Supplementary Material for: The application of Cohen’s stress buffering model for weight bias internalization in prebariatric patients

Introduction: Weight bias internalization (WBI) is associated with reduced psychological well-being in individuals with obesity. The aim of this study was to investigate the application of Cohen’s stress buffering model of social support for WBI on well-being in patients presenting for bariatric surgery. Methods: In N = 804 adult prebariatric patients, WBI, social support, depression severity, health-related quality of life (HRQOL), and self-esteem were assessed by self-report questionnaires. Structural Equation Modeling was applied to test for direct associations between social support and well-being and for a buffering effect of social support on the relationship between WBI and well-being. Results: After controlling for age, sex, and body mass index, greater social support was directly associated with reduced depression severity and increased self-esteem, but not with increased HRQOL. Contrary to Cohen’s stress buffering model, social support showed no moderating effects on the association between WBI and depression severity, HRQOL, and self-esteem. Conclusion: These cross-sectional results may indicate that greater social support is associated with improved well-being, supporting it as a potential coping resource in bariatric surgery. Given the absence of supporting evidence for the buffering effect in the present study, future prospective research may re-evaluate the existence of a moderating effect of social support and investigate whether support-focused interventions improve psychological well-being.