Weight Bias Internalization and Psychosocial, Physical, and Behavioral Health: A Meta-Analysis of Cross-Sectional and Prospective Associations.

Coinciding with widespread efforts to address obesity, weight bias internalization (a process of self-devaluation wherein individuals apply weight-biased stereotypes to themselves) has gained increased attention as a robust correlate of poor health outcomes. The present meta-analysis aimed to provide the largest quantitative synthesis of associations between weight bias internalization and health-related correlates. Studies that provided zero-order correlations for cross-sectional or prospective associations between weight bias internalization and physical, psychosocial, and behavioral health correlates were included in the meta-analysis. Meta-regression determined whether these associations differed based on demographic (sex/gender, race, age), anthropometric (body mass index), and study-level (publication status, sample type, study quality) moderators. Data for 149 (sub)samples were identified that included between 14 and 18,766 participants (M sample size = 534.96, SD = 1,914.43; M age = 34.73, SD = 12.61, range = 9.95-65.70). Results indicated that greater weight bias internalization was concurrently associated with worse psychosocial (e.g., negative and positive mental health, social functioning), physical (e.g., BMI, weight maintenance, health-related quality of life [HRQoL]), and behavioral health (e.g., disordered eating behaviors, healthy eating, physical activity) across most constructs, with effects ranging from small to very large in magnitude. Preliminary evidence also suggested that greater weight bias internalization was subsequently associated with less weight loss and increased negative mental health. Notable variations in the nature and magnitude of these associations were identified based on the health-related correlate and moderator under consideration. These findings indicate that weight bias internalization is linked to multiple adverse health-related outcomes and provide insight into priorities for future research, theory building, and interventions in this area.

Data Quality and Study Compliance Among College Students Across 2 Recruitment Sources: Two Study Investigation.

BACKGROUND: Models of satisficing suggest that study participants may not fully process survey items and provide accurate responses when survey burden is higher and when participant motivation is lower. Participants who do not fully process survey instructions can reduce a study's power and hinder generalizability. Common concerns among researchers using self-report measures are data quality and participant compliance. Similarly, attrition can hurt the power and generalizability of a study. OBJECTIVE: Given that college students comprise most samples in psychological studies, especially examinations of student issues and psychological health, it is critical to understand how college student recruitment sources impact data quality (operationalized as attention check items with directive instructions and correct answers) and retention (operationalized as the completion of follow-up surveys over time). This examination aimed to examine the following: whether data quality varies across recruitment sources, whether study retention varies across recruitment sources, the impact of data quality on study variable associations, the impact of data quality on measures of internal consistency, and whether the demographic qualities of participants significantly vary across those who failed attention checks versus those who did not. METHODS: This examination was a follow-up analysis of 2 previously published studies to explore data quality and study compliance. Study 1 was a cross-sectional, web-based survey examining college stressors and psychological health (282/407, 69.3% female; 230/407, 56.5% White, 113/407, 27.8% Black; mean age 22.65, SD 6.73 years). Study 2 was a longitudinal college drinking intervention trial with an in-person baseline session and 2 web-based follow-up surveys (378/528, 71.6% female; 213/528, 40.3% White, 277/528, 52.5% Black; mean age 19.85, SD 1.65 years). Attention checks were included in both studies to assess data quality. Participants for both studies were recruited from a psychology participation pool (a pull-in method; for course credit) and the general student body (a push-out method; for monetary payment or raffle entry). RESULTS: A greater proportion of participants recruited through the psychology pool failed attention checks in both studies, suggesting poorer data quality. The psychology pool was also associated with lower retention rates over time. After screening out those who failed attention checks, some correlations among the study variables were stronger, some were weaker, and some were fairly similar, potentially suggesting bias introduced by including these participants. Differences among the indicators of internal consistency for the study measures were negligible. Finally, attention check failure was not significantly associated with most demographic characteristics but varied across some racial identities. This suggests that filtering out data from participants who failed attention checks may not limit sample diversity. CONCLUSIONS: Investigators conducting college student research should carefully consider recruitment and include attention checks or other means of detecting poor quality data. Recommendations for researchers are discussed.

A meta-analysis of associations between weight bias internalization and conceptually-related correlates: A step towards improving construct validity.

Weight bias internalization (WBI), a process of weight-based self-devaluation, has been associated with adverse mental and physical health. However, there are limitations with the existing conceptualization and operationalization of WBI that raise questions about the implications of this evidence-base. To address these limitations, the present study investigated the construct validity of WBI by conducting a meta-analysis of associations between WBI (as currently operationalized) and conceptually-related correlates. Studies identified through October 2021 that provided zero-order correlations for associations between WBI and conceptually-related constructs were examined. Meta-regression determined whether these associations differed across WBI measures and demographic (age, sex/gender, race, BMI) and study-level (publication status, sample type, study quality) moderators. Data for 128 (sub)samples were identified (Msample size = 477.83, SD = 1679.90; Mage = 34.46, SD = 12.17; range = 10.21-56.60). Greater WBI exhibited large to very large associations with factors suggested to have considerable overlap with this construct (negative and positive body image, self-devaluation), general and weight-specific experiential avoidance, and individuals' anticipation of future weight stigma. Associations varied for other constructs that have been differentially included in conceptualizations of WBI (endorsing weight bias, weight stigma stereotype awareness, weight stigma experiences), and via measurement-related, demographic, and study-level factors. These findings provide important information that can advance WBI conceptualization and measure-refinement.

Evaluating study procedure training methods for a remote daily diary study of sexual minority women.

BACKGROUND: Ecological momentary assessment (EMA) methods can be used to remotely assess physical and mental health in daily life for hard-to-reach, marginalized, and geographically dispersed populations in the U.S., such as sexual minority women (e.g., lesbian, bisexual). However, EMA studies are often complex, and engaging participants from afar can be a challenge. This study experimentally examined whether adding videos to written recruitment materials would improve consent rates, reduce dropout rates, and improve survey completion rates for an online daily diary study. METHODS: As part of a 2-week study of same-sex female couples' health, 376 women ages 18-35 were recruited from across the U.S. using a market research firm. Couples were randomized to an introductory information condition (written + video materials or written-only materials) prior to informed consent. RESULTS: Overall, 97.1% of eligible women reviewed introductory materials and of these 96.7% consented; consent rates did not differ by condition (written + video: 97.1%, written-only: 97.1%). Dropout rates were low (5.4%) and survey completion rates were high (90.4% of surveys completed); there were no group differences for study dropout (written + video: 3.6%, written-only: 7.0%) or survey completion (written + video: 92.5%, written-only: 88.4%). Data from women randomized to receive videos indicated more than half (53.3%) did not watch any of the five videos in full. However, among those who viewed the videos, time spent watching videos, watching more videos in full, and watching at least one video in full were each positive associated with survey completion rates. CONCLUSIONS: In summary, we had high consent rates, low dropout rates, and high survey completion rates regardless of video instructions. Although sexual minority women can be hard to reach, our potential participants appeared highly motivated to take part in research, and thus video recruitment materials were not necessary to improve participation. Future experimental research to maximize EMA study design and implementation could be important for populations less inclined to participate in EMA studies, or who are less familiar with research.

Measurement of the influences of social processes in appetite using ecological momentary assessment.

Obesity and eating disorders are serious health concerns that both involve dysregulated eating patterns, including binge eating and emotional eating. Though social processes and appetite dysregulation have been shown to predict dysregulated eating separately, limited research has examined the potential link between social processes and appetite in daily life. The purpose of the present study was to examine the association between naturally occurring social processes previously linked with dysregulated eating and appetite using ecological momentary assessment (EMA). Thirty women with binge-eating pathology completed five semi-random EMA surveys a day for 14 days. The EMA surveys included measures of social processes that occurred between surveys (i.e., interpersonal problems, body social comparisons, social media use, and external pressures for thinness) and assessments of appetite at time of survey. Multilevel analyses revealed that each social process approximately 2-h prior positively predicted appetite. Further, using lagged analyses, all of the social processes approximately 4-h prior, aside from social media use, predicted appetite. Our findings suggest that social processes are important in predicting appetite among women with binge-eating pathology. Future extensions of this research that include measures of dysregulated eating are needed.

Gender and Black-White Race Differences in Young Adult Exercise Dependence Prevalence and Associated Disordered Eating.

Purpose: Exercise dependence, an unhealthy preoccupation with exercise that results in physiological and psychological symptoms, may be particularly prevalent among college students given sociocultural exercise and body ideals in this population. Yet few studies have examined this phenomenon in diverse college samples. The aims of the present study were to examine gender and Black-White race differences in the prevalence of exercise dependence and associated disordered eating. Method: Undergraduates (N = 839) completed online measures of exercise dependence and disordered eating. Chi square tests were used to test for differences in prevalence, and linear regression was used to examine race and gender moderating effects on the exercise dependence-disordered eating association. Results: More men reported exercise dependence symptoms than women. More White participants reported symptoms than Black participants. Of the four gender and race combinations examined, White men had the highest proportion and Black women the lowest proportion experiencing symptoms. Gender, but not race, moderated the exercise dependence-disordered eating association. Conclusions: Although more men experience exercise dependence symptoms, women experience stronger associations between exercise dependence symptoms and disordered eating. The number of students who reported exercise dependence symptoms underscores the need for further research in this population and the development of culturally sensitive interventions.

Changes in disordered eating behaviors over 10 or more years: A meta-analysis.

OBJECTIVE: The present meta-analysis evaluated changes in individuals' risk of engaging in distinct disordered eating behaviors (DEBs) in the long-term. METHOD: Longitudinal studies assessing changes in DEBs via ≥2 assessments with a time lag of ≥10 years were included. Risk ratios were calculated for baseline to 10-14.9-year (M = 11.04) follow-up and baseline to ≥15-year (M = 18.62) follow-up changes in the use of binge eating, multiple purging, self-induced vomiting, laxatives, diuretics, diet pills, compensatory exercising, fasting/dieting, and multiple DEBs; Cohen's d was used for continuous binge-eating plus purging variable changes. Subgroup and meta-regression analyses tested whether eating disorder (ED) clinical sample versus nonclinical sample status, female versus male sex/gender, higher versus lower study bias, and baseline mean age and body mass index influenced overall effect magnitude for analyses with sufficient data. RESULTS: Seventeen studies (26 [sub]samples) were included. Overall, individuals' risk of engaging in various restrictive eating and other compensatory behaviors decreased over time and the magnitudes of risk reductions for the use of certain compensatory DEBs were larger over longer follow-up durations. Specifically, for significant DEB change models, risk reductions spanned from 20.0-39.8% for 10-year follow-up and 24.7-74.8% for ≥15-year follow-up. However, nuances were found in the nature of these DEB changes as a function of DEB type, follow-up length, ED versus nonclinical sample composition, and baseline mean age. CONCLUSIONS: These findings provide important information that can help identify treatment priorities and suggest that targeted and tailored preventative ED treatments warrant consistent implementation at the community-level, particularly for youth.

OBJETIVO: El presente metaanálisis evaluó los cambios en el riesgo de los individuos de participar en distintas conductas alimentarias anormales (DEBs, por sus siglas en inglés) a largo plazo. MÉTODO: Se incluyeron los estudios longitudinales que evaluaban los cambios en las DEBs a través de evaluaciones ≥2 con un lapso de tiempo de ≥10 años. Se calcularon los cocientes de riesgo para los cambios de seguimiento basales a 10-14.9 años (M = 11.04) y basales a ≥15 años (M = 18.62) en el uso de atracones, purgaciones múltiples, vómitos autoinducidos, laxantes, diuréticos, píldoras de dieta, ejercicio compensatorio, ayuno/dieta y múltiples DEBs; Cohen's d se usó para atracones continuos más cambios variables de purgación. Los análisis de subgrupos y de metarregresión probaron si la muestra clínica del trastorno de la conducta alimentaria (TCA) versus el estado de la muestra no clínica, el sexo/género femenino versus masculino, el sesgo de estudio mayor versus menor, y la edad media basal y el índice de masa corporal influyeron en la magnitud del efecto general para los análisis con datos suficientes. RESULTADOS: Se incluyeron 17 estudios (26 [sub]muestras). En general, el riesgo de las personas de participar en diversas conductas alimentarias restrictivas y otros comportamientos compensatorios disminuyó con el tiempo y las magnitudes de las reducciones de riesgo por el uso de ciertos DEB compensatorios fueron mayores durante períodos de seguimiento más largos. Específicamente, para los modelos de cambio de DEB significativos, las reducciones de riesgo abarcaron desde 20.0-39.8% para 10 años y 24.7-74.8% para seguimientos de ≥15 años. Sin embargo, se encontraron matices en la naturaleza de estos cambios de DEB en función del tipo de DEB, la duración del seguimiento, TCA versus composición de la muestra no clínica y la edad media basal. CONCLUSIONES: Estos hallazgos brindan información importante que puede ayudar a identificar las prioridades de tratamiento y sugieren que los tratamientos preventivos de TCA específicos y personalizados justifican una implementación constante a nivel comunitario, particularmente para los jóvenes.

An Ecological Momentary Assessment of Self-improvement and Self-evaluation Body Comparisons: Associations with College Women's Body Dissatisfaction and Exercise.

Upward body comparisons are prevalent among college women and associated with body dissatisfaction and disordered eating. However, less is known about distinguishing features of the comparisons themselves as they occur in daily life. The primary purpose of the present study was to examine whether two types of upward body comparisons previously studied experimentally (self-improvement and self-evaluation) are differentially associated with body- and exercise-related outcomes in real-life settings using ecological momentary assessment (EMA). Undergraduate women (N = 74) between 18-25 years (Mage = 20.4, SD = 1.63) completed five surveys on smartphones daily for seven days. EMA measures assessed body comparisons, body dissatisfaction, and exercise cognitions and behaviors. Baseline body dissatisfaction, comparison tendency, and exercise behavior were examined as moderators. Multilevel analyses revealed that both self-improvement and self-evaluation were associated with greater exercise thoughts (ps < .05), but not with changes in body dissatisfaction (ps> .05). Moderator analyses revealed differences between the two types and their associations with outcomes for select subgroups. For example, self-improvement comparisons were associated with fewer exercise thoughts among participants with high baseline exercise behaviors (p < .01). Further research is needed to understand the differences between self-improvement and self-evaluation and the potential protective mechanisms of self-improvement.

Is use of social networking sites associated with young women's body dissatisfaction and disordered eating? A look at Black-White racial differences.

Maladaptive patterns of social networking site (SNS) use, such as excessive reassurance seeking, are associated with body dissatisfaction and disordered eating. However, it is unclear how these processes play out among different racial groups. This study examined racial differences in SNS use and body dissatisfaction and disordered eating. Black (n=445) and White (n=477) female undergraduates completed online measures of SNS use (frequency and reassurance seeking), body dissatisfaction, and disordered eating. Black women reported less body dissatisfaction, marginally less disordered eating, and less frequent Facebook use than White women; there were no race differences in SNS reassurance seeking. More frequent Facebook use was associated with more body dissatisfaction (but not disordered eating), and more SNS reassurance seeking predicted both more body dissatisfaction and disordered eating. Associations were not moderated by race, suggesting maladaptive SNS use may have negative consequences for both Black and White women.