Constant vigilance: The impact of weight stigma, vigilance, and internalization on maladaptive eating behaviors.

Abstract

Objective: Weight stigma (social devaluation because of weight) and weight bias internalization (self-stigma due to weight) have been independently implicated in maladaptive eating, which ultimately contributes to poor cardiometabolic health. Additionally, vigilance (being on the lookout for social devaluation) is connected to stress, poor sleep, and depression. Most research considers these factors separately but establishing how these variables interact with one another is essential to understanding their cumulative impact on health behaviors. Method: Using a diverse national panel of adults in the United States (N = 1,051), this study tested several statistical moderated mediations in which weight stigma was both directly associated with maladaptive eating and indirectly associated with maladaptive eating via vigilance. We simultaneously examined whether the relationship between weight stigma and vigilance was moderated by self-stigma. Results: Results indicated that experiencing weight stigma was directly related to each of the maladaptive eating behaviors (eating to cope, restrictive dieting frequency, and binge eating). Weight stigma was also indirectly related to each eating behavior through vigilance; this indirect relationship was stronger among those with high levels of weight bias internalization, compared to those with low levels of weight bias internalization. Race moderated the relationship between weight stigma and vigilance, such that participants identifying as Black had a stronger relationship between them. Conclusions: These results provide support for a theoretical model which explains how weight stigma, self-stigma, and vigilance interact with one another to produce negative health behaviors and highlight the importance of further investigation of vigilance in the context of weight stigma. Public Significance StatementPoor treatment due to someone's body weight leads to increases in disordered eating such as restricting food, eating to cope, and binge eating. This study finds that one reason this might be happening is chronic stress and worry over the possibility of being treated poorly in the future. This is especially likely if somebody already thinks about themselves poorly because of their body weight.

Associations between adverse childhood experiences and history of weight cycling

“…[32][33][34][35][36] Weight stigma may partially motivate weight loss attempts and make weight regain feel threatening, as people become more vigilant to avoid weight-based devaluation. 37 Indeed, greater weight cycling is related to greater depressive symptoms, with internalized weight stigma as a partial mediator of this association, 38 which has relevance and provides a rationale for the present study given the connection between higher ACEs and greater internalized weight stigma. 21 In addition to depression, weight cycling is linked to anxiety and body image dissatisfaction as well as levels of cortisol, oxidative stress, and C-reactive protein 39,40 -all linked to chronic stress activation and diminished mental health.…”

“…Thus, despite the controversy over its biological harms within certain domains (e.g., metabolism) and its longevity-enhancing effects in rodent models, weight cycling has been associated with psychophysiological harms, 39,40 higher current and historical BMIs with risk of sarcopenic obesity, 42 greater reward sensitivity, 43 and is potentially problematic for those seeking sustained weight loss 44 or avoidance of the harms of weight-based devaluation. 37 The goal of this study is not to answer in which context weight cycling may be harmful but to better understand ACEs as a potential predictor of this phenomenon. Knowing whether a history of ACEs is associated with a history of weight cycling may inform which groups are at greater risk for weight regain cycles.…”

“…Weight stigma impacts individuals at both ends of the weight spectrum and is an established stressor with biochemical effects that are independent of adiposity levels, including blunted cortisol reactivity and greater oxidative stress 32–36 . Weight stigma may partially motivate weight loss attempts and make weight regain feel threatening, as people become more vigilant to avoid weight‐based devaluation 37 . Indeed, greater weight cycling is related to greater depressive symptoms, with internalized weight stigma as a partial mediator of this association, 38 which has relevance and provides a rationale for the present study given the connection between higher ACEs and greater internalized weight stigma 21 …”

“…Given the role of chronic stress in heightened mortality risk, 41 research examining weight cycling should account for its biopsychosocial effects. Thus, despite the controversy over its biological harms within certain domains (e.g., metabolism) and its longevity‐enhancing effects in rodent models, weight cycling has been associated with psychophysiological harms, 39,40 higher current and historical BMIs with risk of sarcopenic obesity, 42 greater reward sensitivity, 43 and is potentially problematic for those seeking sustained weight loss 44 or avoidance of the harms of weight‐based devaluation 37 …”

Demographic predictors of internalized weight stigma in a diverse sample of U.S. adults.

“…For example, people with higher (vs. lower) levels of IWS are more likely to respond to weight discrimination with ineffective emotion regulation tactics (e.g., rumination) and maladaptive coping strategies (e.g., binge eating, social avoidance; Hayward et al, 2017; Himmelstein et al, 2017). High levels of IWS may also lead individuals to anxiously anticipate being rejected because of their weight or to interpret negative social experiences as reflecting weight stigma, which could amplify the negative health consequences of such experiences (Gerend, Patel, et al, 2022; Major et al, 2018; Wetzel & Himmelstein, 2023). IWS may be especially pernicious for health as these processes can occur even in the absence of social encounters with weight stigma; simply experiencing body shame or negative feelings about one’s weight may be sufficient to trigger stress responses that harm psychological and physical health (Major et al, 2018).…”