009 ), and Tomiyama et al. ( 2018 ). Complementarily, the positive correlations of moderate to strong magnitude with indicators of psychological distress, including distress, anxiety, and depression, replicate the pattern reported in the systematic review by Pearl and Puhl ( 2018 ) and reinforce the relationship between self-stigma and heightened negative emotional responses, often shaped by experiences of stigma and discrimination. These findings are consistent with models that integrate experiential avoidance and psychological suffering (Hayes et al., 1996 ; Levin et al., 2012 ), demonstrating the role of internalized devaluation in maintaining behavioral withdrawal and intensified self-criticism. Another relevant set of findings concerns the strong correlations between the WSSQ factors and body image dissatisfaction as measured by the BSQ. This association aligns with studies documenting the impact of stigma and self-stigma on body image, particularly among women, who have been historically subject to stricter sociocultural norms regarding body appearance and increased exposure to stigmatizing practices (Brewis et al., 2018 ; Puhl & Suh, 2015 ). Given that the present sample was predominantly composed of women, such aesthetic pressures may have contributed to the strength of the associations observed, especially for the fear of stigma factor, which involves perceived social evaluations. From a clinical and public health perspective, the findings underscore the need to incorporate the assessment of self-stigma in services for individuals with overweight and obesity. The literature documents that stigmatizing practices in health settings can reduce care seeking and compromise clinical outcomes, a phenomenon reported internationally (Puhl & Heuer, 2009 ; Puhl et al., 2021 ; Tomiyama et al., 2018 ). Accordingly, instruments such as the WSSQ can promote more integrated practices that are sensitive to the emotional and social dimensions of illness and aligned with contemporary behavioral approaches that emphasize psychological flexibility (Levin et al., 2024 ) and with international guidelines recommending interdisciplinary approaches and psychosocial management rather than weight-centered strategies (ABESO, 2022; Grilo, 2024 ; NICE, 2025; Wadden & Bray, 2018 ; WHO, 2022). This study also advances the evidence base beyond the preliminary findings from the first Brazilian adaptation of the WSSQ (Rodrigues et al., 2024 ), by presenting confirmatory analyses, a larger and more heterogeneous sample, more stable reliability estimates, and broader convergent validity evidence. In doing so, it contributes to the consolidation of a culturally appropriate measure for the Brazilian context and provides a valuable tool for the development of clinical, educational, and research strategies that conceptualize obesity through a less reductionist and more psychosocial lens. Despite these contributions, some limitations should be acknowledged. The sample was concentrated in the Central-West region and predominantly female, highlighting the need for future studies with broader regional, social, and gender diversity, as well as factorial invariance analyses to examine potential group differences in self-stigma experiences. Additionally, the cross-sectional design limits causal inference regarding the relationships between self-stigma and psychological distress; longitudinal designs and predictive modeling are recommended for future research. In summary, the findings demonstrate that the Brazilian version of the WSSQ shows consistent validity and reliability evidence, supporting its use in clinical and research settings. Considering the relevance of self-stigma for understanding obesity and its psychosocial determinants, the instrument represents an important step toward improving care practices and generating knowledge about a phenomenon that remains understudied in Brazil. Declarations Author Contribution LPMR contributed to participant recruitment and selection, data collection, data preparation and tabulation, and drafted the introduction and references. She also critically revised the manuscript.SMMN supervised the study and critically revised the manuscript.DSZ contributed to the selection of instruments, provided guidance during data collection and manuscript development, contributed to the discussion, and critically revised the manuscript.IAF contributed to data preparation and tabulation, conducted the data analyses, and contributed to the writing of the results and discussion.CCBM contributed to data collection and data tabulation.EFC contributed to participant recruitment and data collection for part of the sample, assisted in manuscript writing, translated the manuscript into English, prepared the abstract, and formatted the manuscript for submission. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Associação Brasileira para o Estudo da Obesidade e da Síndrome Metabólica (ABESO) (2022). 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Psychological Medicine , 32 (6), 959–976. https://doi.org/10.1017/s0033291702006074 Kyle, T. K., Dhurandhar, E. J., & Allison, D. B. (2016). Regarding obesity as a disease: Evolving policies and their implications. Journal Of The American Medical Association , 315 (17), 1813–1814. https://doi.org/10.1001/jama.2016.1550 Lacroix, E., Alberga, A., Russell-Mathew, S., McLaren, L., & von Ranson, K. (2017). Weight bias: A systematic review of characteristics and psychometric properties of self-report questionnaires. Obesity Facts , 10 (3), 223–237. https://doi.org/10.1159/000475716 Levin, M. E., Hildebrandt, M. J., Lillis, J., & Hayes, S. C. (2012). The impact of treatment components suggested by the psychological flexibility model: A meta-analysis of laboratory-based component studies. Behavior Therapy , 43 (4), 741–756. https://doi.org/10.1016/j.beth.2012.05.003 Levin, M. E., Krafft, J., & Twohig, M. P. (2024). An overview of research on acceptance and commitment therapy. Psychiatric Clinics of North America , 47 (1), 1–16. https://doi.org/10.1016/j.psc.2023.11.001 Lillis, J., Luoma, J. B., Levin, M. E., & Hayes, S. C. (2010). Measuring Weight Self-stigma: The Weight Self-Stigma Questionnaire. Obesity (Silver Spring, Md.) , 18 , 971–976. https://doi.org/10.1038/oby.2009.353 Lin, K. P., & Lee, M. L. (2017). Validating a Chinese version of the Weight Self-stigma Questionnaire for use with obese adults. International Journal of Nursing Practice , 23 (4), e12537. https://doi.org/10.1111/ijn.12537 Luppino, F. S., de Wit, L. M., Bouvy, P. F., Stijnen, P., Cuijpers, P., Penninx, B. W., & Zitman, F. G. (2010). Overweight, obesity, and depression: A systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry , 67 (3), 220–229. https://doi.org/10.1001/archgenpsychiatry.2010.2 Meadows, A., & Higgs, S. (2019). The multifaceted nature of weight-related self-stigma: validation of the two-factor weight bias internalization scale (WBIS-2F). Frontiers in Psychology , 10 , 808. https://doi.org/10.3389/fpsyg.2019.00808 Milaneschi, Y., Simmons, W. K., van Rossum, E. F., & Penninx, B. W. (2019). Depression and obesity: evidence of shared biological mechanisms. Molecular Psychiatry , 24 (1), 18–33. https://doi.org/10.1038/s41380-018-0017-5 Ministério da Saúde (2022). Manual de atenção às pessoas com sobrepeso e obesidade no âmbito da Atenção Primária à Saúde (APS) do Sistema Único de Saúde. https://bvsms.saude.gov.br/bvs/publicacoes/manual_atencao_pessoas_sobrepeso_obesidade.pdf Ministério da Saúde (2024). Saúde lança painel sobre obesidade com dados detalhados e interativos. https://www.gov.br/saude/pt-br/assuntos/noticias/2024/dezembro/saude-lanca-painel-sobre-obesidade-com-dados-detalhados-e-interativos Ministério do Desenvolvimento e Assistência Social, Família e Combate à Fome (2026). Resolução CAISAN/MDS nº 22, de 27 de fevereiro de 2026. https://www.in.gov.br/web/dou/-/resolucao-caisan/mds-n-22-de-27-de-fevereiro-de-2026-689585848 Muthén, L. K., & Muthén, B. O. (2017). Mplus user’s guide (8th ed.). Muthén & Muthén. National Institute for Health and Care Excellence (NICE) (2025). Overweight and obesity management (NICE Guideline NG246). https://www.nice.org.uk/guidance/ng246 Pearl, R. L., & Puhl, R. M. (2018). Weight bias internalization and health: a systematic review. Obesity Reviews , 19 (8), 1141–1163. https://doi.org/10.1111/obr.12701 Peixoto, E. M., Zanini, D. S., & de Andrade, J. M. (2021). Cross-cultural adaptation and psychometric properties of the Kessler Distress Scale (K10): an application of the rating scale model. Psicologia: Reflexão e Crítica , 34 , 21. https://doi.org/10.1186/s41155-021-00186-9 Di Pietro, M., & Silveira, D. X. D. (2009). Internal validity, dimensionality and performance of the Body Shape Questionnaire in a group of Brazilian college students. Brazilian Journal of Psychiatry , 31 , 21–24. https://doi.org/10.1590/S1516-44462008005000017 Puhl, R. M., & Heuer, C. A. (2009). The stigma of obesity: A review and analysis of diverse perspectives. The Milbank Quarterly , 87 (4), 893–941. https://doi.org/10.1038/oby.2008.636 Puhl, R. M., & Suh, Y. (2015). Health consequences of weight stigma: Implications for obesity prevention and treatment. Current Obesity Reports , 4 (4), 182–190. https://doi.org/10.1007/s13679-015-0153-z Puhl, R. M., Lessard, L. M., Himmelstein, M. S., & Foster, G. D. (2021). The roles of experienced and internalized weight stigma in healthcare experiences: perspectives of adults engaged in weight management across six countries. PloS One , 16 (6), e0251566. https://doi.org/10.1371/journal.pone.0251566 Reise, S. P., Scheines, R., Widaman, K. F., & Haviland, M. G. (2013). Multidimensionality and structural coefficient bias in structural equation modeling a bifactor perspective. Educational and Psychological Measurement , 73 (1), 5–26. https://doi.org/10.1177/0013164412449831 Rodriguez, A., Reise, S. P., & Haviland, M. G. (2016). Applying bifactor statistical indices in the evaluation of psychological measures. Journal of Personality Assessment , 98 (3), 223–237. https://doi.org/10.1080/00223891.2015.1089249 Rodrigues, A. C. M., Barbosa, E. S., Neves, S. M. M., & Rochael, L. P. M. (2024). Adaptação e evidências de validade iniciais do Weight Self-Stigma Questionnaire. Revista Fragmentos de Cultura-Revista Interdisciplinar de Ciências Humanas , 34 (5), 698–719. https://doi.org/10.18224/frag.v34i5.14720 Rosenberg, M. (1965). Society and the adolescent self-image . Princeton University Press. Santos, P. J., & Maia, J. (2003). Análise factorial confirmatória e validação preliminar de uma versão portuguesa da Escala de Auto-Estima de Rosenberg. Psicologia: Teoria Investigação e Prática , 2 , 253–268. Sevincer, G. M., Kaya, A., Bozkurt, S., Akin, E., & Kose, S. (2017). Reliability, validity, and factorial structure of the Turkish version of the Weight Self-Stigma Questionnaire (Turkish WSSQ). Psychiatry and Clinical Psychopharmacology , 27 (4), 386–392. https://doi.org/10.1080/24750573.2017.1379717 Tabachnick, B. G., & Fidell, L. S. (2019). Using multivariate statistics (7th ed.). Pearson. The Jamovi Project (2022). jamovi (Version 2.3) [Computer software]. https://www.jamovi.org Tomiyama, A. J., Carr, D., Granberg, E. M., Major, B., Robinson, E., Sutin, A. R., & Brewis, A. (2018). How and why weight stigma drives the obesity ‘epidemic’and harms health. BMC Medicine , 16 (1), 123. https://doi.org/10.1186/s12916-018-1116-5 Wadden, T. A., & Bray, G. A. (2018). Handbook of obesity treatment (2nd ed.).). Guilford Press. Wang, S., Sun, Q., Zhai, L., Bai, Y., Wei, W., & Jia, L. (2019). The prevalence of depression and anxiety symptoms among overweight/obese and non-overweight/non-obese children/adolescents in China: a systematic review and meta-analysis. International Journal of Environmental Research and Public Health , 16 (3), 340. https://doi.org/10.3390/ijerph16030340 World Health Organization (2022). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9204777","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":625663227,"identity":"5c809cb4-536b-4e53-8690-f6f7a25d0df7","order_by":0,"name":"Luciana Pacheco Miranda Rochael","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCElEQVRIiWNgGAWjYBACPiA+AGHyQCh+EJFQgFsLG4YWyQaQFgP8WhhQtBiATcCnRSL54YGfO+zy+NvPHnzwo2JbvvH51YkfHhgwyPOLHcChJc3gYO+Z5GKJM3nJhj1nbltuu/F2swTQYYYzZyfg0JLDcIC3jTmx4QaPmTRj220DsxtnN4C0JBjcxq3l4N+2+sT5N3jMf4O0GM84u/kHIS2HedsOJ24A2sIM0mLA37sNvy08zwwOy7YdLzY8k2MsCfSLgcQN3m0WCQYSOP3Cz578+OPbtuo8ueNnDD/8qLhtwN9/dvPNHxU28vzS2LXAAJKsBJgtgVc5mhb+AwRVj4JRMApGwcgCAJRIYayvBUYgAAAAAElFTkSuQmCC","orcid":"","institution":"Pontifícia Universidade Católica de Goiás","correspondingAuthor":true,"prefix":"","firstName":"Luciana","middleName":"Pacheco Miranda","lastName":"Rochael","suffix":""},{"id":625663228,"identity":"241a80cf-f34d-4969-8bf3-50cca01b94c9","order_by":1,"name":"Sônia Maria Mello Neves","email":"","orcid":"","institution":"Pontifícia Universidade Católica de Goiás","correspondingAuthor":false,"prefix":"","firstName":"Sônia","middleName":"Maria Mello","lastName":"Neves","suffix":""},{"id":625663229,"identity":"0d199fd7-d46d-476d-b4e8-ce53f72c45d2","order_by":2,"name":"Daniela Sacramento Zanini","email":"","orcid":"","institution":"Pontifícia Universidade Católica de Goiás","correspondingAuthor":false,"prefix":"","firstName":"Daniela","middleName":"Sacramento","lastName":"Zanini","suffix":""},{"id":625663230,"identity":"c0712786-6f88-4f06-ab4e-3a3df6dc9d86","order_by":3,"name":"Iorhana Almeida Fernandes","email":"","orcid":"","institution":"Pontifícia Universidade Católica de Goiás","correspondingAuthor":false,"prefix":"","firstName":"Iorhana","middleName":"Almeida","lastName":"Fernandes","suffix":""},{"id":625663231,"identity":"a9024638-2a29-4d34-8766-c717c4afc70e","order_by":4,"name":"Carla Carolina Batista Machado","email":"","orcid":"","institution":"Pontifícia Universidade Católica de Goiás","correspondingAuthor":false,"prefix":"","firstName":"Carla","middleName":"Carolina Batista","lastName":"Machado","suffix":""},{"id":625663232,"identity":"516a2170-70e8-4a6c-a66c-caa3044339da","order_by":5,"name":"Ellen Ferreira de Castro","email":"","orcid":"","institution":"Pontifícia Universidade Católica de Goiás","correspondingAuthor":false,"prefix":"","firstName":"Ellen","middleName":"Ferreira","lastName":"de Castro","suffix":""}],"badges":[],"createdAt":"2026-03-23 22:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9204777/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9204777/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107489324,"identity":"b31b6d08-6c52-485f-b396-c8fa04ab7972","added_by":"auto","created_at":"2026-04-22 02:47:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":369784,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9204777/v1/a3ef54a1-4145-41fe-9357-9b7e995d6f31.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Validity Evidence Based on Internal Structure and Related Constructs of the Brazilian Version of the Weight Self-Stigma Questionnaire (WSSQ-BR)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eObesity is a multifactorial condition, determined by biological, environmental, behavioral, and sociocultural factors, and associated with a wide range of clinical outcomes and functional limitations. Reports from the World Health Organization (WHO, 2022) indicate that the global rise in obesity is related to metabolic and cardiovascular diseases, as well as functional limitations such as reduced mobility, lower cardiorespiratory capacity, limitations in activities of daily living, and reduced social participation. In 2022, an estimated 43% of the world\u0026rsquo;s adult population were overweight and 16% were obese, with a continuous increase since 1990 (WHO, 2022). In Brazil, data from a recently launched national obesity panel, based on integrated information from official national health data sources, indicate patterns consistent with previous epidemiological findings, including higher prevalence among women and individuals in socioeconomically disadvantaged conditions (Minist\u0026eacute;rio da Sa\u0026uacute;de, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eScientific evidence has also demonstrated that obesity frequently co-occurs with depressive and anxiety disorders, forming, alongside these conditions, one of the most prevalent and disabling clusters of global disease burden (Global Burden of Disease Collaborative Network [GBD], 2020; Milaneschi et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Wang et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Consistent findings reveal bidirectional associations between obesity and depression, with longitudinal studies and meta-analyses showing that inflammatory processes, social stressors, adverse environments, and experiences of stigma contribute to this interrelation (Luppino et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Milaneschi et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Tomiyama et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). This scenario underscores the importance of developing care approaches that simultaneously address the physical, emotional, and social dimensions of illness.\u003c/p\u003e \u003cp\u003eCurrent studies indicate that Body Mass Index (BMI), although widely used, is insufficient as a standalone diagnostic criterion (\u003cem\u003eAssocia\u0026ccedil;\u0026atilde;o Brasileira para o Estudo da Obesidade e da S\u0026iacute;ndrome Metab\u0026oacute;lica\u003c/em\u003e [Brazilian Association for the Study of Obesity and Metabolic Syndrome, ABESO], 2022; Kyle et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; WHO, 2022). International and national guidelines have emphasized that obesity is a complex condition that involves more than the weight-to-height ratio and requires an integrated assessment of metabolic parameters, clinical history, eating patterns, mental health conditions, social context, and experiences of stigmatization (ABESO, 2022; Kyle et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; WHO, 2022). Evidence also shows that weight-related stigma acts as a relevant social determinant, shaping emotional responses, health behaviors, and clinical outcomes across the lifespan (Puhl \u0026amp; Suh, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Tomiyama et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the Brazilian context, despite the recognition of obesity as a public health issue, the care provided remains limited in scope. The literature indicates a predominance of interventions centered on bariatric surgery and traditional dietary prescriptions, with low implementation of guidelines recommending interdisciplinary care and psychosocial management of the condition (ABESO, 2022; Minist\u0026eacute;rio da Sa\u0026uacute;de, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This psychosocial management encompasses clinical and educational practices that consider emotional, behavioral, and social determinants, including variables that influence engagement and maintenance of health behaviors, such as coping repertoires, avoidance patterns, self-care contingencies, social support, and stigma-related contexts (National Institute for Health and Care Excellence [NICE], 2025; Puhl \u0026amp; Heuer, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Tomiyama et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; WHO, 2022).\u003c/p\u003e \u003cp\u003eAlthough such approaches are well established in international guidelines, their implementation in Brazil remains limited (Grilo, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Wadden \u0026amp; Bray, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Recent national policies have begun to emphasize the need for intersectoral and socially informed approaches to obesity, recognizing its complex and socially determined nature, including the role of stigma and structural inequalities (\u003cem\u003eMinist\u0026eacute;rio do Desenvolvimento e Assist\u0026ecirc;ncia Social\u003c/em\u003e, 2026).\u003c/p\u003e \u003cp\u003eWithin this broader framework, weight-related stigma emerges as a key phenomenon for understanding how social and institutional practices shape illness trajectories and inform the development of public policies sensitive to inequalities. The concept of stigma, originally described by Erving Goffman (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e1963\u003c/span\u003e), refers to social processes that mark certain bodies as deviant and generate material and symbolic disadvantages. Applied to body weight, stigma manifests when cultural norms associate thinness with discipline, success, and personal worth, while attributing characteristics such as laziness, lack of self-control, or moral failure to higher body weight (Brewis et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Puhl \u0026amp; Heuer, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Tomiyama et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese social contingencies do not operate solely from the outside in. They may be transformed into self-directed behavioral patterns when stigmatizing messages in the environment become verbal rules that guide negative self-evaluations, accompanied by shame, self-censorship, avoidance of social situations, emotional suppression, and behavioral withdrawal (Durso \u0026amp; Latner, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Lillis et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Puhl \u0026amp; Heuer, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). In the literature, this phenomenon is referred to as self-stigma or internalized weight bias and describes the process by which individuals treat themselves according to the negative stereotypes embedded in cultural norms. This process affects everyday functioning by restricting behavioral repertoires, decreasing the likelihood of engagement in valued activities, impairing relationships, and influencing self-esteem, understood as the set of evaluative self-concepts that guide public and private responses (Meadows \u0026amp; Higgs, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Pearl \u0026amp; Puhl, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Empirical evidence indicates that internalized weight bias is associated with negative self-evaluation processes and poorer health outcomes (Hilbert et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConsistent with this pattern, weight self-stigma has also been consistently associated with relevant indicators of psychological distress. The systematic review conducted by Pearl and Puhl (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), encompassing 74 studies, identified significant and moderate correlations between self-stigma and depressive symptoms (r = .47, p \u0026lt; .001), anxiety (r = .39, p \u0026lt; .001), body dissatisfaction (r = .54, p \u0026lt; .001), disordered eating behaviors (r = .38, p \u0026lt; .001), poorer quality of life (r = \u0026ndash;.44, p \u0026lt; .001), and lower self-efficacy for health behaviors (r = .32, p \u0026lt; .001). Collectively, these findings indicate that self-stigma functions as a psychological variable linked to increased experiential avoidance\u0026mdash;a pattern characterized by attempts to avoid or control aversive internal events\u0026mdash;and to reduced likelihood of engaging in self-care behaviors, contributing to cycles of avoidance and heightened distress (Donahue et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Hayes et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1996\u003c/span\u003e; Hayes et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Levin et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral measures have been developed to assess components related to stigma and weight self-stigma. The systematic review by Lacroix et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) identified more than ten instruments evaluating explicit attitudes, implicit attitudes, prejudice, shame, discriminatory behaviors, and self-stigma. Among these instruments, few present robust psychometric properties specifically for assessing self-stigma. The most established measures are the Weight Bias Internalization Scale (WBIS; Durso \u0026amp; Latner, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) and the Weight Self-Stigma Questionnaire (WSSQ; Lillis et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Whereas the WBIS assesses the general internalization of negative weight-related beliefs, the WSSQ was developed to capture the multifaceted nature of weight self-stigma, comprising the factors \u003cem\u003eself-devaluation\u003c/em\u003e and \u003cem\u003efear of enacted stigma\u003c/em\u003e. This distinction enables the assessment of both self-referential devaluation and perceived vulnerability to stigmatization, an aspect relevant for clinical interventions and studies on social processes of prejudice.\u003c/p\u003e \u003cp\u003eSince its development, the WSSQ has been translated and adapted across various cultural contexts. The review by Lacroix et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) identified at least 15 cross-cultural adaptation and validation studies up to that point, with the number increasing substantially in subsequent years. Countries with consistent psychometric evidence include Portugal, Germany, Italy, Spain, China, Japan, Turkey, and Malaysia, with replicated two-factor structures, factor loadings typically above .50, alpha coefficients ranging from .80 to .92, and correlations aligned with variables such as self-esteem, psychological distress, body image, and disordered eating (Hain et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Lin \u0026amp; Lee, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Sevincer et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The selection of these countries in this introduction reflects methodological proximity and the similarity of external variables examined, which directly parallel the analyses conducted in the present study.\u003c/p\u003e \u003cp\u003eIn Brazil, Rodrigues et al. (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) conducted the first translation and cultural adaptation of the WSSQ into Brazilian Portuguese, following established guidelines in the cross-cultural adaptation literature, such as those proposed by Beaton et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2000\u003c/span\u003e) and Borsa et al. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). The study presented initial evidence of semantic equivalence and satisfactory internal consistency for the total scale (α\u0026thinsp;=\u0026thinsp;.83). Exploratory analyses identified two factors, but three items originally belonging to the self-devaluation factor showed cross-loadings\u0026mdash;an expected finding given the small sample size, reinforcing the need for analyses with greater statistical power. As a preliminary step, the study did not assess confirmatory factor structure, validity based on relations with external variables, or factor-specific precision, all of which are essential for psychometric consolidation. The authors also underscored the need for larger samples in subsequent phases, highlighting the relevance of additional validation studies in the Brazilian context.\u003c/p\u003e \u003cp\u003eGiven that weight self-stigma remains scarcely assessed in Brazil, despite its relevance for public health, there is a need for instruments capable of measuring this process with precision. Recent evidence indicates that everyday experiences of stigma and stigmatizing practices by healthcare professionals are associated with reduced help-seeking and poorer clinical outcomes (Puhl et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Research in the field shows that devaluing social messages may be internalized and expressed through negative self-descriptions, avoidance patterns, and other responses consistent with self-stigma. The availability of validated measures contributes to clinical interventions sensitive to self-stigma and may support public policies aimed at reducing bias and improving the quality of healthcare.\u003c/p\u003e \u003cp\u003eThe study aimed to examine the validity evidence of the Brazilian version of the Weight Self-Stigma Questionnaire (WSSQ). The internal structure of the measure and its associations with self-esteem, psychological distress, and body image were examined, in alignment with evidence reported in previously published adaptations.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eA total of 262 individuals participated in this study, aged between 18 and 72 years (M\u0026thinsp;=\u0026thinsp;33.0, SD\u0026thinsp;=\u0026thinsp;13.4), all residing in the Central-West region of Brazil. The sample was composed of cisgender women (72.9%) and cisgender men (27.1%). Regarding race/color, 58% identified as White, 29.4% as Brown, 8.8% as Black, and 3.8% as Yellow.\u003c/p\u003e \u003cp\u003eWith respect to Body Mass Index (BMI), 52.5% presented overweight, 29.3% obesity class I, 12% obesity class II, and 6.2% obesity class III. Concerning educational level, 1.9% had incomplete elementary school, 1.5% completed elementary school, 1.5% incomplete high school, 13.7% completed high school, 43.5% incomplete higher education, 13.4% completed higher education, and 24.4% postgraduate education.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cp\u003eTo meet the objectives of this study, the following instruments were administered:\u003c/p\u003e \u003cp\u003eWeight Self-Stigma Questionnaire (WSSQ; Lillis et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Used as a measure of weight self-stigma among individuals with overweight and obesity, the WSSQ comprises 12 items forming two correlated subscales: \u003cem\u003eself-devaluation\u003c/em\u003e (items 7\u0026ndash;12) and \u003cem\u003efear of enacted stigma\u003c/em\u003e (items 1\u0026ndash;6). Items are rated on a 5-point Likert scale ranging from 1 (\u003cem\u003estrongly disagree\u003c/em\u003e) to 5 (\u003cem\u003estrongly agree\u003c/em\u003e), with total scores ranging from 12 to 60; higher scores reflect greater internalized weight stigma. The original version of the WSSQ presents good internal consistency, as does the Brazilian adaptation (α\u0026thinsp;=\u0026thinsp;.79; Rodrigues et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBody Shape Questionnaire (BSQ; Cooper et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e1987\u003c/span\u003e). Translated and adapted to Brazilian Portuguese by Di Pietro and Silveira (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), the BSQ assesses body image dissatisfaction. It comprises 34 items rated on a 6-point Likert scale from \u003cem\u003enever\u003c/em\u003e to \u003cem\u003ealways\u003c/em\u003e, yielding total scores ranging from 34 to 204. Classification categories include: no body image distortion (\u0026le;\u0026thinsp;110), mild (111\u0026ndash;138), moderate (139\u0026ndash;167), and severe distortion (\u0026gt;\u0026thinsp;167). The Brazilian version demonstrated excellent internal consistency (α\u0026thinsp;=\u0026thinsp;.97).\u003c/p\u003e \u003cp\u003eKessler Psychological Distress Scale (K10; Kessler et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). Adapted to Portuguese by Peixoto et al. (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) for use with individuals aged 14 years or older, the K10 includes 10 self-report items that assess emotional distress over the past 30 days, rated on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;\u003cem\u003enever\u003c/em\u003e to 5\u0026thinsp;=\u0026thinsp;\u003cem\u003ealways\u003c/em\u003e). Total scores indicate overall psychological distress; higher scores denote higher distress levels. Based on its factorial structure, separate indices of anxiety (items 2, 3, 5, and 6) and depression (items 1, 4, 7, 8, 9, and 10) may also be computed. The original study reported adequate reliability (α\u0026thinsp;=\u0026thinsp;.87).\u003c/p\u003e \u003cp\u003eRosenberg Self-Esteem Scale (RSES; Rosenberg, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e1965\u003c/span\u003e). Adapted for Brazil by Hutz (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2000\u003c/span\u003e) and validated by Hutz and Zanon (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), the scale includes ten items, six assessing positive self-evaluation and four assessing negative self-evaluation. Items are rated on a 3-point Likert scale (\u003cem\u003edisagree\u003c/em\u003e, \u003cem\u003eneither agree nor disagree\u003c/em\u003e, \u003cem\u003eagree\u003c/em\u003e). Higher scores indicate higher self-esteem. Internal consistency coefficients in Brazilian studies range from .68 (Avanci et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2007\u003c/span\u003e) to .86 (Hutz, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Santos \u0026amp; Maia, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2003\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003e The study was conducted in accordance with the ethical guidelines of the Brazilian National Health Council (Resolution No. 510/2016) for research involving human subjects and was approved under protocol No. 5.729.640.\u003c/p\u003e \u003cp\u003eParticipants were recruited through physical media (flyers) and digital platforms (WhatsApp, Instagram, X [formerly Twitter]), as well as through active search at a higher education institution where data collection took place in a reserved room. Initially, voluntary participation was confirmed through the signing of the Free and Informed Consent Form (FICF), which ensured anonymity, the possibility of withdrawing at any stage of the study without penalty, and availability of researcher contact for additional information or in case of complications arising from participation.\u003c/p\u003e \u003cp\u003eSubsequently, participants had their weight and height measured using an anthropometric scale and completed the questionnaires either in paper-and-pencil format or online via Google Forms. All responses were collected between May 2022 and June 2024.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eTo examine the factorial structure of the WSSQ, a Confirmatory Factor Analysis (CFA) was conducted. Three models were compared: a one-factor model, a two-factor model, and a bifactor model. For the hierarchical model, parameter estimation was not feasible, preventing identification.\u003c/p\u003e \u003cp\u003eAnalyses were performed in Mplus using the Weighted Least Squares Mean and Variance adjusted estimator (WLSMV). Interpretation was based on the following fit indices: χ\u0026sup2;, degrees of freedom (df), RMSEA (Root Mean Square Error of Approximation), CFI (Comparative Fit Index), and TLI (Tucker\u0026ndash;Lewis Index). The reference values adopted were CFI and TLI \u0026ge; .90, RMSEA \u0026le; .08, and χ\u0026sup2;/df\u0026thinsp;\u0026le;\u0026thinsp;5 (Muth\u0026eacute;n \u0026amp; Muth\u0026eacute;n, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Tabachnick \u0026amp; Fidell, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The adequacy of the bifactor model was assessed through global fit indices and item factor loadings, and auxiliary indices were calculated to evaluate the degree of unidimensionality, including the Percentage of Uncontaminated Correlations (PUC) and the Explained Common Variance (ECV) of the general factor (Reise et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Rodriguez et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInternal consistency was estimated using McDonald\u0026rsquo;s omega and Cronbach\u0026rsquo;s alpha (both computed in Jamovi, Version 2.3; The Jamovi Project, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), as well as composite reliability calculated using the Composite Reliability Calculator (Colwell, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Values \u0026ge; .70 were interpreted as adequate indicators of reliability (Tabachnick \u0026amp; Fidell, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eValidity evidence based on relations with external variables was examined using Spearman correlations. Coefficients were interpreted according to Cohen (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e1988\u003c/span\u003e): values between \u0026minus;\u0026thinsp;0.09 and 0.09 were considered negligible; between 0.10 and 0.29, small; between 0.30 and 0.49, moderate; and between 0.50 and 1.00, strong. These analyses were also conducted in Jamovi.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the fit indices for the models examined. The one-factor model did not yield adequate fit indices. Although the bifactor model showed superior global fit, its item loadings were unsatisfactory, indicating low representativeness of items in their respective factors. This compromises the interpretability and practical utility of the model, as factor meaning becomes unstable. Additionally, the combination of weak factor loadings, a low PUC (0.545), and an ECV for the general factor below recommended thresholds (0.586) suggests that, despite acceptable global fit, the bifactor model lacks sufficient psychometric support for robust interpretation (Reise et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Rodriguez et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn contrast, the two-factor model demonstrated adequate fit indices and substantial factor loadings. Accordingly, the two-factor model appears more appropriate for representing the latent structure of the construct assessed.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFit indices for the three models compared.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModelo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e/df\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTLI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRMSEA (IC\u0026thinsp;\u0026minus;\u0026thinsp;90%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnidimensional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e443.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.811\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.166 (0.152\u0026ndash;0.180)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo-factor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e206.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.887\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.939\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.924\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.105 (0.090\u0026ndash;0.120)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBifactor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107.399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.959\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.077 (0.059\u0026ndash;0.095)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the item loadings on the two factors of the instrument (Self and Fear). Items 1 through 6 loaded on the Self factor, with loadings ranging from 0.465 to 0.878, whereas items 7 through 12 loaded on the Fear factor, with loadings between 0.705 and 0.826. All items showed moderate to high factor loadings, indicating adequate representativeness within their respective factors. Regarding internal consistency indices, both factors showed good reliability indicators. The Self factor presented coefficients ranging from 0.78 to 0.84, and the Fear factor presented coefficients between 0.83 and 0.89.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactor loadings and reliability indicators.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFear\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. I will always gain weight again.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. I caused my own weight problems.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. I feel guilty about my weight problems.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. I became overweight because I am a weak person.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.878\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. I would never have weight problems if I were a stronger person.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. I do not have enough self-control to maintain a healthy weight.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.677\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. I feel insecure about how others view me.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.755\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. People discriminate against me because of my weight problems.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.705\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. It is difficult for people who have never had weight problems to understand me.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.761\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. Others will think I lack self-control because of my weight problems.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.826\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. People think I am to blame for my weight problems.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.804\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. People feel ashamed to be around me because of my weight.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCronbach\u0026rsquo;s α\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMcDonald\u0026rsquo;s ω\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComposite reliability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the correlations between the Self and Fear factors and the variables self-esteem, distress, anxiety, depression, and body image. A strong positive correlation was observed between the Self and Fear factors. Regarding self-esteem, negative correlations of moderate magnitude (Self) and strong magnitude (Fear) were identified, indicating that higher levels of self-esteem are associated with lower scores on both factors.\u003c/p\u003e \u003cp\u003ePsychological distress variables exhibited positive correlations of moderate to strong magnitude with the Self and Fear factors. Distress showed a moderate correlation with Self and a strong correlation with Fear. Anxiety showed moderate correlations with both factors, whereas depression showed strong positive correlations with Self and Fear.\u003c/p\u003e \u003cp\u003eFinally, the BSQ demonstrated strong positive correlations with both factors, suggesting that body image dissatisfaction is consistently related to the two dimensions. These findings indicate that the Self and Fear factors are associated with lower levels of self-esteem and higher levels of psychological distress.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelations between self-stigma (Self and Fear), self-esteem, psychological distress, and body image.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFear\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDIS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eANX\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDEP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.52*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.49*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.55*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDIS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.40*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.54*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.63*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eANX\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.33*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.42*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.41*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.85*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDEP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.40*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.54*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.68*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.95*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.66*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBSQ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.58*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.67*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.58*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.52*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.43*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.52*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: SE\u0026thinsp;=\u0026thinsp;Self-esteem; DIS\u0026thinsp;=\u0026thinsp;Distress; ANX\u0026thinsp;=\u0026thinsp;Anxiety; DEP\u0026thinsp;=\u0026thinsp;Depression; BSQ\u0026thinsp;=\u0026thinsp;Body Image.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of this study was to investigate the validity evidence of the Brazilian version of the Weight Self-Stigma Questionnaire (WSSQ), examining its internal structure and its associations with self-esteem, psychological distress, and body image. The results provide consistent support for the psychometric adequacy of the instrument in the Brazilian context and reinforce the relevance of weight-related self-stigma as a central variable in understanding illness processes, as widely discussed in the international literature.\u003c/p\u003e \u003cp\u003eThe confirmatory factor analysis demonstrated that the two-factor model presented a better fit and greater theoretical coherence, replicating the structure originally proposed by Lillis et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) and observed in international adaptations conducted in countries such as Germany, Italy, Spain, Portugal, China, Turkey, and Malaysia (Hain et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Lin \u0026amp; Lee, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Sevincer et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The bifactor structure, comprising the self-devaluation and fear of stigma factors, also showed adequate performance in the present sample, reinforcing the robustness of the construct and indicating cross-cultural stability. Internal consistency indices for both factors were satisfactory, consistent with those reported in international studies and higher than the preliminary parameters identified in the initial Brazilian adaptation (Rodrigues et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), possibly due to the increased sample size and greater heterogeneity of the participants.\u003c/p\u003e \u003cp\u003eValidity evidence based on relations with external variables was also strong. The negative correlations between WSSQ scores and self-esteem, ranging from moderate to strong magnitude, align with the understanding that internalized stigma affects how individuals evaluate their own worth, shaping self-referential processes that may reduce engagement in health-related behaviors, as described by Durso and Latner (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), Puhl and Heuer (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), and Tomiyama et al. (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eComplementarily, the positive correlations of moderate to strong magnitude with indicators of psychological distress, including distress, anxiety, and depression, replicate the pattern reported in the systematic review by Pearl and Puhl (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and reinforce the relationship between self-stigma and heightened negative emotional responses, often shaped by experiences of stigma and discrimination. These findings are consistent with models that integrate experiential avoidance and psychological suffering (Hayes et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1996\u003c/span\u003e; Levin et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), demonstrating the role of internalized devaluation in maintaining behavioral withdrawal and intensified self-criticism.\u003c/p\u003e \u003cp\u003eAnother relevant set of findings concerns the strong correlations between the WSSQ factors and body image dissatisfaction as measured by the BSQ. This association aligns with studies documenting the impact of stigma and self-stigma on body image, particularly among women, who have been historically subject to stricter sociocultural norms regarding body appearance and increased exposure to stigmatizing practices (Brewis et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Puhl \u0026amp; Suh, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Given that the present sample was predominantly composed of women, such aesthetic pressures may have contributed to the strength of the associations observed, especially for the \u003cem\u003efear of stigma\u003c/em\u003e factor, which involves perceived social evaluations.\u003c/p\u003e \u003cp\u003eFrom a clinical and public health perspective, the findings underscore the need to incorporate the assessment of self-stigma in services for individuals with overweight and obesity. The literature documents that stigmatizing practices in health settings can reduce care seeking and compromise clinical outcomes, a phenomenon reported internationally (Puhl \u0026amp; Heuer, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Puhl et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Tomiyama et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Accordingly, instruments such as the WSSQ can promote more integrated practices that are sensitive to the emotional and social dimensions of illness and aligned with contemporary behavioral approaches that emphasize psychological flexibility (Levin et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) and with international guidelines recommending interdisciplinary approaches and psychosocial management rather than weight-centered strategies (ABESO, 2022; Grilo, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; NICE, 2025; Wadden \u0026amp; Bray, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; WHO, 2022).\u003c/p\u003e \u003cp\u003eThis study also advances the evidence base beyond the preliminary findings from the first Brazilian adaptation of the WSSQ (Rodrigues et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), by presenting confirmatory analyses, a larger and more heterogeneous sample, more stable reliability estimates, and broader convergent validity evidence. In doing so, it contributes to the consolidation of a culturally appropriate measure for the Brazilian context and provides a valuable tool for the development of clinical, educational, and research strategies that conceptualize obesity through a less reductionist and more psychosocial lens.\u003c/p\u003e \u003cp\u003eDespite these contributions, some limitations should be acknowledged. The sample was concentrated in the Central-West region and predominantly female, highlighting the need for future studies with broader regional, social, and gender diversity, as well as factorial invariance analyses to examine potential group differences in self-stigma experiences. Additionally, the cross-sectional design limits causal inference regarding the relationships between self-stigma and psychological distress; longitudinal designs and predictive modeling are recommended for future research.\u003c/p\u003e \u003cp\u003eIn summary, the findings demonstrate that the Brazilian version of the WSSQ shows consistent validity and reliability evidence, supporting its use in clinical and research settings. Considering the relevance of self-stigma for understanding obesity and its psychosocial determinants, the instrument represents an important step toward improving care practices and generating knowledge about a phenomenon that remains understudied in Brazil.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLPMR contributed to participant recruitment and selection, data collection, data preparation and tabulation, and drafted the introduction and references. She also critically revised the manuscript.SMMN supervised the study and critically revised the manuscript.DSZ contributed to the selection of instruments, provided guidance during data collection and manuscript development, contributed to the discussion, and critically revised the manuscript.IAF contributed to data preparation and tabulation, conducted the data analyses, and contributed to the writing of the results and discussion.CCBM contributed to data collection and data tabulation.EFC contributed to participant recruitment and data collection for part of the sample, assisted in manuscript writing, translated the manuscript into English, prepared the abstract, and formatted the manuscript for submission.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAssocia\u0026ccedil;\u0026atilde;o Brasileira para o Estudo da Obesidade e da S\u0026iacute;ndrome Metab\u0026oacute;lica (ABESO) (2022). 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Obesity and overweight. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"weight self-stigma, validity evidence, WSSQ, obesity, psychological distress, body image, self-esteem","lastPublishedDoi":"10.21203/rs.3.rs-9204777/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9204777/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eObesity is a complex biopsychosocial condition that involves biological, behavioral, and sociocultural determinants, and growing evidence highlights the role of weight-related stigma in shaping emotional distress, health behaviors, and clinical outcomes. This study investigated the validity evidence of the Brazilian version of the Weight Self-Stigma Questionnaire (WSSQ), examining its internal structure and its associations with self-esteem, psychological distress, and body image.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA sample of 262 adults residing in the Central-West Brazil, aged between 18 and 72 years (M\u0026thinsp;=\u0026thinsp;33.0; SD\u0026thinsp;=\u0026thinsp;13.4), was predominantly female (72.9%). Among the participants, 58% self-identified as White, 52.5% were classified as overweight, and 47.5% as obese. Participants completed the WSSQ, BSQ, K10, RSES, and a sociodemographic questionnaire.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eConfirmatory factor analyses supported the two-factor model originally proposed, demonstrating superior fit, theoretical coherence, and satisfactory reliability indices. The bifactor model also presented adequate fit but showed weaker item representativeness. Convergent validity analyses revealed moderate to strong negative correlations with self-esteem and moderate to strong positive correlations with distress, anxiety, depression, and body dissatisfaction, replicating international findings and reinforcing the relevance of internalized self-stigma for psychological functioning.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe results provide robust evidence of validity and reliability for the Brazilian WSSQ and support its use in clinical and research contexts. The instrument may contribute to culturally sensitive assessments and to interventions that address the emotional and social dimensions of obesity, a phenomenon still understudied in the Brazilian context.\u003c/p\u003e","manuscriptTitle":"Validity Evidence Based on Internal Structure and Related Constructs of the Brazilian Version of the Weight Self-Stigma Questionnaire (WSSQ-BR)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-21 13:47:39","doi":"10.21203/rs.3.rs-9204777/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0e5f2225-53a6-4a04-ab1f-e4ed8a1ff4aa","owner":[],"postedDate":"April 21st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-21T13:47:39+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-21 13:47:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9204777","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9204777","identity":"rs-9204777","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}