The internalization of weight bias is associated with severe eating pathology among lean individuals
Introduction
Existing research demonstrates that overweight individuals are faced with chronic and repeated weight stigma across multiple domains (Puhl & Heuer, 2009), including health care (Sabin, Marini, & Nosek, 2012), the legal system (Schvey, Puhl, Levandoski, & Brownell, 2013), employment (Caliendo & Lee, 2013), and interpersonal and romantic relationships (Puhl & Brownell, 2006). Additionally, overweight and obese individuals report anti-fat attitudes that are similar to those of their lean peers (Puhl et al., 2007, Wang et al., 2004). Therefore, overweight individuals face weight-based discrimination by both “out-group” as well as “in-group” members.
Potentially as a result of the pervasiveness and social acceptability of weight stigma, overweight individuals frequently internalize negative weight-based stereotypes and anti-fat attitudes (Puhl et al., 2007, Wang et al., 2004). The internalization of weight bias is a distinct construct from anti-fat attitudes; whereas anti-fat attitudes reflect weight-based attributions made about others, weight bias internalization involves attributions made about oneself. Prior research indicates that weight bias internalization may be prevalent among overweight and obese individuals (Crandall, 1994, Durso and Latner, 2008, Puhl et al., 2007, Wang et al., 2004), and associated with numerous harmful outcomes. For instance, research has demonstrated that the internalization of weight bias among overweight individuals is associated with low self-esteem, depression, body dissatisfaction, and somatoform symptoms (Durso and Latner, 2008, Durso et al., 2012, Hilbert et al., 2014, Puhl et al., 2007, Wang et al., 2004). The internalization of weight bias is also associated with clinically significant binge eating and purging among overweight individuals (Schvey, Roberto, & White, 2013), as well as the overvaluation of shape and weight (Durso et al., 2012). Of particular importance is the fact that internalization of weight bias may, in fact, stymie weight loss efforts; among overweight individuals in a weight loss program, the internalization of weight bias was associated with poorer self-monitoring, decreased energy expenditure, greater caloric intake, greater rates of attrition, and ultimately less weight loss (Carels et al., 2009). Recent research also indicates that the internalization of weight bias may contribute to poor physical health, above and beyond the contribution of BMI (Latner et al., 2013, Pearl et al., 2013). Importantly, the internalization of weight bias appears to be persistent; it has been observed among individuals who have successfully lost weight, indicating that formerly obese, average weight individuals may internalize negative weight-based stereotypes (Levy & Pilver, 2012).
While there is mounting evidence that the internalization of weight bias is both common and harmful among overweight individuals, to our knowledge, no research to date has examined the relationship between internalization of weight bias and eating pathology among lean individuals. The internalization of weight bias among lean individuals is important to assess since prior research indicates that a significant proportion of individuals with a healthy BMI perceive themselves as overweight (Paeratakul, White, Williamson, Ryan, & Bray, 2002). One recent study adapted the Weight Bias Internalization Scale (WBIS) (Durso & Latner, 2008), used to assess internalized bias in overweight respondents, to measure internalized weight attitudes across weight categories (Pearl & Puhl, 2014). Results indicated that the internalization of weight bias was a distinct construct from anti-fat attitudes among respondents of all weight strata, including lean individuals. The authors also observed that internalization of weight bias was associated with body dissatisfaction, binge eating, poor self-esteem, anxiety, and depression, above and beyond the effects of body mass index (BMI) and anti-fat attitudes. Thus, there is emerging research indicating that even individuals of a healthy body weight may internalize some degree of weight bias and subsequently endorse poor body image and eating pathology. The present study expands on the extant research and examines 1) the presence of weight bias internalization among a community sample of lean respondents, and 2) the relationship between weight bias internalization and clinically significant binge eating and purging among lean respondents.
Section snippets
Participants
Participants were 197 lean (mean BMI: 22.28 ± 1.89, range 15.80–24.98) adult community volunteers who were selected from a sample of 1720 volunteers. Only those participants who were classified as “normal weight” or “underweight” (BMI < 25 kg/m2) according to the National Institutes of Health's weight classification guidelines and who had completed the WBIS in full were selected for the present study. The study was advertised on Craigslist classified advertisements in different cities throughout the
Participant characteristics
The mean age of the present sample was 31.58 ± 10.87 years and the mean body mass index (BMI) was 22.28 kg/m2 (range: 15.80–24.98). Nine participants (4.6%) were classified as underweight (BMI < 18.5), thus subsequent analyses were conducted both including and excluding these participants; however, since results did not differ, underweight participants were included in all reported findings. The sample was predominantly female (89.3%) and the racial/ethnic distribution was: 77.2% Caucasian, 1.0%
Discussion
Results of this study indicate that not only do individuals of a healthy body weight internalize weight bias, but that the internalization of weight bias is significantly associated with both binge eating and purging among individuals of all weight strata (Schvey, Roberto, & White, 2013). Furthermore, those who reported binge and/or purge behaviors scored significantly higher on the measure of internalized weight bias than individuals who did not report binge or purge behaviors. Weight bias
Conclusions
This study makes a valuable contribution to the existing literature by demonstrating that not only do lean individuals internalize weight bias but that this internalization is associated with significant eating pathology. Additionally, those who misperceive themselves to be overweight may be especially vulnerable to the internalization of weight bias, and may consequently diet or engage in unhealthy weight control practices to reduce body weight. These findings corroborate a previous study
Role of funding sources
Dr. White was supported in conducting the current research by NIH/NIDDK K23DK071646.
Contributors
NS developed the analytic plan, conducted analyses, and wrote the manuscript. MW designed the study, collected the data, and contributed to analytic plan, data analysis and manuscript writing. Both authors reviewed the final manuscript and had final approval of the paper.
Conflict of interest
The authors report no competing interests. Dr. White was supported in conducting the current research by NIH/NIDDK K23 DK071646.
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2022, Body ImageCitation Excerpt :Many individuals internalize this bias, accepting and applying negative weight-related stereotypes to themselves (i.e., weight-bias internalization; WBI; Durso & Latner, 2008). WBI is associated with higher rates of disordered eating, sedentary behaviors, and healthcare avoidance (Mensinger & Meadows, 2017; Mensinger, Tylka, & Calamari, 2018; Schvey & White, 2015). One factor that might help explain healthcare avoidance in people with WBI is healthcare stress (i.e., anxiety around healthcare encounters).
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Present Address for Corresponding Author: Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, United States.