Simply too much: the extent to which weight bias internalization results in a higher risk of eating disorders and psychosocial problems

Abstract

Purpose Weight bias internalization (WBI) is associated with negative health consequences such as eating disorders and psychosocial problems in children. To date, it is unknown to what extent WBI considerably raises the risk of negative outcomes. Methods Analyses are based on cross-sectional data of 1,061 children (9–13 years, M = 11, SD = 0.9; 52.1% female) who filled in the WBI scale (WBIS-C). First, ROC analyses were run to identify critical cut-off values of WBI (WBIS-C score) that identify those who are at higher risk for psychosocial problems or eating disorder symptoms (as reported by parents). Second, it was examined whether WBI is more sensitive than the relative weight status in that respect. Third, to confirm that the cut-off value is also accompanied by higher psychological strain, high- and low-risk groups were compared in terms of their self-reported depressive symptoms, anxious symptoms, body dissatisfaction, and self-esteem. Results WBIS-C scores ≥ 1.55 were associated with a higher risk of disturbed eating behavior; for psychosocial problems, no cut-off score reached adequate sensitivity and specificity. Compared to relative weight status, WBI was better suited to detect disturbed eating behavior. Children with a WBIS-C score ≥ 1.55 also reported higher scores for both depressive and anxious symptoms, higher body dissatisfaction, and lower self-esteem. Conclusion The WBIS-C is suitable for identifying risk groups, and even low levels of WBI are accompanied by adverse mental health. Therefore, WBI is, beyond weight status, an important risk factor that should be considered in prevention and intervention. Level of evidence Level III, cross-sectional analyses based on data taken from a well-designed, prospective cohort study.

Global Proportion of Disordered Eating in Children and Adolescents

“…The main characteristics of the 32 included studies are summarized in the Table. Twenty-six of the studies were cross-sectional, 4 were longitudinal, 1 was a quasi-experimental study, and 1 was a randomized clinical trial . A total of 63 181 participants (51.8% girls) aged 7 to 18 years were included in this systematic review and meta-analysis.…”

“…The remaining 8 studies did not report proportion segmented by gender. In terms of geographical regions, 16 different countries were identified, including 21 studies in Europe, 5 in Asia, 4 in North America, 1 in South America, and 1 in Africa . All the studies were conducted with participants from only 1 country.…”

“…The main sources of bias were associated with the representativeness of the analyzed sample. 19,20,30,31,[35][36][37][38][39]41,44,46,47,50,52,54,55 A summary of the risk of bias scoring is shown in eTable 3 in Supplement 1.…”

“…The remaining eight studies did not report proportion segmented by sex. In terms of geographical regions, 16 different countries were identified, including 21 studies in Europe 19,20,30,[33][34][35][37][38][39][40][41][42][43][44]46,47,[49][50][51]56,57 , five in Asia 31,48,53,55,58 , four in North America 36,45,52,54 , one in South America 59 , and one in Africa 32 . All the studies were conducted with participants from only one country.…”

Developing and validating a Japanese version of the Weight Self-Stigma Questionnaire

“…WBI is related to depression, anxiety, body image, and self-esteem [4,18,19], and contributes to disordered eating in adults [17,[20][21][22][23] with any body weight status, including underweight/average weight, overweight, obese [24], and also in children [25]. Such disordered eating would result in increased risk of metabolic syndrome [18] and di culty maintaining a moderate weight [14,26].…”