Background: Weight bias internalization (WBI) is common in people with obesity and is associated with adverse mental and physical health outcomes, greater food intake, binge eating, and difficulty ...losing weight. While prior evidence suggests that difficulty with weight loss may arise from differences in eating behavior, it is unclear whether dietary quality (DQ) may play a role. This study aimed to identify associations between WBI and DQ measured with the Healthy-Eating Index-2015 (HEI). Methods: This cross-sectional analysis of baseline data from an ongoing trial (ID NCT05648344) included 376 adults with BMI between 26 and < 45 kg/m2. Participants completed a survey that included the WBI Scale-2F and three 24 h-dietary recalls using the Automated Self-Administered 24-H Dietary Assessment Tool where HEI scores were computed. Multivariate linear/robust regressions adjusted by sex, self-reported ethnicity, race, education, age, BMI, and neighborhood food availability were constructed. Results: Participants mean age = 47.7 ± 12.2; mean HEI = 55.3 ± 12.3 and WBIS total score = 3.2 ± 1.1). WBIS total score was not significantly associated with DQ, p = 0.531. Statistically significant associations between WBIS total score and age, b = -0.01, standard error (SE) = 0.00, p = 0.005; BMI, b = 0.03, SE = 0.01, p = 0.03); and Black, b = -0.66, SE = 0.29, p = 0.02 were identified. WBI-Distress score was associated with age b = -0.02, SE = 0.01, p = 0.001; BMI, b = 0.05, SE = 0.02, p = 0.001; and Black, b =-1.05, SE = 0.37, p = 0.006. WBI-Self-devaluation score was associated with female sex, b = -0.43, SE = 0.13, p < 0.001. Conclusions: In this sample of US adults with overweight/obesity, WBI was not associated with DQ. Black participants were associated with significantly lower WBI and distress scores versus those identified as Other. As age increased, lower WBI and distress scores were observed, and higher BMIs were related with greater WBI total- and distress scores. Females were associated with significantly lower WBI self-devaluation scores.
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