Social anxiety and disordered overeating: An association among overweight and obese individuals
Highlights
► Social anxiety was associated with binge eating in overweight individuals. ► Social anxiety was associated with emotional eating in overweight individuals. ► Social anxiety was not significantly higher among extremely obese. ► Social anxiety may be a barrier to healthy eating and weight loss.
Introduction
Frequent emotional overeating and binge eating may be contributing to the high rates of obesity in the United States. Currently, 72.3% of adult men and 64.1% of adult women are overweight or obese (Flegal, Carroll, Ogden, & Curtin, 2010), but among individuals with Binge Eating Disorder (BED) the lifetime rate of obesity is 87% (Villarejo et al., 2012). Psychosocial factors associated with disordered overeating need to be addressed to promote healthy weight and facilitate weight loss interventions. Social anxiety is the anxiety one experiences in social or performance situations. Studies that have examined the association suggest a correlation between social anxiety disorder/social phobia and binge eating frequency (Koskina et al., 2011, Sawaoka et al., 2011, Wittchen et al., 1999). While prevalence rates of social phobia have been estimated at around 6 to 9% among obese persons (Kalarchian et al., 2007, Mather et al., 2008, Petry et al., 2008), obese individuals with BED have been reported to have higher rates of social phobia, close to 36% (Wittchen et al., 1999). The prevalence of sub-clinical social anxiety is likely to be even higher.
Overweight and obese individuals who fail to meet society's standard for a thin body weight may experience body image dissatisfaction and experience anxiety about their physique (Ahrberg et al., 2011, Hart et al., 1989). Several studies suggest that obese individuals experience high levels of body image dissatisfaction and low self-esteem, although it may not be directly related to Body Mass Index (BMI) (Kruger et al., 2008, Schwartz and Brownell, 2004). To an extent this social anxiety may be warranted, as overweight and obese individuals are subjected to frequent and pervasive weight bias and discrimination (Puhl & Heuer, 2009). Weight based discrimination has been associated with binge eating among obese adults (Ashmore, Friedman, Reichmann, & Musante, 2008), and obese individuals with BED experience higher levels of weight and shape concerns than obese individuals without BED (Ahrberg et al., 2011).
The objective of this study was to examine how social anxiety and disordered overeating are related among overweight and obese individuals. It was hypothesized that social anxiety would be associated with emotional eating and binge eating in an overweight and obese population.
Section snippets
Participants
Participants (n = 231) were English speaking individuals > 18 years old with a self-reported BMI > 25 kg/m2. Participants were recruited through various internet listserves and bulletin boards, as well as advertising by undergraduate psychology professors associated with the university. Access to the internet was needed to participate. This study was approved by the Institutional Review Board at the Albert Einstein College of Medicine.
Design and procedure
Participants completed a battery of questionnaires posted online at
Demographics
The demographic characteristics of the participants (n = 231) are listed in Table 1. Participants were predominantly female (87%), white (89%), and highly educated (96% had completed at least some college). BMI ranged from 25.0 to 54.9 kg/m2, with a mean BMI of 33.7 ± 6.7 kg/m2. Thirty-five percent of the participants were overweight, 48% were moderately obese, and 17% were extremely obese. Many participants reported first becoming overweight as children (39%) or adolescents (29%). While 88% of the
Discussion
This sample of overweight and obese individuals reported a high level of social anxiety and disordered eating. Social anxiety was significantly associated with emotional eating and binge eating, but not with restrained eating. The association between social physique anxiety and emotional and binge eating did not remain significant after adjusting for potential confounders. In this sample, BMI was associated with binge eating but not emotional eating. Social anxiety was not correlated with BMI,
Conclusion
As obesity rates in the United States continue to soar, successful obesity prevention and treatment programs are greatly needed. Findings from the study, suggest that social anxiety, like other types of psychopathology, may interfere with treatment for obesity as it may lead to an increase in disordered overeating (Vlierberghe, Braet, Goossens, Rosseel, & Mels, 2009). In addition, social anxiety may act as a barrier to seeking help and actively participating in treatment (Goodwin & Fitzgibbon,
Role of funding sources
No financial support was provided for the conduct of this study.
Contributors
Dr. Ostrovsky took the lead on this study and in the preparation of this manuscript. All authors have participated fully in the conception and design of the work, as well as writing of the manuscript, and have approved the final manuscript.
Conflict of interest
All other authors declare that they have no conflicts of interest.
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