Examining the relationship between weight controllability beliefs and eating behaviors: The role of internalized weight stigma and BMI.

Body weight is often viewed as personally controllable. This belief, however, ignores the complex etiology of body weight. While such attributions of personal willpower may help some individuals regulate their eating patterns, they have also been associated with increased internalized weight stigma which, itself, is associated with more disinhibited eating. The current investigation aimed to examine how internalized weight stigma, along with BMI, may explain the effect of weight controllability beliefs on disparate dietary behaviors. A community sample of 2702 U.S. adults completed an online survey about their weight controllability beliefs, eating behaviors, and internalized weight stigma, as well as demographic items and self-reported BMI. Results showed that greater weight controllability beliefs were positively related to both more restricted eating, ß = 0.135, p < .001, and more disinhibited eating, ß = 0.123, p < .001. This ironic effect was partially explained by increased internalized weight stigma. Moreover, BMI moderated the relationship, such that individuals with lower weights demonstrated stronger effects for two of the three eating outcomes than those with higher weights. These findings advance our understanding of the relationship between attributions of personal control for body weight and subsequent health behaviors, and further underscore the need to target internalized weight stigma in dietary interventions.

Psychological threat avoidance as a barrier to HIV testing in gay/bisexual men.

The present study examined how three psychosocial barriers-anticipated HIV stigma, HIV infectiousness-reduction beliefs, and optimism about available HIV treatments-related to HIV testing history and acceptance of an at-home HIV test among men who have sex with men. We also examined the mediating role of a variable that affects medical screening for other health conditions but has not yet been investigated in HIV contexts: the tendency to avoid psychologically threatening information. Volunteers completed a paper and pencil survey and were offered a free at-home HIV test during the 2015 Atlanta Pride Festival in Atlanta, GA. Anticipated HIV stigma, infectiousness beliefs, and treatment optimism were inconsistently related to HIV testing history and acceptance of an at-home HIV test, but all had direct effects on the desire to avoid HIV information. In a mediation model, each of these psychosocial barriers had indirect effects on both HIV testing outcomes via information avoidance. These findings suggest that information avoidance is an important proximal HIV testing barrier, thus providing a novel target for interventions and information campaigns.

The Role of Stigma in Weight Loss Maintenance Among U.S. Adults.

BACKGROUND: Challenges of maintaining long-term weight loss are well-established and present significant obstacles in obesity prevention and treatment. A neglected but potentially important barrier to weight-loss maintenance is weight stigmatization. PURPOSE: We examined the role of weight stigma-experienced and internalized-as a contributor to weight-loss maintenance and weight regain in adults. METHODS: A diverse, national sample of 2702 American adults completed an online battery of questionnaires assessing demographics, weight-loss history, subjective weight category, experienced and internalized weight stigma, weight-monitoring behaviors, physical activity, perceived stress, and physical health. Analyses focused exclusively on participants who indicated that their body weight a year ago was at least 10% less than their highest weight ever (excluding pregnancy), the weight loss was intentional, and that attempts to lose or maintain weight occurred during the past year (n = 549). Participants were further classified as weight regainers (n = 235) or weight-loss maintainers (n = 314) based on subsequent weight loss/gain. Data were collected in 2015 and analyzed in 2016. RESULTS: Hierarchical logistic regression models showed that internalized weight stigma and subjective weight category made significant individual contributions to prediction of weight-loss maintenance, even after accounting for demographics, perceived stress, experienced stigma, physical health, and weight-loss behaviors. For every one-unit increase in internalized weight stigma, the odds of maintaining weight loss decreased by 28% (95% CI: 14-40%, p < .001). CONCLUSIONS: Findings provide initial evidence that overlooked psychosocial factors, like weight stigma, may hinder weight-loss maintenance. Implications for addressing stigma in obesity-focused clinical interventions are highlighted.

Internalized stigma and HIV status disclosure among HIV-positive black men who have sex with men.

Black men who have sex with men (BMSM) are severely affected by the HIV epidemic, yet research on the relationship between HIV stigma and status disclosure is relatively limited among this population. Within this epidemic, internalized HIV stigma, the extent to which people living with HIV/AIDS endorse the negative beliefs associated with HIV as true of themselves, can negatively shape interpersonal outcomes and have important implications for psychological and physical health. In a sample of HIV-positive BMSM (N=156), the current study examined the effect of internalized stigma on HIV status disclosure to sexual partners, which can inform sexual decision-making in serodiscordant couples, and HIV status disclosure to family members, which can be beneficial in minimizing the psychological distress associated with HIV. Results revealed that greater internalized stigma was associated with less HIV status disclosure to participants' last sexual partner and to family members. Findings from this study provide evidence that internalized negative beliefs about one's HIV status are linked to adverse interpersonal consequences. Implications of these findings are discussed with regard to prevention and intervention efforts to reduce HIV stigmatization.

Development and psychometric evaluation of the Chronic Illness Anticipated Stigma Scale.

The Chronic Illness Anticipated Stigma Scale (CIASS) was developed to measure anticipated stigma (i.e., expectations of prejudice, stereotyping, and discrimination) among people living with chronic illnesses. The CIASS is a 12-item scale with three subscales differentiating among sources of anticipated stigma, including friends and family members, work colleagues, and healthcare workers. Results support the reliability, validity, and generalizability of the CIASS in two samples of people living with chronic illnesses. The CIASS was correlated with other stigma-related constructs as well as indicators of mental health, physical health, and health behaviors. The CIASS can help researchers gauge the degree to which people living with chronic illnesses anticipate stigma, better understand the processes by which anticipated stigma contributes to the health and behavior of people living with chronic illnesses, and compare the extent to which people living with different types of chronic illnesses anticipate stigma.

Influenza Stigma during the 2009 H1N1 Pandemic.

The current study examines the extent to which H1N1 was stigmatized at the height of the 2009 H1N1 pandemic in the U.S. and explores the role that H1N1 stigma played in people's desire for physical distance from others with H1N1. H1N1 was the most stigmatized disease, with participants endorsing greater prejudice towards people with H1N1 than people with cancer or HIV/AIDS. Further, H1N1 stigma partially mediated the relationship between participants' perceptions that H1N1 was threatening and their desire for physical distance from people with H1N1. Therefore, H1N1 stigma played a role in, but was not entirely responsible for, the relationship between perceptions that H1N1 was threatening and desire for distance from others with H1N1.

Neighborhood ethnic composition and social identity threat: the mediating role of perceived discrimination.

Ethnic proportions of neighborhoods are a "macro" measure of intergroup contact and can buffer or expose people of color to discrimination. Simultaneously, perceived discrimination can sensitize students of color to social identity threat in environments in which they are numerically underrepresented and negatively stereotyped. In the current research, we integrate these two lines of research to examine whether neighborhood ethnic composition - the percentage of Latinx residents in one's home community - predicts social identity threat for Latinx students attending college at a predominately White institution (PWI). In two studies, Latinx college students attending a PWI provided their 5-digit zip code and completed measures assessing their perceived discrimination and social identity threat. Across both studies, neighborhood ethnic composition (greater percentage of Latinx residents) was associated with greater social identity threat and this association was mediated by greater perceived discrimination. These studies advance research on neighborhood ethnic composition and social identity threat.

Understanding the role of depressive symptoms in academic outcomes: A longitudinal study of college roommates.

Rising rates of depression among adolescents raise many questions about the role of depressive symptoms in academic outcomes for college students and their roommates. In the current longitudinal study, we follow previously unacquainted roommate dyads over their first year in college (N = 245 dyads). We examine the role of depressive symptoms of incoming students and their roommates on their GPAs and class withdrawals (provided by university registrars) at the end of the Fall and Spring semesters. We test contagion between the roommates on both academic outcomes and depressive symptoms over time. Finally, we examine the moderating role of relationship closeness. Whereas students' own initial levels of depressive symptoms predicted their own lower GPA and more course withdrawals, they did not directly predict the academic outcomes of their roommates. For roommates who form close relationships, there was evidence of contagion of both GPAs and depressive symptoms at the end of Fall and Spring semesters. Finally, a longitudinal path model showed that as depressive symptoms spread from the student to their roommate, the roommate's GPA decreased. The current work sheds light on a common college experience with implications for the role of interventions to increase the academic and mental health of college students.

Weight stigma and posttraumatic stress disorder symptoms in individuals seeking bariatric surgery.

BACKGROUND: After bariatric surgery, some patients experience adverse psychiatric outcomes, including substance use, suicidality, and self-harm. These factors are commonly associated with posttraumatic stress disorder (PTSD) and related symptoms (PTSD-S) that develop following adverse childhood experiences (ACEs) and traumatic events. However, emerging evidence suggests that chronic discrimination also may contribute to PTSD-S. Weight-based discrimination is salient for people with obesity but has received little attention in relation to PTSD-S. OBJECTIVE: Our study examined factors that may contribute to the link between experienced weight stigma (WS), which is common in individuals seeking bariatric surgery, and PTSD-S. SETTING: Teaching hospital and surgical weight loss center in the United States. METHODS: A total of 217 participants completed self-report surveys of experienced and internalized WS, ACEs, and PTSD-S. Demographics and trauma history were obtained from patient medical records. A stepwise multiple regression examined associations between experienced WS and internalized WS with PTSD-S, co-varying demographics, ACEs, and trauma, followed by examination of whether findings held co-varying anxiety/depressive symptoms in a participant subset (n = 189). RESULTS: After accounting for covariates in step 1 and ACEs and trauma in step 2 (ΔR2 = .14), experienced WS and internalized WS accounted for substantial PTSD-S variance in steps 2 and 3 (ΔR2 = .12 and .13, respectively; overall model R2 =.44; P < .001). Findings held after co-varying anxiety/depressive symptoms. CONCLUSIONS: Over and above ACEs and trauma, experienced WS and internalized WS may contribute to PTSD-S. Longitudinal research is needed to better elucidate the pathways underlying these associations.

Shame and Self-compassion as Risk and Protective Mechanisms of the Internalized Weight Bias and Emotional Eating Link in Individuals Seeking Bariatric Surgery.

BACKGROUND: Emotional eating in bariatric surgery patients is inconsistently linked with poor post-operative weight loss and eating behaviors, and much research to date is atheoretical. To examine theory-informed correlates of pre-operative emotional eating, the present cross-sectional analysis examined paths through which experienced weight bias and internalized weight bias (IWB) may associate with emotional eating among individuals seeking bariatric surgery. METHODS: We examined associations of experienced weight bias, IWB, shame, self-compassion, and emotional eating in patients from a surgical weight loss clinic (N = 229, 82.1% female, M. BMI: 48 ± 9). Participants completed a survey of validated self-report measures that were linked to BMI from the patient medical record. Multiple regression models tested associations between study constructs while PROCESS bootstrapping estimates tested the following hypothesized mediation model: IWB ➔ internalized shame ➔ self-compassion ➔ emotional eating. Primary analyses controlled for adverse childhood experiences (ACE), a common confound in weight bias research. Secondary analyses controlled for depressive/anxiety symptoms from the patient medical record (n = 196). RESULTS: After covariates and ACE, each construct accounted for significant unique variance in emotional eating. However, experienced weight bias was no longer significant and internalized shame marginal, after controlling for depressive/anxiety symptoms. In a mediation model, IWB was linked to greater emotional eating through heightened internalized shame and low self-compassion, including after controlling for depressive/anxiety symptoms. CONCLUSIONS: Pre-bariatric surgery, IWB may signal risk of emotional eating, with potential implications for post-operative trajectories. Self-compassion may be a useful treatment target to reduce IWB, internalized shame, and related emotional eating in bariatric surgery patients. Further longitudinal research is needed.

Interacting like a body: objectification can lead women to narrow their presence in social interactions.

The present experiment tested the impact of sexual objectification on women's behavior in social interactions. We predicted that when objectified, women would narrow their social presence by spending little time talking, particularly when interacting with men. Participants (males and females) gave an oral introduction of themselves to an alleged interaction partner (male or female). Objectification was manipulated by having participants believe their bodies were either visually inspected or not inspected during this introduction. Specifically, participants introduced themselves through a closed-circuit device in one of three conditions: body (videotaped from the neck down), face (videotaped from the neck up), or audio (no videotaping). Women who were in the body condition and thought they were interacting with men spent less time talking than participants in all other groups. In addition, the majority of women disliked the body condition, indicating that they found having their bodies gazed at aversive. Implications for women's behavior in mixed-sex contexts are discussed.

Disclosure and concealment of stigmatized identities.

People with concealable stigmatized identities face decisions on whether, when, and to whom to disclose their stigmatized status. Research has shown that disclosing one's identity yields benefits to the individual such as greater social support and increased physical and psychological health outcomes. However, further examination shows greater nuance in the matter: Some disclosures are related to more negative health outcomes, particularly when the response to the disclosure and/or the environment are/is more hostile. Moreover, recent research shows that the active concealment of a stigmatized identity may be a more reliable predictor of psychological well-being than whether a person has disclosed. Future research should consider intersecting identities, as well as the broader consequences of living with a concealable stigmatized identity.

Trying again (and again): Weight cycling and depressive symptoms in U.S. adults.

As the prevalence of overweight and obesity have risen over the past few decades, so have weight control attempts. Research has shown, however, that intentional weight loss results are often short-lived, with people regaining the weight over time. This can lead to weight cycling-losing and gaining weight repeatedly. Previous research, mostly done over two decades ago, concluded there was no relationship between weight cycling and psychological health. The goal of the current paper was to re-examine the relationship between weight cycling and depressive symptoms in a national sample of American adults (N = 2702; 50.7% female; mean age = 44.8 years). If, as hypothesized, there is a relationship between more frequent weight cycling and depressive symptoms, then internalized weight stigma will be examined as a potential mediator of the relationship. Results of a cross-sectional survey showed that 74.6% of adults report they have intentionally tried to lose weight. Amongst those who have tried to lose to weight, the average number of weight cycles over the lifetime was 7.82 cycles. Simultaneous regression showed that greater weight cycling was related to greater reported depressive symptoms (ß = .15, p < .001), controlling for age, gender, education, income, and body mass index. Internalized weight stigma was a partial mediator of this relationship. Discussion focuses on the potential implications for weight cycling and mental health.

Visible and Concealable Stigmatized Identities and Mental Health: Experiences of Racial Discrimination and Anticipated Stigma.

Experiencing and anticipating discrimination because one possesses a visible (e.g., race) or concealable (e.g., mental illness) stigmatized identity has been related to increased psychological distress. Little research, however, has examined whether experiencing and anticipating discrimination related to possessing both a visible and concealable stigmatized identity (e.g., a racial/ethnic minority with a history of mental illness) impacts mental health. In the current study, we test two hypotheses. In the first, we examine whether experienced discrimination due to a visible stigma (race/ethnicity) and anticipating stigma due to a concealable stigma (e.g., substance abuse) each predict unique variance in depressive symptomatology. In the second, we examine whether experienced discrimination due to a visible stigma is related to greater anticipated stigma for a concealable stigma, which in turn is related to more depression. A total of 265 African American and Latinx adults who reported concealing a stigmatized identity at least some of the time completed measures of racial/ethnic discrimination, anticipated stigma of a concealable stigmatized identity, and depressive symptomatology. Results of a simultaneous linear regression revealed that increased racial/ethnic discrimination and anticipated stigma independently predicted greater depressive symptomatology (controlling for each other). A mediation analysis showed that the positive association between increased racial/ethnic discrimination and higher depressive symptomatology was partially mediated by greater anticipated stigma. These results demonstrate that a person can experience increased psychological distress from multiple types of stigma separately, but also may anticipate greater stigma based on previous experiences of racial discrimination, which in turn relates to increased distress.

Body shape concerns across racial and ethnic groups among adults in the United States: More similarities than differences.

This study evaluated the relationship between race/ethnicity and body shape concerns among adults in the U.S. and evaluated if this relationship varied by Body Mass Index (BMI) and gender. Data were collected from U.S. adults (N = 2,212) using a national online survey panel designed to approximate the US census data. Gender, age, race/ethnicity, BMI and body shape concerns (Body Shape Questionnaire) were assessed. Analysis of variance was utilized to evaluate the race/ethnicity and BSQ association and if the relationship varied by gender and BMI category. The sample (65 % White, 13 % Black/African American, 16 % Latino/Hispanic/Mexican American and 6 % Asian/Pacific Islander) was 50 % female; mean age of 44.2 years (SD = 16.8); BMI of 27.4 (SD = 6.7). A gender by BMI category interaction (p < .01) revealed no difference in BSQ scores by gender when BMI < 18, but higher BSQ scores among women for all other BMI groups. A main effect of race/ethnicity revealed BSQ scores were equally high across racial/ethnic groups, except individuals who identified as White (M = 42.0, SD = 19.7) reported higher BSQ than those identified as Asian/Pacific Islander (M = 37.4, SD = 17.4). Body shape concerns are common among US adults. Individuals of racial/ethnic minority status may experience similar gender- and BMI-related differences in body shape concerns as White individuals.

Weight Bias, Shame, and Self-Compassion: Risk/Protective Mechanisms of Depression and Anxiety in Prebariatic Surgery Patients.

OBJECTIVE: Psychopathology in bariatric surgery patients may contribute to adverse postoperative sequelae, including weight regain, substance use, and self-harm. This cross-sectional study aimed to advance the understanding of the risk and protective paths through which weight bias associates with depressive and anxiety symptoms in bariatric surgery candidates (BSC). METHODS: BSC recruited from a surgical clinic (N = 213, 82.2% women, 43 [SD 12] years, mean BMI: 49 [SD 9] kg/m2 ) completed measures of experienced weight bias (EWB), internalized weight bias (IWB), body and internalized shame, and self-compassion; anxiety and depression screeners were accessed from medical charts. Multiple regression and PROCESS bootstrapping estimates tested our hypothesized mediation model as follows: EWB→IWB→body shame→shame→self-compassion→symptoms. RESULTS: After accounting for EWB and IWB, internalized shame accounted for greater variance in both end points than body shame. EWB was associated with greater anxiety through risk paths implicating IWB, body shame, and/or internalized shame. Protective paths associated EWB with fewer depressive and anxiety symptoms among those with higher self-compassion. CONCLUSIONS: The findings suggest a potentially important role for weight bias and shame in psychological health among BSC and implicate self-compassion, a trainable affect-regulation strategy, as a protective factor that may confer some resiliency. Future research using longitudinal and causal designs is warranted.

Living with a concealable stigmatized identity: the impact of anticipated stigma, centrality, salience, and cultural stigma on psychological distress and health.

The current research provides a framework for understanding how concealable stigmatized identities impact people's psychological well-being and health. The authors hypothesize that increased anticipated stigma, greater centrality of the stigmatized identity to the self, increased salience of the identity, and possession of a stigma that is more strongly culturally devalued all predict heightened psychological distress. In Study 1, the hypotheses were supported with a sample of 300 participants who possessed 13 different concealable stigmatized identities. Analyses comparing people with an associative stigma to those with a personal stigma showed that people with an associative stigma report less distress and that this difference is fully mediated by decreased anticipated stigma, centrality, and salience. Study 2 sought to replicate the findings of Study 1 with a sample of 235 participants possessing concealable stigmatized identities and to extend the model to predicting health outcomes. Structural equation modeling showed that anticipated stigma and cultural stigma were directly related to self-reported health outcomes. Discussion centers on understanding the implications of intraindividual processes (anticipated stigma, identity centrality, and identity salience) and an external process (cultural devaluation of stigmatized identities) for mental and physical health among people living with a concealable stigmatized identity.

Overlooked and Understudied: Health Consequences of Weight Stigma in Men.

OBJECTIVE: A substantial amount of literature has suggested that weight stigma impairs health. Evidence on gender differences in weight stigma has been mixed, but studies of weight stigma within men have been primarily absent from the literature. METHODS: In two samples of men recruited nationally from across the United States (N = 1,753), participants completed self-report measures assessing their height, weight, demographics, weight stigma (experienced and internalized), psychological well-being (depression), health behaviors (sleep, alcohol, smoking, binge eating, dieting, physical activity), and self-rated health. RESULTS: Regression analyses showed that, independent of race, socioeconomic status, and BMI, experienced weight stigma and weight bias internalization among men were associated with poor health, including greater depressive symptoms, increased dieting, lower self-reported health, and increased odds of binge eating. Neither internalized nor experienced weight stigma was consistently associated with physical activity, smoking, drinking, or trouble sleeping. CONCLUSIONS: These findings suggest that both experienced and internalized weight stigma are associated with several indices of poor health in men. It may be informative for future work to examine how men cope with weight stigma, particularly if certain coping responses to stigma involve behaviors that contribute to poorer health.

Weight stigma and health: The mediating role of coping responses.

OBJECTIVE: Considerable evidence has documented links between weight stigma and poor health, independent of weight. However, little research has assessed how individuals cope with weight stigma, and how stigma-specific coping responses contribute to health. The present study examined multiple stigma-specific coping responses as mediators of the relationship between experienced weight stigma and health. METHOD: A diverse national sample of 912 adults (53.9% female, Mage = 40.33, SD = 15.58) reporting experiences of weight stigma completed questionnaires about stigma, stigma-specific coping responses (i.e., coping with weight stigma via negative affect, maladaptive eating behavior, healthy lifestyle behavior, and exercise avoidance), and health indices including depressive symptoms, physical health, psychological wellbeing, dieting frequency, and self-esteem. RESULTS: Stigma-specific coping responses mediated the relationship between experienced weight stigma and all health indices, though indirect effects of weight stigma on health varied by coping strategy. Weight stigma was indirectly associated with greater frequency of depressive symptoms, lower scores on psychological wellbeing, self-esteem and physical health through coping via negative affect. Weight stigma indirectly contributed to greater frequency of depressive symptoms and dieting, as well as lower self-esteem and poorer physical health through coping via maladaptive eating. Weight stigma was associated with less frequent depressive symptoms, more frequent dieting, better psychological wellbeing, better self-esteem, and better physical health through coping with healthy lifestyle behaviors. CONCLUSIONS: These findings suggest that it may be useful to address weight stigma and coping in the context of weight management and obesity treatment programs, to help protect individuals from negative health effects of experiencing weight stigma. (PsycINFO Database Record

Internalizing Weight Stigma: Prevalence and Sociodemographic Considerations in US Adults.

OBJECTIVE: This study aimed to conduct a comprehensive assessment of the presence, severity, and sociodemographic correlates of weight bias internalization (WBI) across three distinct samples of US adults. METHODS: Levels of WBI were compared in (1) a sample of adults with obesity and heightened risk of weight stigma (N = 456), (2) an online community sample (N = 519), and (3) a national online panel (N = 2,529). Samples 2 and 3 comprised adults with and without obesity. Participants completed identical self-report measures, including demographic variables and weight-related factors, to determine their relationship with low, mean, and high levels of WBI. RESULTS: At least 44% of adults across samples endorsed mean levels of WBI (as determined by sample 3). The highest levels of WBI were endorsed by approximately one in five adults in the general population samples and by 52% in the sample of adults with obesity. Individuals with the highest WBI were white, had less education and income, were currently trying to lose weight, and had higher BMIs, higher self-perceived weight, and previous experiences of weight stigma (especially teasing). CONCLUSIONS: Internalized weight bias is prevalent among women and men and across body weight categories. Findings provide a foundation to better understand characteristics of individuals who are at risk for internalizing weight bias.