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Chang DF, Donald J, Whitney J, Miao IY, Sahdra B. Does Mindfulness Improve Intergroup Bias, Internalized Bias, and Anti-Bias Outcomes?: A Meta-Analysis of the Evidence and Agenda for Future Research. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2024; 50:1487-1516. [PMID: 37382426 DOI: 10.1177/01461672231178518] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Whereas mindfulness has been shown to enhance personal well-being, studies suggest it may also benefit intergroup dynamics. Using an integrative conceptual model, this meta-analysis examined associations between mindfulness and (a) different manifestations of bias (implicit/explicit attitudes, affect, behavior) directed toward (b) different bias targets (outgroup or ingroup, e.g., internalized bias), by (c) intergroup orientation (toward bias or anti-bias). Of 70 samples, 42 (N = 3,229) assessed mindfulness-based interventions (MBIs) and 30 (N = 6,002) were correlational studies. Results showed a medium-sized negative effect of MBIs on bias outcomes, g = -0.56, 95% confidence interval [-0.72, -0.40]; I(2;3)2: 0.39; 0.48, and a small-to-medium negative effect between mindfulness and bias for correlational studies, r = -0.17 [-0.27, -0.03]; I(2;3)2: 0.11; 0.83. Effects were comparable for intergroup bias and internalized bias. We conclude by identifying gaps in the evidence base to guide future research.
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Affiliation(s)
| | - James Donald
- The University of Sydney, New South Wales, Australia
| | | | | | - Baljinder Sahdra
- Australian Catholic University, North Sydney, New South Wales, Australia
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2
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DeFazio S, Mastrili N, Szoka N, Schneider KL, Cox S, Aylward L. Sexual orientation moderates the relationship between internalized weight bias and binge eating symptoms among adults pursuing bariatric surgery. Surg Obes Relat Dis 2024; 20:784-789. [PMID: 38641526 DOI: 10.1016/j.soard.2024.03.019] [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: 12/21/2023] [Revised: 02/16/2024] [Accepted: 03/09/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Sexual minorities have higher rates of anxiety, depression, and binge eating compared to heterosexual peers. Internalized weight bias (IWB) is also higher for sexual minorities when compared to heterosexual peers. However, research has not examined whether the relationships between IWB and anxiety, depression, and binge eating differ among heterosexual and sexual minority adults pursuing bariatric surgery. OBJECTIVES To examine whether sexual orientation (heterosexual or sexual minority) moderated the relationships between IWB and anxiety, depression, and binge eating among adults pursuing bariatric surgery. SETTING University hospital, United States METHODS: Participants included 811 adults who presented for bariatric surgery, 45 (5.5%) of which identified as a sexual minority. Self-reported data were collected as part of a standard preoperative psychological evaluation for surgical clearance. Three separate moderation models were run to test hypotheses. RESULTS Sexual orientation did not moderate the association of IWB with anxiety or depression. The IWB by sexual orientation interaction was significant for binge eating (F 1856) = 4.84, P = .03, R2 = .27 such that the association between IWB and binge eating was significantly stronger for sexual minority patients (b = .54, 95% confidence interval {CI} [.36, .70]), compared to heterosexual patients (b = .33, 95% CI [.30, .38]). CONCLUSIONS Minority stress from identifying as a sexual minority may increase vulnerability to binge eating from IWB among bariatric candidates. Future research examining the directionality of the relationship between IWB and binge eating among sexual minorities is warranted.
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Affiliation(s)
- Sarah DeFazio
- School of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Noelle Mastrili
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Nova Szoka
- Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Kristin L Schneider
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Stephanie Cox
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Laura Aylward
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia.
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Smith SS, Ten Hoor GA, Lakhote N, Massar K. Emotion in Motion: Weight Bias Internalization, Exercise Avoidance, and Fitness-Related Self-Conscious Emotions. Healthcare (Basel) 2024; 12:955. [PMID: 38786367 PMCID: PMC11121544 DOI: 10.3390/healthcare12100955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/15/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
Weight bias internalization (WBI), the process of internalizing negative attitudes and stereotypes towards overweight individuals, significantly impacts self-worth and health behaviors, such as exercise avoidance. In the current study, we focused on the mediating role of fitness-related self-conscious emotions, particularly shame and guilt. A cross-sectional study involving 150 self-described overweight Dutch women (age M = 49.63 ± 10.72) was conducted online. Participants completed measures assessing weight bias internalization, exercise avoidance, and body/fitness-related self-conscious emotions. Data were analyzed using linear regression and mediation analysis, controlling for age, BMI, and exercise frequency. The results show that weight bias internalization, guilt-free shame, and shame-free guilt uniquely predict exercise avoidance. Guilt-free shame partially mediated the relationship between weight bias internalization and exercise avoidance, indicating that increased internalized weight bias led to higher levels of guilt-free shame, which in turn contributed to exercise avoidance. Shame-free guilt did not act as a unique mediator. These findings underscore the importance of addressing weight bias internalization and fitness-related self-conscious emotions, particularly guilt-free shame, in interventions targeting exercise avoidance among overweight individuals. Strategies promoting self-compassion and reducing shame may prove beneficial in improving exercise behaviors and overall well-being.
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Affiliation(s)
| | | | | | - Karlijn Massar
- Department of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (S.S.S.); (G.A.T.H.); (N.L.)
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4
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O'Donnell AT, Foran AM. The link between anticipated and internalized stigma and depression: A systematic review. Soc Sci Med 2024; 349:116869. [PMID: 38678910 DOI: 10.1016/j.socscimed.2024.116869] [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: 01/19/2024] [Revised: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
Stigmatized groups may experience psychological distress. Yet, some studies show no significant relation between stigma and mental health outcomes. This systematic review investigates the link between anticipated and internalized stigma, and one mental health outcome, depression. We aimed to (1) determine whether anticipated and internalized stigma predict levels of depression, and (2) review the quality of evidence for this link. We searched PsycInfo, PubMed and EMBASE databases. Eighty-three studies (N = 34,705) met our inclusion criteria, across five stigma categories: Sexual and gender minorities; HIV/AIDS; Illness or disability-related (non-HIV); Weight, and Other. We reviewed evidence within each category and study design and developed a narrative synthesis. Sixty studies (72.3%) supported the proposed link, which varied across categories from 53.6% to 100%. Using the NIH quality assessment tool, most studies were of fair quality. Most cross-sectional studies (76.7%) straightforwardly supported the positive relation between internalized and/or anticipated stigma and depression, while only 40% of longitudinal studies did. Implications for the study of stigma and mental health outcomes are discussed.
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Affiliation(s)
- Aisling T O'Donnell
- Centre for Social Issues Research, Department of Psychology, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Aoife-Marie Foran
- Centre for Social Issues Research, Department of Psychology, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
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Schraven S, Hübner C, Eichler J, Mansfeld T, Sander J, Seyfried F, Kaiser S, Dietrich A, Schmidt R, Hilbert A. Psychometric Properties of the WBIS/M in a Representative Prebariatric Sample: Evidence for an Improved 10-Item Version. Obes Facts 2024; 17:329-337. [PMID: 38350429 PMCID: PMC11299967 DOI: 10.1159/000537689] [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: 11/09/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION The Weight Bias Internalization Scale and the Modified Weight Bias Internalization Scale are well-established self-report questionnaires for assessing weight bias internalization, which is widespread among bariatric patients. However, among this group, psychometric properties of the Weight Bias Internalization Scale have only been examined in small samples showing unsatisfactory model fit and have not been explored for the modified questionnaire. METHODS This study psychometrically evaluated and compared the Weight Bias Internalization Scale and Modified Weight Bias Internalization Scale in a large sample of prebariatric patients (N = 825, mean age = 46.75 years, SD = 11.55) regarding item characteristics, model fit to unidimensionality, reliability, construct validity, and measurement invariance. RESULTS Item 4 of both questionnaires showed low corrected item-total correlations (<0.40) and was therefore removed from the scales. The new 10-item versions showed improved item characteristics, internal consistency, model fit to unidimensionality, and convergent and divergent validity when compared to the 11-item versions. The best psychometric properties were found for the 10-item version of the Modified Weight Bias Internalization Scale. CONCLUSION The 10-item version of the Modified Weight Bias Internalization Scale surpasses the other versions studied in all psychometric properties. Therefore, it should be used in prebariatric patients to detect weight bias internalization and provide them with psychological interventions that could improve bariatric surgery outcomes.
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Affiliation(s)
- Simon Schraven
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany,
| | - Claudia Hübner
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Janina Eichler
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Thomas Mansfeld
- Department of General Surgery, Asklepios Clinic Hamburg, Hamburg, Germany
| | - Johannes Sander
- Schön Klinik Hamburg Eilbek, Obesity Clinic Hamburg, Hamburg, Germany
| | - Florian Seyfried
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Kaiser
- Department of Visceral, Pediatric and Vascular Surgery, Hospital Konstanz, Konstanz, Germany
| | - Arne Dietrich
- Department of Surgery, Clinic for Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Ricarda Schmidt
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
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6
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Nakamura Y, Asano M. Developing and validating a Japanese version of the Weight Self-Stigma Questionnaire. Eat Weight Disord 2023; 28:44. [PMID: 37195385 DOI: 10.1007/s40519-023-01573-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/11/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE Weight bias internalization (WBI) is significantly associated with negative physiological and psychological consequences. Given its negative effects, appropriate measurement of WBI is required for weight management and mental and physical health in people with weight problems. One of the most reliable and frequently used questionnaires to assess WBI is the Weight Self-Stigma Questionnaire (WSSQ). However, a Japanese version of the WSSQ has not yet been developed. Thus, the current study aimed to develop a Japanese version of the WSSQ (WSSQ-J) and validate its psychometric properties in the Japanese context. METHODS A total of 1454 Japanese participants (age 34.44 ± 6.92; male = 498) with diverse weight statuses (Body mass index: 21.44 ± 3.52, 13.79-41.40 kg/m2) completed an online survey for the WSSQ-J. The internal consistency of the WSSQ-J was estimated by calculating Cronbach's α. Confirmatory factor analysis (CFA) was then carried out to confirm that the factor structure of the WSSQ-J was the same as that of the subscales of the original WSSQ. RESULTS The WSSQ-J had a Cronbach's α of 0.917, indicating good internal consistency. In CFA, the comparative fit index was 0.945, the root mean square error of approximation was 0.085, and the standardized root mean square residual was 0.040, indicating that the two-factor model showed satisfactory goodness-of-fit. CONCLUSION This study replicated the original findings related to the WSSQ, showing that the WSSQ-J is a reliable WBI questionnaire consisting of two factors. Therefore, the WSSQ-J would be a reliable tool for assessing WBI among Japanese. LEVEL OF EVIDENCE Level V, descriptive cross-sectional study.
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Affiliation(s)
- Yuko Nakamura
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, 3-8-1, Komaba, Meguro-Ku, Tokyo, 153-8902, Japan.
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Meguro-Ku, Tokyo, 153-8902, Japan.
| | - Michiko Asano
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, 3-8-1, Komaba, Meguro-Ku, Tokyo, 153-8902, Japan
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7
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He J, Barnhart WR, Zhang Y, Han J, Wang Z, Cui S, Nagata JM. Muscularity teasing and its relations with muscularity bias internalization, muscularity-oriented body dissatisfaction, and muscularity-oriented disordered eating in Chinese adult men. Body Image 2023; 45:382-390. [PMID: 37104997 DOI: 10.1016/j.bodyim.2023.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
Despite increasing research on weight teasing and other forms of appearance teasing, muscularity teasing, which occurs when an individual is victimized due to low muscularity, has not yet received research attention. Given the solid evidence of positive relations between weight teasing and thinness-oriented body dissatisfaction and disordered eating, we aimed to tap into muscularity teasing and examine its relations with muscularity-oriented body dissatisfaction and muscularity-oriented disordered eating (e.g., rigid dietary rules for enhancing muscularity). A sample of 500 Chinese men, aged 18 - 62 years, were recruited online, and they competed questionnaires assessing muscularity teasing, muscularity bias internalization, muscularity-oriented body dissatisfaction, and muscularity-oriented disordered eating. Correlation analyses showed that muscularity teasing was significantly related to muscularity bias internalization (r = 0.55, p < .001), muscularity-oriented body dissatisfaction (r = 0.50, p < .001), and muscularity-oriented disordered eating (r = 0.38, p < .001). Structural equation modelling indicated that muscularity bias internalization and muscularity-oriented body dissatisfaction, as concurrent mediators, fully mediated the relationships between muscularity teasing and muscularity-oriented disordered eating. Findings extend existing knowledge in appearance teasing research to encompass muscularity teasing in order to better understand the etiology of muscularity-oriented body dissatisfaction and muscularity-oriented disordered eating.
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Affiliation(s)
- Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China.
| | - Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Yuchen Zhang
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Jiayi Han
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Ziyue Wang
- School of Humanities and Social Sciences, Beijing Forestry University, Beijing, China
| | - Shuqi Cui
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Jason M Nagata
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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8
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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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9
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Associations among enacted weight stigma, weight self-stigma, and multiple physical health outcomes, healthcare utilization, and selected health behaviors. Int J Obes (Lond) 2023; 47:33-38. [PMID: 36333585 DOI: 10.1038/s41366-022-01233-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study examined the relationship among enacted weight stigma, weight self-stigma, and multiple health outcomes. Weight stigma, a stressor experienced across all body sizes, may contribute to poorer physical health outcomes by activating the nervous and endocrine system or by triggering counterproductive health behaviors like lower physical activity, maladaptive eating patterns, and delayed health care, as well as provider bias that may cause a medical concern to be discounted. While associations of weight stigma with mental health issues are well documented, less is known about its association with physical health. METHODS We enrolled 3821 adults who completed an online survey assessing enacted weight stigma, weight self-stigma, multiple self-reported physical health outcomes, healthcare utilization, and selected health behaviors. RESULTS After controlling for BMI, health care delay or avoidance, sedentary behavior, and selected demographic characteristics, enacted weight stigma, significantly increased the odds of six physical health problems including hypertension (OR 1.36; CI 1.08, 1.72), hyperglycemia (OR 1.73; CI 1.29, 2.31), thyroid disorder, (OR 1.65; CI 1.27, 2.13), any arthritis (OR 1.70; CI 1.27, 2.26), non-arthritic chronic pain (OR 1.76; CI 1.4, 2.29), and infertility (OR 1.53; CI 1.14, 2.05). Weight self-stigma significantly increased the odds for three physical health problems including hypertension (OR 1.43; CI 1.16, 1.76), hyperglycemia (OR 1.37; CI 1.03, 1.81), and non-arthritic chronic pain (OR 1.5; CI 1.2,1.87). Enacted stigma was associated with more than a four-fold increase in odds of believing that a medical concern was disregarded by a health care provider. CONCLUSIONS In this study, enacted stigma and weight self-stigma were independently associated with heightened risk for multiple physical health problems, as well as, believing health concerns were discounted by providers. Reducing weight stigma may be an important component of managing multiple physical health conditions.
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10
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Magallares A, de Valle PB, Irles JA, Recio P, Jáuregui-Lobera I. Psychometric properties of the Spanish version of the Weight Self-Stigma Questionnaire (S-WSSQ) in a sample of participants with obesity seeking weight loss treatment. Eat Weight Disord 2022; 27:3685-3693. [PMID: 36434471 PMCID: PMC9803612 DOI: 10.1007/s40519-022-01511-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Weight self-stigma may be defined as a self-devaluation due to one's identification with the group of people with obesity. The Weight Self-Stigma Questionnaire (WSSQ) is an instrument specifically designed to measure weight self-stigma in populations with overweight or obesity. The objective of this study was to adapt the WSSQ to the Spanish population (S-WSSQ) following the guidelines for cross-cultural adaptations. METHODS The sample comprised 165 participants with obesity seeking weight loss treatment (65% women) at the "Hospital de Valme" (Seville, Spain). Scales to measure life satisfaction, self-esteem, positive and negative affect, and antifat attitudes were used to analyze the convergent and divergent validity of the S-WSSQ. RESULTS A confirmatory factor analysis showed adequate values of the goodness of fit indexes of a two-factor model (χ2/df = 2.01 CFI = 0.92, IFI = 0.92, SRMR = 0.08, RMSEA = 0.078), replicating the structure found by the original authors. Cronbach's alphas of the two factors were 0.76 (self-devaluation) and 0.77 (fear of enacted stigma). Composite Reliability values were 0.72 (self-devaluation) and 0.76 (fear of enacted stigma). Self-devaluation and fear of enacted stigma were negatively related to self-esteem, and positive affect, and positively related to negative affect and antifat attitudes. Finally, life satisfaction was negatively correlated to fear of enacted stigma. CONCLUSIONS Based on these results, it is concluded that the S-WSSQ has good psychometric properties and might be used by the Spanish-speaking scientific community to measure weight self-stigma. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Alejandro Magallares
- School of Psychology, Social Psychology Department, Spanish Open University (UNED), Madrid, Spain.
- Departamento de Psicología Social y de las Organizaciones, Facultad de Psicología UNED, C/ Juan del Rosal, 10, 28040, Madrid, Spain.
| | | | | | - Patricia Recio
- School of Psychology, Methodology Department, Spanish Open University (UNED), Madrid, Spain
| | - Ignacio Jáuregui-Lobera
- School of Experimental Sciences, Nutrition and Bromatology, Universidad Pablo de Olavide, Seville, Spain
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11
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He J, Tang C, Song J, Cui T, Barnhart WR, Cui S, Ren Y, Nagata JM. The Muscularity Bias Internalization Scale: Development and initial validation in Chinese adult men. Body Image 2022; 43:326-336. [PMID: 36244184 DOI: 10.1016/j.bodyim.2022.09.013] [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: 01/27/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 11/05/2022]
Abstract
The present study developed the Muscularity Bias Internalization Scale (MBIS), a measure of muscularity bias internalization, which assesses the extent to which an individual endorses muscularity-based stereotypes and engages in negative self-evaluations due to muscularity. In Study 1, a pool of candidate items was developed. By using exploratory factor analysis (EFA) on a sample of 300 Chinese adult men (Mage = 29.98 years, SD = 7.81), 14 items from the item pool were retained. The 14-item MBIS contained three factors. In Study 2, a second sample of 300 Chinese adult men (Mage = 29.50 years, SD = 7.50) was used to confirm the factor structure of the MBIS, as well as to examine its reliability and validity. Confirmatory factor analysis (CFA) further confirmed the three-factor structure of the MBIS with a good model fit. The MBIS showed high internal consistency reliability and high two-week test-retest reliability. The MBIS also showed good construct validity with measures of drive for muscularity, muscularity-oriented disordered eating, and muscle dysmorphia symptoms. The newly developed MBIS may help understand the role of muscularity bias internalization in the development and maintenance of muscularity-oriented body image and muscularity-oriented disordered eating.
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Affiliation(s)
- Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China.
| | - Chanyuan Tang
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Jianwen Song
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China; Department of Educational Psychology, Baylor University, Waco, TX, United States
| | - Tianxiang Cui
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China; Department of Psychology, University of Macau, Macau, China
| | - Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Shuqi Cui
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Yaoxiang Ren
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | - Jason M Nagata
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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12
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Bidstrup H, Brennan L, Hindle A, Kaufmann L, de la Piedad Garcia X. Internalised Weight Stigma Mediates Relationships Between Perceived Weight Stigma and Psychosocial Correlates in Individuals Seeking Bariatric Surgery: a Cross-sectional Study. Obes Surg 2022; 32:3675-3686. [PMID: 36094627 PMCID: PMC9613718 DOI: 10.1007/s11695-022-06245-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Research suggests that internalised weight stigma may explain the relationship between perceived weight stigma and adverse psychological correlates (e.g. depression, disordered eating, body image disturbances). However, few studies have assessed this mechanism in individuals seeking bariatric surgery, even though depression and disordered eating are more common in this group than the general population. MATERIALS AND METHODS We used data from a cross-sectional study with individuals seeking bariatric surgery (n = 217; 73.6% female) from Melbourne, Australia. Participants (Mage = 44.1 years, SD = 11.9; MBMI = 43.1, SD = 7.9) completed a battery of self-report measures on weight stigma and biopsychosocial variables, prior to their procedures. Bias-corrected bootstrapped mediations were used to test the mediating role of internalised weight stigma. Significance thresholds were statistically corrected to reduce the risk of Type I error due to the large number of mediation tests conducted. RESULTS Controlling for BMI, internalised weight stigma mediated the relationship between perceived weight stigma and psychological quality of life, symptoms of depression and anxiety, stress, adverse coping behaviours, self-esteem, exercise avoidance, some disordered eating measures and body image subscales, but not physical quality of life or pain. CONCLUSION Although the findings are cross-sectional, they are mostly consistent with previous research in other cohorts and provide partial support for theoretical models of weight stigma. Interventions addressing internalised weight stigma may be a useful tool for clinicians to reduce the negative correlates associated with weight stigma.
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Affiliation(s)
- Hugh Bidstrup
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC, 3065, Australia
- School of Psychology and Public Health, La Trobe University, Albury-Wodonga, 3690, Australia
| | - Leah Brennan
- School of Psychology and Public Health, La Trobe University, Albury-Wodonga, 3690, Australia
- Centre for Eating, Weight, and Body Image, Suite 215, 100 Victoria Parade, East Melbourne, VIC, 3002, Australia
| | - Annemarie Hindle
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC, 3065, Australia
- School of Psychology and Public Health, La Trobe University, Albury-Wodonga, 3690, Australia
- Centre for Eating, Weight, and Body Image, Suite 215, 100 Victoria Parade, East Melbourne, VIC, 3002, Australia
| | - Leah Kaufmann
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Xochitl de la Piedad Garcia
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC, 3065, Australia.
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13
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Bennett BL, Lawson JL, Funaro MC, Ivezaj V. Examining weight bias before and/or after bariatric surgery: A systematic review. Obes Rev 2022; 23:e13500. [PMID: 36053042 DOI: 10.1111/obr.13500] [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: 04/08/2022] [Revised: 06/10/2022] [Accepted: 07/24/2022] [Indexed: 11/29/2022]
Abstract
Research examining weight bias in the bariatric population, who may be at greater risk of weight stigma, is scarce. The present study aimed to systematically review the literature for quantitative evidence that explores the medical, psychosocial, and behavioral sequelae associated with experienced, internalized, and/or externalized weight bias in patients seeking or who have undergone bariatric surgery. Five databases were systematically searched for English peer-reviewed quantitative studies, which examined weight bias in a sample of individuals seeking or who had undergone bariatric surgery. Risk of bias was assessed. Twenty-nine studies were included, of which 13 examined internalized weight bias, 12 examined experienced weight bias, 4 examined both, and 0 examined externalized weight bias. Most studies were cross-sectional, and the results showed high risk of bias. The results suggested that both experienced and internalized weight bias were associated with a host of negative psychosocial, behavioral, and medical sequelae. The findings of this review underscore the need for more rigorous research to better understand the relationship between weight bias and bariatric surgery, particularly longitudinally. Future patients may benefit from research developing interventions for reducing weight bias prior to and following bariatric surgery in order to reduce the associated negative correlates and improve outcomes.
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Affiliation(s)
- Brooke L Bennett
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jessica L Lawson
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, USA
| | - Valentina Ivezaj
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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14
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Endo S, Kasuga H, Yusuke M, Hidaka T, Kakamu T, Fukushima T. Reliability and validity of the Japanese version of the weight bias internalization scale. BMC Res Notes 2022; 15:333. [PMID: 36273190 PMCID: PMC9588207 DOI: 10.1186/s13104-022-06221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/22/2022] [Indexed: 11/26/2022] Open
Abstract
Objective The weight bias internalization scale (WBIS) is widely used in several languages. However, there is no Japanese version of the WBIS. The purpose of this study is to develop a Japanese version of the WBIS and to verify its reliability and validity. We translated the original version of the WBIS and had approval from the scale developer. Adults who perceived themselves to be obese completed online baseline survey (N = 285) and two-week follow-up survey (N = 100). We used the Japanese WBIS and scales for obesity-related quality of life, self-esteem, self-efficacy, and depression. We calculated Cronbach’s alpha and intra-class correlation coefficient (ICC) to assess reliability of the WBIS and conducted confirmatory factor analysis (CFA) and correlation analysis to assess its validity. Results Cronbach’s alpha was 0.91 at baseline and 0.92 at follow-up, and the ICC was 0.87. CFA showed that a one-factor model demonstrated an acceptable fit (χ2 (44) = 158.6, CFI = 0.93, RMSEA = 0.096, SRMR = 0.051), similar to the original version. As we had hypothesized, overall, the Japanese version of the WBIS was significantly correlated with obesity-related quality of life, self-esteem, self-efficacy, and depression. These results confirmed its adequate reliability and validity. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-06221-x.
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Affiliation(s)
- Shota Endo
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Hikarigaoka 1, 960-1295, Fukushima, Japan.
| | - Hideaki Kasuga
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Hikarigaoka 1, 960-1295, Fukushima, Japan
| | - Masuishi Yusuke
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Hikarigaoka 1, 960-1295, Fukushima, Japan
| | - Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Hikarigaoka 1, 960-1295, Fukushima, Japan
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Hikarigaoka 1, 960-1295, Fukushima, Japan
| | - Tetsuhito Fukushima
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Hikarigaoka 1, 960-1295, Fukushima, Japan
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15
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Rossi AA, Manzoni GM, Pietrabissa G, Di Pauli D, Mannarini S, Castelnuovo G. Weight stigma in patients with overweight and obesity: validation of the Italian Weight Self-Stigma Questionnaire (WSSQ). Eat Weight Disord 2022; 27:2459-2472. [PMID: 35290623 PMCID: PMC9556395 DOI: 10.1007/s40519-022-01385-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/26/2022] [Indexed: 02/06/2023] Open
Abstract
PURPOSE This study aimed to explore the factorial structure of the Italian Weight Self-Stigma Questionnaire (WSSQ) (Study1); and to test structural validity, internal consistency, test-retest reliability, and measurement invariance of the questionnaire across gender, Body Mass Index (BMI), age and occurrence of previous hospitalization for obesity (Study2). METHODS At admission into a hospital-based program for weight reduction and rehabilitation, 150 inpatients with overweight/obesity (68% females) completed the WSSQ (Study1). In Study2, in addition to the WSSQ, 446 inpatients (61.9% females) completed the Weight Bias Internalization Scale (WBIS), the Body Uneasiness Test (BUT), and the Center for Epidemiologic Studies Depression Scale (CES-D). A subsample of 40 patients also re-completed the WSSQ at discharge from the hospital. RESULTS The Italian WSSQ showed good overlap with the original factorial structure (Study1) and results were confirmed in Study2. Test-retest reliability and convergent validity showed adequate values. Measurement invariance revealed that WSSQ was perfectly invariant across both BMI and the occurrence of previous hospitalizations for obesity. In both studies, the internal consistency of the questionnaire was deemed acceptable. CONCLUSIONS The Italian WSSQ is a valid, reliable, and invariant tool for the assessment of weight-related self-stigma among patients with overweight/obesity. Future studies should assess its longitudinal invariance as well as its responsiveness to weight reduction treatments. LEVEL OF EVIDENCE V, descriptive study.
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Affiliation(s)
- Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy. .,Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy.
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,Faculty of Psychology, eCampus University, Novedrate, Como, Italy
| | - Giada Pietrabissa
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,Department of Psychology, Catholic University of Milan, Milan, Italy
| | | | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy.,Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy.,Department of Psychology, Catholic University of Milan, Milan, Italy
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16
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Liu X, Zhang W, Yue W, Sun C, Li W. From Weight Bias Internalization to Health-Related Quality of Life: Self-esteem and Psychopathology in Pre-bariatric Surgery Patients. Obes Surg 2022; 32:3705-3713. [PMID: 36057756 PMCID: PMC9613576 DOI: 10.1007/s11695-022-06261-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION It has been reported that people seeking bariatric surgery have poor health-related quality of life (HRQoL). Weight bias internalization (WBI) is prevalent in this population and strongly associated with psychopathology and health status. However, the psychological mechanisms underlying the relationship between WBI and the physical and mental dimensions of HRQoL remain to be clarified. METHODS A preoperative sample of patients with obesity (N = 246; women = 75.2%; Mage = 32.07) completed validated measures as part of a routine preoperative psychological assessment to assess their WBI, self-esteem, anxiety symptoms, depressive symptoms, and HRQoL. RESULTS After controlling for the effects of gender, age, and BMI, WBI was linked to poorer physical and mental HRQoL through low self-esteem and increased psychological distress, including anxiety and depressive symptoms. CONCLUSION In pre-bariatric surgery patients with obesity, high WBI may predict impairments in mental and physical HRQoL by lowering self-esteem, and further increasing anxiety and depressive symptoms. Interventions targeting WBI may be an important aspect to consider in the clinical treatment of pre-bariatric surgery patients. Further longitudinal studies are warranted to determine causality.
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Affiliation(s)
- Xu Liu
- Operating Theater, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China
| | - Wenjing Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China
| | - Wenwen Yue
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China
| | - Chaonan Sun
- Operating Theater, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China
| | - Weihua Li
- Operating Theater, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China.
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17
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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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18
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Jones A, Hardman CA, Devlin N, Pennington CR, Robinson E. Weight-based discrimination in financial reward and punishment decision making: causal evidence using a novel experimental paradigm. Int J Obes (Lond) 2022; 46:1288-1294. [PMID: 35338259 PMCID: PMC9239905 DOI: 10.1038/s41366-022-01109-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Cross-sectional research has demonstrated weight-related stigma and discrimination, however experimental research providing causal evidence of financial-based weight discrimination is lacking. The aim of these preregistered experiments was to examine whether a novel paradigm in which participants attributed financial rewards and punishments could be used to detect weight bias. SUBJECTS/METHODS One-hundred and twenty-one individuals participated in experiment 1 and one-hundred and sixty-six individuals participated in experiment 2. Both studies were conducted online, and participants were provided with biographies of hypothetical individuals in which weight-status was manipulated (normal weight vs. overweight/obesity) before being asked to provide rewards and punishments on their cognitive performance. In experiment 1 (within-participants design) participants observed one individual they believed to be normal weight and one individual they believed to be overweight/have obesity. In experiment 2 (between-participants design) participants observed one individual whilst also being provided with information about food addiction (Food addiction is real + individual with overweight/obesity vs. food addiction is a myth + individual with overweight/obesity vs control + individual with normal weight). RESULTS In experiment 1, participants punished individuals who were described as having overweight/obesity to a greater extent to individuals who were normal weight (Hedge's g = -0.21 [95% CI: -0.02 to -0.41], p = 0.026), but there was no effect on rewards. They were also less likely to recommend individuals with overweight/obesity to pass the tasks (X2(1) = 10.05, p = 0.002). In experiment 2, participants rewarded individuals whom they believed were overweight/obese to a lesser extent than normal-weight individuals (g = 0.49 [95% CI: 0.16 to 0.83]. There was no effect on punishment, nor any impact of information regarding food addiction as real vs a myth. CONCLUSION Using a novel discrimination task, these two experiments demonstrate causal evidence of weight-based discrimination in financial decision making.
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Affiliation(s)
- Andrew Jones
- Psychology, University of Liverpool, Liverpool, UK.
| | | | - Niamh Devlin
- Psychology, University of Liverpool, Liverpool, UK
| | - Charlotte R Pennington
- School of Psychology, Aston University, Birmingham, UK.,Institute of Health & Neurodevelopment, Aston University, Birmingham, England
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19
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Hopkins CM, Miller HN, Brooks TL, Mo-Hunter L, Steinberg DM, Bennett GG. Designing Ruby: Protocol for a 2-Arm, Brief, Digital Randomized Controlled Trial for Internalized Weight Bias. JMIR Res Protoc 2021; 10:e31307. [PMID: 34842549 PMCID: PMC8663559 DOI: 10.2196/31307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Weight bias internalization, also known as weight self-stigma, is a serious health concern for individuals with higher body weight. Weight bias internalization is associated with the greater avoidance of health care and health-promoting activities, disordered eating, social isolation, and weight gain. Elevated weight bias internalization has been associated with low self-compassion, yet few investigations have explored self-compassion as a potential mechanism for reducing internalized weight bias. OBJECTIVE Ruby is a 2-arm randomized controlled trial that was designed to test the efficacy of a 4-week digital self-compassion intervention to reduce internalized weight bias compared with a wait-list control. METHODS Adults with elevated internalized weight bias and a BMI of >30 kg/m2 (N=80) were recruited. Ruby is a standalone digital trial that will be delivered entirely via a smartphone and will involve web-based data collection and text messages. The intervention content will include psychoeducation and daily mindfulness practices with a focus on self-compassion and body concerns. We will use intent-to-treat analyses to examine changes in weight bias internalization throughout time by treatment arm. The analyses will be conducted by using one-way analysis of covariance models and linear mixed models. RESULTS The protocol was designed in May 2020 and approved in December 2020. Data collection is currently underway. CONCLUSIONS Ruby will be the first digital standalone, self-compassion-based intervention designed to reduce internalized weight bias. Owing to its standalone digital delivery, Ruby may be a highly scalable treatment for internalized weight bias that can be delivered on its own or combined with other treatments. We expect Ruby to be accessible to many, as participants can access the digital intervention at times of the day that are the most convenient in their schedule and are not burdened by in-person time commitments, which can be a barrier for participants with competing demands on their time and resources. If efficacious, Ruby will be poised to expand a burgeoning body of literature related to psychological intervention in this area. TRIAL REGISTRATION ClinicalTrials.gov NCT04678973; https://clinicaltrials.gov/ct2/show/NCT04678973. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/31307.
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Affiliation(s)
- Christina M Hopkins
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Hailey N Miller
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States.,School of Nursing, Duke University, Durham, NC, United States
| | - Taylor L Brooks
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Lihua Mo-Hunter
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Dori M Steinberg
- School of Nursing, Duke University, Durham, NC, United States.,Equip Health, San Diego, CA, United States
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
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20
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Christensen KA, Forbush KT, Cushing CC, Lejuez CW, Fleming KK, Swinburne Romine RE. Evaluating associations between fitspiration and thinspiration content on Instagram and disordered-eating behaviors using ecological momentary assessment: A registered report. Int J Eat Disord 2021; 54:1307-1315. [PMID: 33836098 PMCID: PMC9434495 DOI: 10.1002/eat.23518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/11/2021] [Accepted: 03/31/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Greater use of appearance-focused social media, such as Instagram, is associated with increased body dissatisfaction and eating disorder (ED) symptoms; however, questions remain about the mechanism connecting social media use to disordered-eating behaviors (DEBs). The proposed study evaluates how and for whom exposure to fitspiration or thinspiration on Instagram is associated with DEBs. METHODS We will evaluate a hypothesized pathway from Instagram use to disordered-eating mediated by negative affect. We will test how individual differences in internalized weight stigma, trait self-esteem, and trait self-comparison moderate the pathway from social media use to negative affect. We will recruit 175 undergraduate women who report engaging in DEBs on average at least once per week over the past 3 months. Participants will complete a 7-day ecological momentary assessment protocol, during which they will report their Instagram use, affect, and engagement in DEBs. RESULTS Multi-level modeling will be used to assess moderated mediation. Results from this study will provide increased specificity about how Instagram usage is linked to eating pathology and who may be most vulnerable to experiencing distress. DISCUSSION Information about negative affect from Instagram and engagement in DEBs could contribute to the development of Just-In-Time Interventions for problematic social media use.
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Affiliation(s)
| | - Kelsie T. Forbush
- Department of Psychology, University of Kansas, Lawrence, KS 66045 USA
| | - Christopher C. Cushing
- Department of Psychology, University of Kansas, Lawrence, KS 66045 USA,Department of Applied Behavioral Science, University of Kansas, Lawrence, KS 66045 USA
| | - Carl W. Lejuez
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269 USA
| | - Kandace K. Fleming
- Research Design and Analysis Unit, Lifespan Institute, University of Kansas, Lawrence, KS 66045 USA
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21
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A Revalidation of the Weight Related Behaviours Questionnaire within an Australian Pregnancy Cohort. Midwifery 2021; 97:102951. [PMID: 33677171 DOI: 10.1016/j.midw.2021.102951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/17/2020] [Accepted: 02/10/2021] [Indexed: 11/23/2022]
Abstract
PROBLEM Studies investigating the direct and indirect relationships between psychosocial factors (i.e. attitudes, beliefs and values), health related behaviour (diet and physical activity) and gestational weight gain are increasing. To date heterogeneity of psychosocial measurement tools has limited research progress in this area, preventing measurement of effects by meta-analysis techniques. AIM To conduct a revalidation analysis of a Weight Related Behaviours Questionnaire, originally developed by Kendall, Olson and Frangelico within the United States of America and assess its performance for use within the Australian context. METHODS A revalidation study using Exploratory Factor Analysis was undertaken to assess the factor structure and internal consistency of the six psychosocial scales of the Weight Related Behaviours Questionnaire, within the Woman and Their Children's Health (WATCH), pregnancy cohort. The questionnaire was self-completed between 18 - 20 weeks gestation. Psychosocial factors included; Weight locus of control; Self-efficacy; Attitudes towards weight gain; Body image, Feelings about the motherhood role; and Career orientation. FINDINGS Weight locus of control, Self-efficacy and Body image, retained the same factor structure as the original analysis. The remaining psychosocial factors observed a different factor structure in terms of loadings or number of factors. Deleted items modelling suggests the questionnaire could be strengthened and shortened. CONCLUSION Weight Locus of control, Self-efficacy and Body image were observed as consistent, valid and reliable psychosocial measures for use within the Australian context. Further research is needed to confirm the model and investigate the potential for combining these scales into a shorter psychosocial measurement tool.
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22
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Kliem S, Puls HC, Hinz A, Kersting A, Brähler E, Hilbert A. Validation of a Three-Item Short Form of the Modified Weight Bias Internalization Scale (WBIS-3) in the German Population. Obes Facts 2020; 13:560-571. [PMID: 33238284 PMCID: PMC7802509 DOI: 10.1159/000510923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Individuals suffering from overweight or obesity frequently experience weight-based stigmatization. The widespread belief that weight is a matter of personal will and self-control results in various weight-based stereotypes (e.g., laziness, lack of self-discipline, or neglect). OBJECTIVE Based on the modified version of the Weight Bias Internalization Scale (WBIS-M), a short form for the economic assessment of weight bias internalization in the general population was compiled and validated. METHODS A three-item short form (WBIS-3) was derived based on data from a representative sample of the German population (n = 1,092). This new short form was validated in a second representative population sample (n = 2,513). Item characteristics and internal consistency were obtained. Measurement invariance was tested. Construct validity was established via the correlation with theoretically related constructs (depression, anxiety, eating behavior, discrimination, weight status). To establish scale validity, all analyses were performed for the whole sample as well as for the subsample of individuals with overweight. Age- and gender-specific population norms were provided. RESULTS The WBIS-3 exhibited excellent psychometric properties. Internal consistency was α = 0.92. Strong measurement invariance was confirmed regarding age, gender, discrimination, and weight status in both the whole sample as well as the overweight subsample. CONCLUSIONS The WBIS-3 constitutes a valid and economical tool for the assessment of weight bias internalization in epidemiological contexts. Measurement invariance allows for an unbiased comparison of means, correlation coefficients, and path coefficients within structural equation modeling across groups.
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Affiliation(s)
- Sören Kliem
- Ernst-Abbe-Hochschule, University of Applied Sciences, Jena, Germany
| | - Hans-Christian Puls
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany,
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, University of Leipzig Medical Center, Leipzig, Germany,
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, University of Leipzig Medical Center, Leipzig, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Anja Hilbert
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, University of Leipzig Medical Center, Leipzig, Germany
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Lin CY, Imani V, Cheung P, Pakpour AH. Psychometric testing on two weight stigma instruments in Iran: Weight Self-Stigma Questionnaire and Weight Bias Internalized Scale. Eat Weight Disord 2020; 25:889-901. [PMID: 31055783 DOI: 10.1007/s40519-019-00699-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 04/20/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE This study aimed to comprehensively and thoroughly examine the psychometric properties of two commonly used weight-related self-stigma instruments on Iranian adolescents with overweight or obesity: Weight Self-Stigma Questionnaire [WSSQ] and Weight Bias Internalization Scale [WBIS]. METHODS After ensuring the linguistic validity of both the WSSQ and WBIS in their Persian versions, 737 Iranian adolescents with overweight or obesity (male = 354; mean age = 15.8 ± 1.3 years; body mass index = 30.0 ± 4.8 kg/m2) completed both questionnaires and other relevant measures regarding their depression, anxiety, stress, dietary self-efficacy, weight efficacy lifestyle, quality of life, body fat, self-esteem, body shape preoccupation, and sleepiness. RESULTS In the scale level, the confirmatory factory analysis verified the two-factor structure for the WSSQ and the single-factor structure for the WBIS. The factorial structures were further found to be invariant across gender (male vs. female) and across weight status (overweight vs. obesity). Additionally, both the WSSQ and WBIS had promising properties in internal consistency, test-retest reliability, separation reliability, and separation index. In the item level, all items but WBIS item 1 (infit mean square = 1.68; outfit mean square = 1.60) had satisfactory properties in factor loadings, corrected item-total correlation, test-retest reliability, and infit and outfit mean square. Moreover, all the items did not display substantial differential item functioning (DIF) across gender and across weight status. CONCLUSION Both the WSSQ and WBIS were valid instruments to assess the internalization of weight bias for Iranian adolescents with overweight or obesity. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Chung-Ying Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Vida Imani
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Pauline Cheung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Amir H Pakpour
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Shahid Bahonar Blvd, Qazvin, 3419759811, Iran. .,Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
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Meadows A, Higgs S. A bifactor analysis of the Weight Bias Internalization Scale: What are we really measuring? Body Image 2020; 33:137-151. [PMID: 32155463 DOI: 10.1016/j.bodyim.2020.02.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/23/2020] [Accepted: 02/23/2020] [Indexed: 12/13/2022]
Abstract
Internalized weight stigma (IWS) has been linked with disordered eating behavior, both directly, and as a mediator of the relationship between experienced weight stigma and maladaptive coping. However, the construct of IWS is highly correlated with the related constructs of body image and global self-esteem, and the three constructs may better be represented by underlying trait self-judgment. This overlap is not generally accounted for in existing studies. The present study investigated the shared variance between self-esteem, body image, and IWS in an international sample of higher-weight individuals. Bifactor analysis confirmed that the intermediary role of IWS in the relationship between experienced stigma and self-reported eating behavior was largely accounted for by aspects of body image and global self-esteem. Greater conceptual clarity in the study of IWS is needed to understand the mechanisms via which societal weight stigma impacts on individuals' self-directed judgments and downstream health-related behaviors.
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Affiliation(s)
- Angela Meadows
- School of Psychology, Western University, London, Ontario, N6A 5C2, Canada.
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.
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Abstract
The aims of this article are to (1) present a shared definition of weight stigma related to pregnancy and (2) develop a definition to inform valid and reliable nursing research addressing weight stigma in the obstetric setting. Weight stigma is increasingly prevalent in society, especially among women with prepregnancy overweight or obesity. However, a universally accepted definition of weight stigma related to pregnancy has yet to be identified. We followed Walker and Avant's concept analysis methodology using an iterative approach to ensure a robust and conceptually sound definition of weight stigma related to pregnancy.
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Pearl RL, Wadden TA, Bach C, Gruber K, Leonard S, Walsh OA, Tronieri JS, Berkowitz RI. Effects of a cognitive-behavioral intervention targeting weight stigma: A randomized controlled trial. J Consult Clin Psychol 2020; 88:470-480. [PMID: 31971410 DOI: 10.1037/ccp0000480] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To test the effects of a cognitive-behavioral intervention for weight bias internalization (WBI; i.e., self-stigma) combined with behavioral weight loss (BWL). METHOD Adults with obesity and elevated WBI were randomly assigned to BWL alone or combined with the Weight Bias Internalization and Stigma Program (BWL + BIAS). Participants attended weekly group meetings for 12 weeks, followed by 2 biweekly and 2 monthly meetings (26 weeks total). Changes at Week 12 on the Weight Bias Internalization Scale (WBIS) and Weight Self-Stigma Questionnaire (WSSQ) were the principal outcomes, with changes at Week 26 assessed as secondary outcomes. Other outcomes included changes in mood, body image, eating behaviors, self-monitoring, and weight. RESULTS Seventy-two participants were randomized (84.7% female, 66.7% Black, mean age = 47.1 ± 11.5 years) Linear mixed models showed no significant differences between the BWL + BIAS and BWL groups in WBIS changes at Week 12 (-1.3 ± 0.2 vs. -1.0 ± 0.2) or week 26 (-1.5 ± 0.2 vs. -1.3 ± 0.2). BWL + BIAS participants had greater reductions in WSSQ total scores at Week 12 (p = .03), with greater changes on the self-devaluation subscale at Weeks 12 and 26 (p ≤ .03). BWL + BIAS participants reported significantly greater benefits on measures of eating and self-monitoring. Percent weight loss at Week 26 did not differ significantly between groups (BWL + BIAS = -4.5 ± 1.0%, BWL = -5.9 ± 1.0%, p = .28). CONCLUSION A psychological intervention for WBI produced short-term reductions in some aspects of weight self-stigma in persons with obesity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Caroline Bach
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Kathryn Gruber
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Sharon Leonard
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Olivia A Walsh
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Jena S Tronieri
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Robert I Berkowitz
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
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Psychometric properties and measurement invariance of the Weight Self-Stigma Questionnaire and Weight Bias Internalization Scale in children and adolescents. Int J Clin Health Psychol 2019; 19:150-159. [PMID: 31193103 PMCID: PMC6517648 DOI: 10.1016/j.ijchp.2019.03.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/13/2019] [Indexed: 02/05/2023] Open
Abstract
Given the negative consequences of weight bias, including internalized weight stigma, on health outcomes, two instruments—the Weight Self-Stigma Questionnaire (WSSQ) and Weight Bias Internalization Scale (WBIS)—have been developed. However, their psychometric properties are yet to be tested for Asian pediatric populations. Method:Participants aged 8 to 12 years (N = 287; 153 boys) completed the WSSQ and the WBIS, and they were classified into either a group with overweight or a group without overweight based on self-reported weight and height. Results:Both WSSQ and WBIS had their factor structures supported by confirmatory factor analyses (CFAs). The measurement invariance of two-factor structure was further supported for WSSQ across gender and weight status. The measurement invariance of single-factor structure was supported for WBIS across gender but not across weight status. Conclusions:WSSQ and WBIS were both valid to assess the internalization of weight bias. However, the two instruments demonstrated different properties and should be applied in different situations.
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Walsh OA, Wadden TA, Tronieri JS, Chao AM, Pearl RL. Weight Bias Internalization Is Negatively Associated With Weight-Related Quality of Life in Persons Seeking Weight Loss. Front Psychol 2019; 9:2576. [PMID: 30618992 PMCID: PMC6304379 DOI: 10.3389/fpsyg.2018.02576] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/30/2018] [Indexed: 11/17/2022] Open
Abstract
Research has shown a negative relationship between weight bias internalization (WBI) and general measures of health-related quality of life (QOL), such as the Short Form–36. Less is known about the impact of WBI on weight-specific domains of QOL. This study examined the relationship between WBI and weight-related QOL, as measured by the Impact of Weight on Quality of Life (IWQOL-Lite) scale. Participants were 178 adults with obesity [71.3% black, 87.6% female, mean body mass index (BMI) = 40.9 ± 5.9 kg/m2] enrolled in a weight loss trial testing the effects of lorcaserin on weight loss maintenance. At baseline, participants completed the Weight Bias Internalization Scale (WBIS), the IWQOL-Lite and the Patient Health Questionnaire (PHQ-9, to assess symptoms of depression). Total scores for the IWQOL-Lite and its five subscales (Physical Function, Self-Esteem, Sexual Life, Public Distress and Work) were calculated. Linear regression analyses showed that WBIS scores were associated with the IWQOL-Lite total score and all subscales above and beyond the effects of demographic variables, BMI, and depressive symptoms (beta values = -0.18 to -0.70, p values < 0.019). The relationship between WBIS and the IWQOL-Lite scales did not differ by gender or race. WBI was associated with mental and physical aspects of weight-related QOL in a predominantly black and female treatment-seeking sample of patients with obesity. Prioritizing the development of interventions to reduce WBI may be important for improving weight-related QOL.
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Affiliation(s)
- Olivia A Walsh
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Jena Shaw Tronieri
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Ariana M Chao
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.,Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
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Pearl RL, Puhl RM. Weight bias internalization and health: a systematic review. Obes Rev 2018; 19:1141-1163. [PMID: 29788533 PMCID: PMC6103811 DOI: 10.1111/obr.12701] [Citation(s) in RCA: 286] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 01/31/2023]
Abstract
A robust literature has documented the negative health effects of being the target of weight bias. Weight bias internalization (WBI) occurs when individuals apply negative weight stereotypes to themselves and self-derogate because of their body weight. Compared with experiences of weight bias, less is known about the relationship between WBI and mental and physical health, although more literature on this topic has emerged in recent years. The current systematic review identified 74 studies assessing the relationship between WBI and health and interventions designed to reduce WBI and improve health. Over half of identified studies were published from 2016 to 2017. Results showed strong, negative relationships between WBI and mental health outcomes. Fewer studies have examined the relationship between WBI and physical health, and results were less consistent. Key directions for future research are highlighted, including the need for prospective and experimental studies with greater sample diversity.
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Affiliation(s)
- R L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - R M Puhl
- Rudd Center for Food Policy and Obesity, Department of Human Development & Family Studies, University of Connecticut, Hartford, CT, USA
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Zuba A, Warschburger P. Weight bias internalization across weight categories among school-aged children. Validation of the Weight Bias Internalization Scale for Children. Body Image 2018; 25:56-65. [PMID: 29477970 DOI: 10.1016/j.bodyim.2018.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 02/16/2018] [Accepted: 02/16/2018] [Indexed: 11/20/2022]
Abstract
Anti-fat bias is widespread and is linked to the internalization of weight bias and psychosocial problems. The purpose of this study was to examine the internalization of weight bias among children across weight categories and to evaluate the psychometric properties of the Weight Bias Internalization Scale for Children (WBIS-C). Data were collected from 1484 primary school children and their parents. WBIS-C demonstrated good internal consistency (α = .86) after exclusion of Item 1. The unitary factor structure was supported using exploratory and confirmatory factor analyses (factorial validity). Girls and overweight children reported higher WBIS-C scores in comparison to boys and non-overweight peers (known-groups validity). Convergent validity was shown by significant correlations with psychosocial problems. Internalization of weight bias explained additional variance in different indicators of psychosocial well-being. The results suggest that the WBIS-C is a psychometrically sound and informative tool to assess weight bias internalization among children.
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Affiliation(s)
- Anna Zuba
- Department of Psychology, University of Potsdam, Karl-Liebknecht-Str. 24/25, 14476 Potsdam, Germany
| | - Petra Warschburger
- Department of Psychology, University of Potsdam, Karl-Liebknecht-Str. 24/25, 14476 Potsdam, Germany.
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Eating Behaviors, Weight Bias, and Psychological Functioning in Multi-ethnic Low-income Adolescents. J Pediatr Nurs 2018; 38:81-87. [PMID: 29167087 DOI: 10.1016/j.pedn.2017.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/10/2017] [Accepted: 11/11/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE The purposes of this study were to: 1) Describe the incidence of disordered eating, weight bias, body dissatisfaction, and psychological distress, 2) Examine the relationship between sociodemographic variables (gender, ethnicity, and income) and disordered eating, weight bias, body dissatisfaction, and psychological distress in a sample of low-income adolescents. DESIGN AND METHODS A cross-sectional study was conducted with 105 adolescents from low-income neighborhoods. Participants completed self-report questionnaires to assess eating behaviors, weight bias, body dissatisfaction, and psychological functioning. Height and weight were measured, and information on household income was collected. RESULTS The participant's mean age was 16.31 (SD=2.8) years, 66% female, 47% Hispanic, and 46% African American. The mean annual income was $17,018 (SD=11,355). Twenty-eight percent self-reported having some form of disordered eating, and 15% reported an eating disorder. The group with eating disorder reported the highest levels of weight bias (M=93.4, SD=109.6), body dissatisfaction (M=94.6, SD=47.6), and psychological distress (M=1.4, SD=0.97). CONCLUSION This study found a high prevalence of eating disorders with eating disorder participants experiencing the highest levels of weight bias and psychological distress. Future studies are needed to identify and evaluate community and school-based interventions to minimize weight bias and disordered eating. PRACTICE IMPLICATIONS Nurses are at the forefront of healthcare and should collaborate with educators, school counselors, administrators, coaches, parents, and students, to address weight bias and disordered eating in schools by implementing school-based curriculum and policies.
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Puhl RM, Himmelstein MS, Quinn DM. Internalizing Weight Stigma: Prevalence and Sociodemographic Considerations in US Adults. Obesity (Silver Spring) 2018; 26:167-175. [PMID: 29082666 DOI: 10.1002/oby.22029] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 08/29/2017] [Accepted: 09/06/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study aimed to conduct a comprehensive assessment of the presence, severity, and sociodemographic correlates of weight bias internalization (WBI) across three distinct samples of US adults. METHODS Levels of WBI were compared in (1) a sample of adults with obesity and heightened risk of weight stigma (N = 456), (2) an online community sample (N = 519), and (3) a national online panel (N = 2,529). Samples 2 and 3 comprised adults with and without obesity. Participants completed identical self-report measures, including demographic variables and weight-related factors, to determine their relationship with low, mean, and high levels of WBI. RESULTS At least 44% of adults across samples endorsed mean levels of WBI (as determined by sample 3). The highest levels of WBI were endorsed by approximately one in five adults in the general population samples and by 52% in the sample of adults with obesity. Individuals with the highest WBI were white, had less education and income, were currently trying to lose weight, and had higher BMIs, higher self-perceived weight, and previous experiences of weight stigma (especially teasing). CONCLUSIONS Internalized weight bias is prevalent among women and men and across body weight categories. Findings provide a foundation to better understand characteristics of individuals who are at risk for internalizing weight bias.
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Affiliation(s)
- Rebecca M Puhl
- Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut, USA
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - Mary S Himmelstein
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - Diane M Quinn
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
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Pearl RL, Wadden TA, Shaw Tronieri J, Chao AM, Alamuddin N, Bakizada ZM, Pinkasavage E, Berkowitz RI. Sociocultural and Familial Factors Associated with Weight Bias Internalization. Obes Facts 2018; 11:157-164. [PMID: 29656285 PMCID: PMC5981623 DOI: 10.1159/000488534] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/17/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/AIMS Sociocultural and familial factors associated with weight bias internalization (WBI) are currently unknown. The present study explored the relationship between interpersonal sources of weight stigma, family weight history, and WBI. METHODS Participants with obesity (N = 178, 87.6% female, 71.3% black) completed questionnaires that assessed the frequency with which they experienced weight stigma from various interpersonal sources. Participants also reported the weight status of their family members and completed measures of WBI, depression, and demographics. Participant height and weight were measured to calculate body mass index (BMI). RESULTS Linear regression results (controlling for demographics, BMI, and depression) showed that stigmatizing experiences from family and work predicted greater WBI. Experiencing weight stigma at work was associated with WBI above and beyond the effects of other sources of stigma. Participants who reported higher BMIs for their mothers had lower levels of WBI. CONCLUSION Experiencing weight stigma from family and at work may heighten WBI, while having a mother with a higher BMI may be a protective factor against WBI. Prospective research is needed to understand WBI's developmental course and identify mechanisms that increase or mitigate its risk.
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Affiliation(s)
- Rebecca L. Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Edwin & Fannie Gray Hall Center for Human Appearance, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- *Rebecca L. Pearl, Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Suite 3026, 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, Philadelphia, PA, USA
| | - Jena Shaw Tronieri
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ariana M. Chao
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Naji Alamuddin
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Institute for Diabetes, Obesity, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Zayna M. Bakizada
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Emilie Pinkasavage
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert I. Berkowitz
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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The Effect of Body Mass Index on Clinical Outcomes in Patients Without Radiographic Evidence of Degenerative Joint Disease After Arthroscopic Partial Meniscectomy. Arthroscopy 2017; 33:2054-2063.e10. [PMID: 28969948 DOI: 10.1016/j.arthro.2017.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 05/09/2017] [Accepted: 06/17/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the effect of obesity on clinical outcomes at 1 year after arthroscopic partial meniscectomy. METHODS We conducted a secondary analysis of the ChAMP (Chondral Lesions and Meniscus Procedures) randomized controlled trial (N = 256). The visual analog scale for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion, and presence of effusion were assessed preoperatively and at 1 year after arthroscopic partial meniscectomy. Body mass index was categorized as normal weight, 24.99 or less; overweight, 25 to 29.99; or obese, 30 or greater. Analysis of variance or the Cochran-Mantel-Haenszel test was used to examine differences in clinical outcomes between body mass index categories, and mean ± standard deviation or number (percentage) is reported. RESULTS Preoperatively, obese patients had worse WOMAC pain (56.2 ± 17.2 vs 61.3 ± 17.2, P = .02), WOMAC physical function (55.8 ± 17.1 vs 62.8 ± 17.1, P = .004), pain visual analog scale (4.9 ± 2.1 vs 4.2 ± 1.9, P = .01), KOOS pain (49.5 ± 14.9 vs 54.0 ± 15.1, P = .02), and KOOS quality-of-life (27.9 ± 18.3 vs 36.9 ± 17.0, P = .001) scores, as well as decreased flexion (121.8° ± 22.6° vs 132.3° ± 16.5°, P = .003), compared with normal-weight patients. Overweight patients (n = 51 [51.5%], P = .03) and obese patients (n = 56 [52.8%], P = .002) were more likely to have knee effusion before surgery than normal-weight patients (n = 17 [34%]). At 1 year after surgery, overweight (130.2° ± 7.7°, P = .03) and obese (128.1° ± 7.1°, P = .003) patients had decreased flexion compared with normal-weight patients (134.5° ± 8.3°). CONCLUSIONS Obese patients had worse pain, physical functioning, and quality-of-life scores, as well as decreased flexion, compared with normal-weight patients before arthroscopic partial meniscectomy. At 1 year after arthroscopic partial meniscectomy, there were no statistically significant differences in clinical outcomes but obesity was associated with decreased knee flexion. LEVEL OF EVIDENCE Level II, prospective comparative trial.
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Erratum zu: Diagnostik der Körperbildstörung. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0231-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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36
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Steinfeld B, Bauer A, Waldorf M, Hartmann AS, Vocks S. Diagnostik der Körperbildstörung. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0188-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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