New study: Internalised weight stigma predicts eating pathology

Title: Weight Bias Internalization, Emotion Dysregulation, and Non-Normative Eating Behaviors in Prebariatric Patients

Authors: Baldofski, Rudolph, Tigges, Herbig, Jurowich, Kaiser, Dietrich, Hilbert

Source: International Journal of Eating Disorders. Epub 23 Nov 2015. Link to article

Super-quick summary: Higher internalised weight stigma was associated with more disordered eating and clinical eating and body image pathology in 240 pre-WLS patients. Emotional dysregulation played a role in some, but not all of these pathways.

In more detail:

What they did

The authors gave a series of questionnaires to 240 patients seeking weight-loss surgery in six German bariatric centres. The questionnaires asked about:

• Levels of internalised weight stigma (WBIS; a measure of how much people value themselves less because of their weight);
• Emotional dysregulation (DERS; the trouble people have identifying and dealing appropriately with their emotions);
• Eating disorder questionnaire (EDE-Q; clinical pathological eating behaviours and body image issues);
• Addictive-like eating behaviours (YFAS);
• Emotional eating (DEBQ-Emotional; the extent to which people eat in response to emotional distress);
• Eating in the absence of hunger (EAH; starting or continuing to eat because of external cues, despite not being hungry).

The researchers had predicted that emotional dysregulation would be the key intermediate step between internalised weight stigma (IWS) and disordered eating behaviours. That is, they thought that the more people devalued themselves because of their weight, the more likely they were to have trouble dealing with their emotions, and it was this, in turn, that would lead to more problem eating.

What they found

First, they found that IWS was higher in women and younger people, but that BMI didn’t explain weight self-stigma. They also found that internalised weight stigma did significantly predict all of the measures of disordered eating and clinical eating disorders they asked about – in other words, lower weight-related self-esteem was associated with more problem eating. As for the role of emotional dysregulation, they found that it was the ‘middle-man’ between IWS and emotional eating and eating in the absence of hunger, as predicted. For addictive-like eating behaviours, emotional dysregulation played a part, but IWS also increased ‘food addiction’ directly. Emotional dysregulation didn’t link IWS and eating disorder symptoms.

What it means

The evidence that IWS is associated with range of negative health and behavioural outcomes is accumulating rapidly. Researchers are interested in explaining how and why this process happens. The more we understand about it, the more likely it is that we can do something about it. This research provides one piece in the puzzle and shows that emotion management may play an important role in at least some of the eating-related outcomes that cause individuals distress. Having said that, this is a cross-sectional study, so the relationship could well be the other way around: people who have issues around food could feel worse about themselves and their weight.

While the researchers in this study were interested in improving the success of WLS, understanding IWS has implications for all people who suffer from it. Interestingly, more and more evidence is suggesting that high IWS isn’t just for people with high BMI. So people of all sizes can devalue themselves because of their weight, although it is worth remembering that only the higher-weight individuals are likely to be devalued and discriminated against by other people.

The fact that IWS is often seen to be higher in women than in men, and experiences of stigma in employment, health, education and so on are also more common in women, gives us some clue as to the nature of the problem. It is clearly not just about weight, but about how society polices women’s bodies. Ideally, the solution to high levels of IWS in the population would be to do something about levels of anti-fat bias in society in general. But the research we have so far isn’t promising on that front. So although helping the ‘victim’ to change is not the optimal solution, it may be a short-term strategy that helps to improve health and wellbeing and protect against some of the widespread fat shaming that we are exposed to every day.