Examining bidirectional relationships among weight bias internalization, body image flexibility, and intuitive Eating: An 8-month longitudinal study in Chinese adults

Empirical support and theory underscore robust links among weight bias internalization (WBI), intuitive eating (IE), and body image flexibility (BIF). Yet existing research is largely cross-sectional, limiting inferences about temporal directionality and potential reciprocal associations among WBI, IE, and BIF. Using a two-wave longitudinal design, we examined bidirectional associations among WBI, IE and BIF in an underresearched cultural context (China) to address numerous gaps in the empirical literature. Chinese adult women and men (N = 491) completed validated self-report measures of WBI, IE, and BIF at baseline (T1) and 8-month follow-up (T2). Cross-lagged panel models revealed bidirectional negative associations between WBI and IE and between WBI and BIF. While T1 BIF predicted higher IE at T2, the reverse association was not found. These reciprocal patterns suggest that WBI and adaptive eating and body image constructs are related and mutually reinforcing across time. Half-longitudinal mediation using two data points (T1 and T2), controlling for covariates (age, body mass index, and gender) and autoregressive effects (baseline levels of the mediator and outcome variables), identified that BIF and WBI were significant mediators of the longitudinal links between T1 WBI and T2 IE and T1 BIF and T2 IE, respectively. Auxiliary multi-group analyses indicated that these cross-lagged and mediation pathways did not differ by gender. Responding to a wealth of research underscoring the lasting, noxious effects of WBI on biopsychosocial health, the present study identified adaptive eating (IE) and body image (BIF) variables as promising points of prevention in the reduction of WBI.