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Barnes RD, Lawson JL. Weight stigma and binge eating related to poorer perceptions of healthcare provider interaction quality in a community-based sample. J Eat Disord 2024; 12:128. [PMID: 39223683 PMCID: PMC11370053 DOI: 10.1186/s40337-024-01093-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Weight stigma refers to the social rejection, discrimination, and ideological devaluation of individuals because of body size and is a direct result of weight bias and anti-fat attitudes. Individuals with higher weight may be less likely to seek healthcare due to weight stigma, and if or when they do present for care, medical providers with weight bias may fail to provide high quality care. Little, however, is known about the intersectionality of weight stigma and perceptions of healthcare interactions as experienced by individuals who also binge eat. METHODS Community-based adults completed online self-report questionnaires regarding generalized weight stigma (Attitudes Towards Obese Persons1), healthcare interaction quality (Patient Perceptions of Healthcare Provider Interaction Quality; PPH), and disordered eating (Eating Disorder Examination-Questionnaire) via Amazon's Mechanical Turk platform. For this cross-sectional study, participants were categorized by the presence and absence of regular binge episodes. Pearson's correlations, T-tests, ANOVA/ANCOVA, and a multivariate regression were used to examine relationships among demographic variables, weight stigma, disordered eating, and the PPH. RESULTS Participants (N = 648) primarily identified as female (65.4%) and White, non-Hispanic (72.7%). Participants' average age and body mass index (BMI) were 37.5 (SD = 12.3) years old and 27.3 (SD = 6.9) kg/m2, respectively. Higher healthcare provider interaction quality ratings (PPH) were significantly related to lower BMI (r(648)=-0.098,p = 0.012), less weight stigma (r(648) = 0.149,p < 0.001), and identifying as a woman (t(514) = 2.09, p = 0.037, Cohen's d = 0.165) or White, non-Hispanic (t(646)=-2.73, p = 0.007, Cohen's d=-0.240). Participants reporting regular binge eating endorsed significantly worse perceptions of healthcare provider quality than those who did not, even after accounting for BMI, F(1, 645) = 8.42, p = 0.004, η2 = 0.013. A multivariate linear regression examining the PPH as dependent, and weight stigma and binge eating as independent, variable/s, was significant even after accounting for covariates (sex, race, BMI), F(95, 640) = 7.13,p < 0.001, R2 = 0.053 (small effect). CONCLUSIONS More negative experiences with healthcare providers was associated with worse weight stigma, higher BMI, regular binge eating and overall disordered eating, and for participants identifying as male or a Person of Color. These data have implications for non-clinical community populations and are particularly important as experiencing poorer quality of interactions with healthcare providers may decrease individuals' likelihood of seeking needed care for both disordered eating and health-related concerns. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Rachel D Barnes
- Division of General Internal Medicine, University of Minnesota Medical School, MMC 741, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Jessica L Lawson
- VA Connecticut Healthcare System, West Haven, CT, USA
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
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2
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Nutter S, Saunders JF, Waugh R. Current trends and future directions in internalized weight stigma research: a scoping review and synthesis of the literature. J Eat Disord 2024; 12:98. [PMID: 39010124 PMCID: PMC11247756 DOI: 10.1186/s40337-024-01058-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/30/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Since the first papers focused on internalized weight stigma were published in the mid 2000's, the literature has grown into a robust field that complements existing knowledge on weight stigma. Recently, researchers have documented the need for increased conceptual and measurement clarity, to distinguish internalized weight stigma from body dissatisfaction. Although several systematic reviews have been conducted on portions of the internalized weight stigma literature, no review to date has been conducted examining the entirety of the literature. OBJECTIVE The aim of this research was to conduct a systematic scoping review and synthesis of research on internalized weight stigma. Specifically, we sought to examine the broad scope of the literature, terms used to refer to internalized weight stigma, how internalized weight stigma is defined, sample characteristics, and weight-based framings of internalized weight stigma research. METHODS We conducted a single-concept search across six databases (EMBASE, Medline, PsychINFO, PubMed, SCOPUS, and Web of Science) of peer-reviewed papers published in English on internalized weight stigma. Data were extracted for article authors, year published, journal name and type, general article topic(s), study design, study location, sample characteristics, variables measured, paper framing, term used to describe internalized weight stigma, and definition of internalized weight stigma. RESULTS Of the 931 unique records screened, 376 were identified for inclusion in the scoping review. The majority of internalized weight stigma research is characterized by cross-sectional methods, has been conducted in the US, and has utilized samples of higher weight white women. Further, 40 unique terms were used across the literature to refer to internalized weight stigma, and 19 different components of definitions of internalized weight stigma were identified. The literature is also characterized by a focus on understanding the association between internalized weight stigma and health outcomes with an emphasis on obesity. CONCLUSIONS This scoping review confirms a lack of concept clarity of internalized weight stigma, in part influenced by an inconsistency in definitions of internalized weight stigma across the literature. Considerations are provided for steps to enhance conceptual and measurement clarity. Given the obesity focused framing of much of the research on internalized weight stigma, considerations are also provided for reducing weight-centric approaches to research. In the early 2000's, researchers began to pay more attention to the potential health impacts of believing societal stereotypes, negative attitudes, and beliefs about higher weight people. When these stereotypes, negative attitudes, and beliefs are directed towards the self, it can have significant consequences for an individual's perceptions of self. This research collected and summarized all existing research published in English on internalized weight stigma. Our results highlighted that researchers do not use consistent terminology to refer to internalized weight stigma and that they do not have a consistent definition of internalized weight stigma. Further, a large proportion of the research is focused on obesity or weight loss, which may unintentionally perpetuate weight stigma in scientific research. We provide several recommendations for researchers to address these challenges in future research on internalized weight stigma as well as recommendations to address other identified gaps in the existing literature.
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Affiliation(s)
- Sarah Nutter
- Educational Psychology and Leadership Studies, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
| | - Jessica F Saunders
- Psychology Convening Group, Ramapo College of New Jersey, 505 Ramapo Valley Road, Mahwah, NJ, 07430, USA
| | - Rachel Waugh
- Educational Psychology and Leadership Studies, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
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3
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Rancaño KM, Puhl R, Skeer M, Eliasziw M, Must A. Negative familial weight talk and weight bias internalization in a US sample of children and adolescents. Pediatr Obes 2024; 19:e13108. [PMID: 38375755 PMCID: PMC11006571 DOI: 10.1111/ijpo.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Negative familial weight talk may contribute to higher weight bias internalization in pre- and early adolescents (hereafter referred to as children) and may differ by gender, weight status, and race and ethnicity. OBJECTIVE Examine the relationship between negative familial weight talk and weight bias internalization and examine differences by gender, weight status, and race and ethnicity. METHODS We cross-sectionally analysed 5th-7th graders (10-15 years old) living in Massachusetts (n = 375, 52.3% girls, 21.3% BMI ≥85th percentile, 54.8% non-Hispanic White). Negative familial weight talk frequency during the past 3 months was self-reported and discretized as 'never,' 'occasionally' (1-9 times) and 'often' (>9 times); the Modified Weight Bias Internalization Scale assessed weight bias internalization. Generalized linear models estimated the relationship between negative familial weight talk and weight bias internalization and sub-analyses estimated the relationship across gender, weight status, and race and ethnicity. Results are summarized as ratios of means (RoM). RESULTS Children experiencing negative familial weight talk occasionally (RoM = 1.12, p = 0.024) and often (RoM = 1.48, p < 0.001) had significantly higher weight bias internalization than children who never experienced it. In sub-analyses, experiencing negative familial weight talk often was associated with higher weight bias internalization among girls (RoM = 1.66, p < 0.001), boys (RoM = 1.32, p = 0.007), children with BMI <85th percentile (RoM = 1.44, p = 0.007) and BMI ≥85th percentile (RoM = 1.39, p = 0.001), and non-Hispanic White children (RoM = 1.78, p < 0.001), but not Hispanic (RoM = 1.25, p = 0.085) or non-Hispanic Black children (RoM = 1.20; p = 0.31). CONCLUSIONS Frequent negative familial weight talk was associated with higher weight bias internalization across gender and weight status and in non-Hispanic White children only.
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Affiliation(s)
- Katherine M. Rancaño
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston MA, Boston, MA
| | - Rebecca Puhl
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut
| | - Margie Skeer
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston MA, Boston, MA
| | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston MA, Boston, MA
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston MA, Boston, MA
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4
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Zancu AS, Diaconu-Gherasim LR. Weight stigma and mental health outcomes in early-adolescents. The mediating role of internalized weight bias and body esteem. Appetite 2024; 196:107276. [PMID: 38367911 DOI: 10.1016/j.appet.2024.107276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/28/2024] [Accepted: 02/14/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Weight stigma is increasingly common in early adolescence and may lead to weight bias internalization, with negative consequences for mental health outcomes. This study aimed to: examine the relations of perceived weight stigma and internalized weight bias with early adolescents' internalizing symptoms and disordered eating behavior; explore the mediating role of internalized weight bias on the relations of perceived weight stigma with internalizing symptoms and disordered eating behaviors; examine body esteem as a mediator between internalized weight bias and mental health outcomes. METHODS A sample of 406 early adolescents (59.6% girls) aged between 11 and 13 participated in this cross-sectional study. They completed self-report measures assessing perceived weight stigma, internalized weight bias, body esteem, internalizing symptoms and disordered eating. RESULTS Path analysis indicated that perceived weight stigma was positively related with internalizing symptoms and internalized weight bias. Further, internalized weight bias was negatively related with body esteem and positively related with internalizing symptoms and disordered eating. Internalized weight bias mediated the relations of perceived weight stigma with internalizing symptoms, disordered eating and body esteem. Further, body esteem mediated the relations of internalized weight bias with internalizing symptoms and disordered eating behavior. CONCLUSIONS The findings highlight internalized weight bias as a psychological mechanism potentially explaining negative links of weight stigma with internalizing symptoms and disordered eating in early adolescence. The results emphasize the need for early intervention during this developmental stage, in order to prevent psychological and behavioral outcomes of weight stigma and internalized weight bias.
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Affiliation(s)
- Alexandra Simona Zancu
- Faculty of Psychology and Educational Sciences, Alexandru Ioan Cuza University of Iași, Romania.
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5
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Hughes AM, Flint SW, Clare K, Kousoulis AA, Rothwell ER, Bould H, Howe LD. Demographic, socioeconomic and life-course risk factors for internalized weight stigma in adulthood: evidence from an English birth cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100895. [PMID: 38745988 PMCID: PMC11092882 DOI: 10.1016/j.lanepe.2024.100895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 05/16/2024]
Abstract
Background Obesity is highly stigmatized, with negative obesity-related stereotypes widespread across society. Internalized weight stigma (IWS) is linked to negative outcomes including poor mental health and disordered eating. Previous evidence examining population groups at higher risk of experiencing IWS comes from small, nonrepresentative samples. Here, we re-assess previously reported associations of IWS with demographic, socioeconomic, and wider social factors in a large general population birth cohort study for the first time. Methods In the Avon Longitudinal Study of Parents and Children (ALSPAC), we explored differences in IWS at age 31 years by sex, ethnicity, socioeconomic factors, sexual orientation, and family and wider social influences, using confounder-adjusted multivariable regression. Findings In models adjusted for potential confounders and BMI in childhood, adolescence, and adulthood (N = 4060), IWS was higher for females (standardized beta: 0.56, 95% CI: 0.50, 0.61), sexual minorities (0.17 S.D. higher, 95% CI: 0.09, 0.24), and less socioeconomically advantaged individuals (e.g., 0.16 S.D. higher (95% CI: 0.08, 0.24) for participants whose mothers had minimum or no qualifications, compared to a university degree). The social environment during adolescence and young adulthood was important: IWS was higher for people who at age 13 years felt pressure to lose weight from family (by 0.13 S.D., 95% CI: 0.03, 0.23), and the media (by 0.17, 95% CI: 0.10, 0.25), or had experienced bullying (e.g., 0.25 S.D., 95% CI: 0.17, 0.33 for bullying at age 23 years). Interpretation Internalized weight stigma differs substantially between demographic groups. Risk is elevated for females, sexual minorities, and socioeconomically disadvantaged adults, and this is not explained by differences in BMI. Pressure to lose weight from family and the media in adolescence may have long-lasting effects on IWS. Funding The ESRC, MRC, NIHR, and Wellcome Trust.
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Affiliation(s)
- Amanda M. Hughes
- MRC Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stuart W. Flint
- School of Psychology, University of Leeds, Leeds, UK
- Scaled Insights, Nexus, University of Leeds, Leeds, UK
| | - Ken Clare
- Leeds Beckett University, Leeds, UK
- Obesity UK, Halifax, UK
- European Coalition for People Living with Obesity, Dublin, Ireland
| | | | - Emily R. Rothwell
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Helen Bould
- MRC Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Gloucestershire Health and Care NHS Foundation Trust, Gloucestershire, UK
| | - Laura D. Howe
- MRC Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
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6
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Kramer EB, Pietri ES, Bryan AD. Reducing anti-fat bias toward the self and others: a randomized controlled trial. J Eat Disord 2024; 12:46. [PMID: 38637889 PMCID: PMC11025213 DOI: 10.1186/s40337-024-00994-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/01/2024] [Indexed: 04/20/2024] Open
Abstract
Despite strong evidence linking anti-fat bias directed toward others with markers of self-directed anti-fat bias, there is a dearth of theory-based research examining the cognitive pathways underlying this relationship, and existing bias-reduction intervention efforts have thus far been conducted with exclusive focus on one domain or the other. Cognitive dissonance (CD)-based interventions have been identified as viable for reducing anti-fat bias directed toward the self and others. However, no study has yet examined whether the effects of these domain-specific interventions (e.g., anti-fat bias towards the self) extend to anti-fat bias in the non-targeted domain (e.g., anti-fat bias towards others). The present study aimed to address these gaps in the literature by comparing effects of brief CD-based interventions targeting anti-fat bias directed toward either the self or others on measures of anti-fat bias. Participants (N = 197, female-identifying undergraduates) were randomized to a writing activity prompting cognitive dissonance about either self-directed or other-directed anti-fat bias, or a bias-consistent control condition. Results indicated that participants in the CD intervention conditions showed significantly greater reductions in both explicit self- and other-directed anti-fat biases than those in the control condition, but results did not significantly differ across CD conditions. This supports the potential utility of interventions simultaneously targeting anti-fat bias in both domains and provides insight into the cognitive pathways underlying these related forms of bias.
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Affiliation(s)
- Emily B Kramer
- Department of Psychology and Neuroscience, University of Colorado Boulder, Muenzinger D244, 345 UCB, Boulder, CO, 80309-0345, USA.
| | - Evava S Pietri
- Department of Psychology and Neuroscience, University of Colorado Boulder, Muenzinger D244, 345 UCB, Boulder, CO, 80309-0345, USA
| | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Muenzinger D244, 345 UCB, Boulder, CO, 80309-0345, USA
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7
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Carels RA, Jansen E, Mansour L, Byrd R, Metzler AL. An examination of the unique contributions of body image and internalized weight bias to psychological well-being outcomes. Body Image 2024; 48:101668. [PMID: 38091859 DOI: 10.1016/j.bodyim.2023.101668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 03/05/2024]
Abstract
High correlations between measures of internalized weight bias (IWB) and body image (BI) have resulted in concerns that IWB is conceptually redundant with BI. This investigation examined the contribution of the unique variance of BI and IWB on three important, weight-related factors: self-esteem, depressive symptoms, and body shame. The study included 403 participants recruited through a Qualtrics research panel. Participants were required to be aged 18 + and have a BMI > 25. The sample contained three equally represented, self-identified racial/ethnic groups: Black non-Hispanic (N = 140), Hispanic (N = 133), and White non-Hispanic (N = 130). When BI was entered in the first step of the regression model, it accounted for 14-40% of the variance in various models; the addition of IWB in step two contributed 11-18% of unique variance. By contrast, when IWB was entered in the first step, it accounted for 25-56% of the variance in various models, with the addition of BI contributing between 0% and 2% unique variance. Therefore, even with a high correlation among the constructs of IWB and BI, IWB was able to contribute unique variance in predicting depressive symptoms, self-esteem, and body shame, and is not redundant with the construct of BI.
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Affiliation(s)
- Robert A Carels
- Department of Psychology, East Carolina University, United States.
| | - Emily Jansen
- Department of Psychology, East Carolina University, United States
| | - Lydia Mansour
- Department of Psychology, East Carolina University, United States
| | - Rhonda Byrd
- Department of Psychology, East Carolina University, United States
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8
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Leget DL, LaCaille LJ, Pearl RL. Comparing measurement of internalized weight stigma and body dissatisfaction. Body Image 2023; 47:101622. [PMID: 37672860 DOI: 10.1016/j.bodyim.2023.101622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
Respective conceptualizations of internalized weight stigma and body dissatisfaction are distinct; however, strong relationships between measures of these two constructs prompts consideration about if these are truly unique constructs or whether current measurement tools are not adequately capturing their uniqueness. In this cross-sectional study, 480 U.S. women (78.8% white; MBMI = 25.9) ages 18-40 years, recruited from Amazon's MechanicalTurk and a mid-sized university, completed an online survey with the Modified Weight Bias Internalization Scale (WBIS-M), a modified Body Parts Satisfaction Scale (BPSS), and other validated measures of body image, eating behavior, and mental health. Exploratory factor analysis of the WBIS-M and the BPSS supported a two-factor solution, although two items from the WBIS-M loaded with BPSS items. After removing these items, the 9-item version of the WBIS-M demonstrated stronger relationships with dysfunctional eating and mental health symptoms than did the BPSS (ꞵ range = 0.32-0.62 vs. 0.01-0.18, respectively). Findings from this study provide evidence to support the validity of WBIS-M and BPSS measuring unique constructs, suggesting that internalized weight stigma can be differentiated from body dissatisfaction. This study also highlights the need for further research that examines current measurement tools for internalized weight stigma and body dissatisfaction.
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Affiliation(s)
- Dakota L Leget
- Department of Psychology, University of Minnesota Duluth, 320 BohH 1207 Ordean Court, Duluth, MN, 55812, USA; Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL, 32611, USA.
| | - Lara J LaCaille
- Department of Psychology, University of Minnesota Duluth, 320 BohH 1207 Ordean Court, Duluth, MN, 55812, USA
| | - Rebecca L Pearl
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL, 32611, USA
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9
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Keast R, Withnell S, Bodell LP. Longitudinal associations between weight stigma and disordered eating across the weight spectrum. Eat Behav 2023; 50:101788. [PMID: 37572490 DOI: 10.1016/j.eatbeh.2023.101788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 08/14/2023]
Abstract
Weight stigma reflects discrimination or stereotyping based on weight, and this construct is associated with body dissatisfaction, low self-esteem, and eating pathology. Recent research suggests that internalizing weight stigma (i.e., endorsing negative stereotypes about one's weight) mediates associations between experienced weight stigma and disordered eating. However, much of this research has been cross-sectional and limited data exist on associations between weight stigma constructs and eating pathology across the weight spectrum. The current study explored whether internalized weight stigma differentially mediates the relationship between experiencing weight stigma and disordered eating symptoms over time in higher-weight versus non-higher-weight individuals. Undergraduate students (N = 661, 80 % Female, 28.5 % higher weight) completed surveys at three time points over six months. Multigroup path analyses tested whether the effects of experienced weight stigma and internalized weight stigma on binge eating, food restriction, and body dissatisfaction differed between the higher-weight and non-higher-weight groups. All models showed improved fit when path estimates were allowed to vary between groups. Mediation analyses indicated a significant indirect effect of experienced weight stigma on binge eating via internalized weight stigma among the higher-weight group but not the non-higher-weight group. Only internalized weight stigma was directly associated with body dissatisfaction across weight status. A direct effect of experienced weight stigma on restriction was found in the non-higher-weight group. Findings suggest that, in general, weight stigma negatively affects body image and eating behavior, although specific effects may vary depending on one's weight.
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Affiliation(s)
- Riley Keast
- Department of Psychology, University of Western Ontario, London, ON, Canada
| | - Samantha Withnell
- Department of Psychology, University of Western Ontario, London, ON, Canada
| | - Lindsay P Bodell
- Department of Psychology, University of Western Ontario, London, ON, Canada.
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10
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Donahue ML, Levin ME, Olson K, Panza E, Lillis J. Examining the role of experiential avoidance and valued action in the negative effects of weight self-stigma. J Behav Med 2023; 46:517-524. [PMID: 36370244 PMCID: PMC10175510 DOI: 10.1007/s10865-022-00378-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/03/2022] [Indexed: 11/15/2022]
Abstract
Harmful effects of weight self-stigma on quality of life and health behaviors have been well-established. However, the processes that lead to these negative outcomes are less understood. Psychological inflexibility is defined as a pattern of rigid psychological reactions dominating over values and meaningful actions. A lack in valued action is characterized by the absence of activities that are connected to what is personally meaningful. In this secondary analysis, we aim to extend research by examining two subprocesses of psychological inflexibility, experiential avoidance and lack of valued action, as statistical mediators of the relations between weight self-stigma and quality of life/health behavior outcomes. Baseline data from a clinical trial comparing weight loss maintenance interventions in a sample of 194 adults living with overweight or obesity and seeking treatment is analyzed. Results show that greater experiential avoidance and lower valued action were significantly related to lower quality of life and satisfaction with social roles, as well as greater depression, anxiety, and binge eating. Further, results from a parallel mediation analysis indicated that weight self-stigma is indirectly related to anxiety, disinhibited eating, and hunger through the relationship with experiential avoidance and lack of valued action.
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Affiliation(s)
- Marissa L Donahue
- Department of Psychology, Utah State University, Logan, UT 84322, USA.
| | - Michael E Levin
- Department of Psychology, Utah State University, Logan, UT 84322, USA
| | - KayLoni Olson
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, USA
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA
| | - Emily Panza
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, USA
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA
| | - Jason Lillis
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, USA
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA
- Department of Psychology, California Northstate University, California, USA
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11
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Romano KA, Heron KE, Sandoval CM, MacIntyre RI, Howard LM, Scott M, Mason TB. Weight Bias Internalization and Psychosocial, Physical, and Behavioral Health: A Meta-Analysis of Cross-Sectional and Prospective Associations. Behav Ther 2023; 54:539-556. [PMID: 37088509 PMCID: PMC10126478 DOI: 10.1016/j.beth.2022.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/25/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
Coinciding with widespread efforts to address obesity, weight bias internalization (a process of self-devaluation wherein individuals apply weight-biased stereotypes to themselves) has gained increased attention as a robust correlate of poor health outcomes. The present meta-analysis aimed to provide the largest quantitative synthesis of associations between weight bias internalization and health-related correlates. Studies that provided zero-order correlations for cross-sectional or prospective associations between weight bias internalization and physical, psychosocial, and behavioral health correlates were included in the meta-analysis. Meta-regression determined whether these associations differed based on demographic (sex/gender, race, age), anthropometric (body mass index), and study-level (publication status, sample type, study quality) moderators. Data for 149 (sub)samples were identified that included between 14 and 18,766 participants (M sample size = 534.96, SD = 1,914.43; M age = 34.73, SD = 12.61, range = 9.95-65.70). Results indicated that greater weight bias internalization was concurrently associated with worse psychosocial (e.g., negative and positive mental health, social functioning), physical (e.g., BMI, weight maintenance, health-related quality of life [HRQoL]), and behavioral health (e.g., disordered eating behaviors, healthy eating, physical activity) across most constructs, with effects ranging from small to very large in magnitude. Preliminary evidence also suggested that greater weight bias internalization was subsequently associated with less weight loss and increased negative mental health. Notable variations in the nature and magnitude of these associations were identified based on the health-related correlate and moderator under consideration. These findings indicate that weight bias internalization is linked to multiple adverse health-related outcomes and provide insight into priorities for future research, theory building, and interventions in this area.
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Affiliation(s)
| | - Kristin E Heron
- The Virginia Consortium Program in Clinical Psychology; Old Dominion University
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Pearl RL, Wadden TA, Groshon LC, Fitterman-Harris HF, Bach C, LaFata EM. Refining the conceptualization and assessment of internalized weight stigma: A mixed methods approach. Body Image 2023; 44:93-102. [PMID: 36549092 DOI: 10.1016/j.bodyim.2022.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
Internalized weight stigma has gained increasing attention in empirical studies, though questions remain about the adequacy of existing measures. The current study utilized a mixed methods approach, including a novel semi-structured interview, to revisit the conceptualization of internalized weight stigma and explore in more depth the stereotypes and impacts of weight reported by individuals with high scores on the widely-used Weight Bias Internalization Scale. All participants were interviewed as part of the screening procedures for two clinical trials (Study 1 n = 84, mean age=47.8 years, 83.3% women, 67.9% Black, mean BMI=39.2 kg/m2; Study 2 n = 129, mean age=50.0 years, 88.4% women, 65.1% white, mean BMI=37.8 kg/m2). The most common weight stereotypes identified were being lazy, lacking willpower or self-control, and having poor eating habits. Up to 66% of participants reported that they did not endorse negative weight stereotypes or apply them to themselves. The most highly identified impacts of weight were on self-image (>70%) and emotions (68-83%), followed by social (37-62%) and health concerns (20-25%). Approximately 60% of participants indicated that weight affected their self-directed thoughts and feelings "very much" to "extremely." Findings have implications for understanding and assessing internalized weight stigma in research and in clinical settings where interventions are needed.
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Affiliation(s)
- Rebecca L Pearl
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL 32610-0165, USA; Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104, USA.
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104, USA
| | - Laurie C Groshon
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL 32610-0165, USA
| | - Hannah F Fitterman-Harris
- Department of Psychological & Brain Sciences, University of Louisville, 2301 S. 3rd St., Life Sciences, Room 317, Louisville, KY 40292, USA
| | - Caroline Bach
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104, USA
| | - Erica M LaFata
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104, USA
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Barnhart WR, Cui S, Cui T, He J. Relationships between weight bias internalization and biopsychosocial health outcomes: A prospective study in Chinese adolescents. Int J Eat Disord 2023; 56:1021-1033. [PMID: 36706116 DOI: 10.1002/eat.23904] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/14/2023] [Accepted: 01/15/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVE An extensive literature has documented the deleterious effects of weight bias internalization (WBI) on biopsychosocial health outcomes. Still, this research is largely confined to the Western context. Furthermore, few studies have explored associations between WBI and biopsychosocial health outcomes, including in non-Western adolescent populations. METHOD The present study explored the longitudinal relationships between WBI and body dissatisfaction, disordered eating, psychosocial impairment related to eating disorder features, and psychological and physical well-being in a sample (N = 1549; aged 11-18 years at baseline) of Chinese adolescents. Relationships between study variables were examined between two waves of data measurement (Time 1, baseline, and Time 2, 6-month). Cross-lagged and multivariate models were used to explore prospective relationships between WBI and biopsychosocial correlates. RESULTS Bidirectional relationships were observed between WBI and biopsychosocial correlates in Chinese adolescents. Adjusting for covariates and other predictor variables, higher body dissatisfaction, disordered eating, psychosocial impairment, and psychological distress at Time 1 predicted higher WBI at Time 2. Furthermore, higher WBI at Time 1 predicted higher body dissatisfaction, disordered eating, psychosocial impairment, and psychological distress at Time 2. DISCUSSION Weight bias internalization and psychosocial correlates were interrelated across time in Chinese adolescents. Improving WBI might be promising in the prevention of eating and body image disturbances and diminished psychosocial well-being. Similarly, reducing eating and body image disturbances and improving psychosocial well-being might be useful prevention targets in reducing WBI in Chinese adolescents. PUBLIC SIGNIFICANCE The present study represents an initial effort to explore bidirectional relationships between WBI and biopsychosocial health outcomes in Chinese adolescents. Findings suggest bidirectional relationships between WBI and psychosocial variables, highlighting the potential utility of incorporating WBI interventions into eating pathology and poor psychosocial well-being prevention designs for Chinese adolescents.
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Affiliation(s)
- Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Shuqi Cui
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Tianxiang Cui
- Department of Psychology, University of Macau, Macau, China
| | - Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
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Morse JL, Dochat C, Wooldridge JS, Herbert MS, Materna K, Blanco BH, Hernandez J, Afari N. Baseline Characteristics and Their Associations with Body Composition of Active-Duty Service Members Enrolling in a Randomized Controlled Trial of a Weight Management Program. Mil Med 2022:usac242. [PMID: 35960850 DOI: 10.1093/milmed/usac242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/20/2022] [Accepted: 07/28/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Increasing rates of overweight and obesity among military service members (SMs) necessitate the implementation of weight management interventions. Evidence for the effectiveness of military weight management interventions is mixed. Effectiveness may be impacted by individual sociodemographic, psychiatric, psychological, and behavioral factors. Baseline data from SMs who were overweight/obese or at risk of failing body composition or physical fitness tests and enrolling in a weight management randomized controlled trial were used to examine (1) individual characteristics of this sample as a whole and by gender and (2) relationships between those characteristics and body composition metrics that are targeted by military weight management interventions. Understanding these relationships may inform intervention approaches. MATERIALS AND METHODS Active duty SMs (N = 178) who enrolled in a randomized clinical trial of the Navy's weight management program "ShipShape" at a large military hospital provided data at their baseline visit. Because of gender differences in average body fat percentage (BF%) and underrepresentation of women SMs in research, independent samples t-tests and chi-square analyses were used to examine differences between male and female SMs across study variables. Multiple regression analyses were used to examine relationships of sociodemographic, psychiatric, psychological, and behavioral variables with body composition metrics, including weight, body mass index (BMI), BF%, and waist circumference (WC). RESULTS Participants (61% female; Mage = 29.66 ± 6.92 years; 59.60% White) had an average BMI in the "obese" range (MBMI = 33.1 ± 3.9 kg/m2). Female participants had significantly higher BF% and significantly lower weight and WC than male participants. Compared to male participants, females reported significantly higher rates of pain and headache diagnoses, lifetime diagnosis of an anxiety disorder, lifetime treatment for a mental health concern, lifetime experiences of sexual trauma/harassment and military sexual trauma, and higher current anxiety and post-traumatic stress disorder symptoms. Across all SMs, body composition metrics were significantly associated with several demographic variables, including gender, age, marital status, Asian race, and Black race. Higher weight-related stigma was significantly associated with higher weight, BMI, BF%, and WC. Additionally, more emotional eating was significantly associated with higher BF%, and higher weight-loss confidence was significantly associated with higher BMI. Sociodemographic, psychiatric, psychological, and behavioral variables predicted the greatest variance in BF% compared to other body composition metrics evaluated. CONCLUSIONS Participants in this study were more likely to be female, relatively young members of the Navy with overweight/obesity, who endorsed pain-related medical conditions, probable mental health conditions, and traumatic experiences at relatively high rates. Despite high endorsement of anxiety, depression, and post-traumatic stress disorder symptoms in this group, only weight-related stigma consistently emerged as significantly associated with body composition metrics. Regression results varied by body composition metric, with the most variance explained in BF%, suggesting that BF% may relate most strongly to sociodemographic, psychiatric, psychological, and behavioral variables associated with weight management. These results highlight the need for weight management programs that address weight-related stigma and mental health concerns of SMs to maximize the effectiveness of intervention efforts.
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Affiliation(s)
- Jessica L Morse
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
| | - Cara Dochat
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA 92093, USA
| | - Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
| | - Karla Materna
- VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Brian H Blanco
- VA San Diego Healthcare System, San Diego, CA 92161, USA
| | | | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
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Bennett BL, Wagner AF, Latner JD. Body Checking and Body Image Avoidance as Partial Mediators of the Relationship between Internalized Weight Bias and Body Dissatisfaction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9785. [PMID: 36011420 PMCID: PMC9408144 DOI: 10.3390/ijerph19169785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
Internalized weight bias is associated with body image disturbances and the development of disordered eating. The association between weight bias internalization and body dissatisfaction has proven difficult to disrupt. In order to develop more effective interventions, we must identify the behavioral targets which account for this robust association. The present study sought to examine whether body checking and body image avoidance mediate the relationship between weight bias internalization and body dissatisfaction. In total, 279 female undergraduates (Mage = 20.13, SD = 4.10) were administered a battery of survey measures. Results demonstrated that body checking partially mediates the relationship between weight bias internalization and body dissatisfaction, Z = 7.42, p < 0.001. Body image avoidance was also found to partially mediate the relationship between weight bias internalization and body dissatisfaction, Z = 70.03, p < 0.001. These findings suggest that body checking and body image avoidance may both partially account for the association between weight bias internalization and body dissatisfaction. These findings extend the existing literature on weight bias internalization by highlighting two behavioral targets for prevention and intervention efforts. Understanding these relationships has important implications for both reducing weight bias internalization and improving body dissatisfaction.
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Affiliation(s)
- Brooke L. Bennett
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, CT 06103, USA
| | - Allison F. Wagner
- Counseling and Psychological Services, University of California San Diego, La Jolla, CA 92093, USA
| | - Janet D. Latner
- Department of Psychology, University of Hawai‘i at Mānoa, Honolulu, HI 96822-2294, USA
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Saunders JF, Nutter S, Russell-Mayhew S. Examining the Conceptual and Measurement Overlap of Body Dissatisfaction and Internalized Weight Stigma in Predominantly Female Samples: A Meta-Analysis and Measurement Refinement Study. Front Glob Womens Health 2022; 3:877554. [PMID: 35528312 PMCID: PMC9070483 DOI: 10.3389/fgwh.2022.877554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/24/2022] [Indexed: 01/31/2023] Open
Abstract
Both body dissatisfaction and internalized weight stigma have been identified as risk factors for many negative health outcomes for women, including depression and eating disorders. In addition to these contributions, these concepts have been found to overlap to various degrees in existing literature. We conducted a systematic review and meta-analysis on articles published prior to February 2022 to demonstrate the conceptual and measurement overlap between body dissatisfaction and internalized weight stigma as currently quantified. We identified 48 studies examining the interrelation between body dissatisfaction and internalized weight stigma in predominantly female samples. Stronger correlations between these two constructs, some bordering on multicollinearity, were prevalent in community samples compared to clinical samples and with some but not all the commonly used measures in the body image and weight stigma fields. Body mass index (BMI) moderated these relations such that individuals with higher self-reported BMI were more likely to report lower correlations between the constructs. This concept proliferation, stronger for individuals with lower BMIs and community samples, necessitates the need change how we conceptualize and measure body dissatisfaction and internalized weight stigma. To this end, we conducted study two to refine existing measures and lessen the degree of measurement overlap between internalized weight stigma and body dissatisfaction, particularly in community samples of women. We aimed to clarify the boundaries between these two concepts, ensuring measurement error is better accounted for. Female university students completed existing measures of body satisfaction and internalized weight stigma, which were analyzed using an exploratory followed by a confirmatory factor analysis. In our attempts to modify two existing measures of internalized weight stigma and body dissatisfaction, the majority of the internalized weight stigma items were retained. In contrast, most of the body dissatisfaction items either cross-loaded onto both factors or loaded on to the internalized weight stigma factor despite being intended for the body dissatisfaction factor, suggesting that the measurement issues identified in recent prior research may be due not only to the way we conceptualize and quantify weight stigma, but also the ways in which we quantify body dissatisfaction, across the existing corpus of body dissatisfaction scales.
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Affiliation(s)
- Jessica F. Saunders
- Hiatt School of Psychology, Clark University, Worcester, MA, United States
- *Correspondence: Jessica F. Saunders
| | - Sarah Nutter
- Department of Educational Psychology and Leadership Studies, University of Victoria, Victoria, BC, Canada
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