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The internalization of weight bias is associated with severe eating pathology among lean individuals

Objective: The internalization of weight bias is associated with clinically significant eating pathology among overweight adults. However, these relationships have not yet been assessed in lean individuals, who may perceive themselves to be overweight and subsequently internalize weight bias. The aim of the present study, therefore, was to determine whether lean individuals internalize weight bias and if the internalization of weight bias among lean respondents is associated with eating pathology.

Method: Participants were 197 lean (mean BMI: 22.28 ± 1.89, range 15.80–24.98) adults who completed the Weight Bias Internalization Scale (WBIS) and measures of disordered eating behaviors and attitudes via an anonymous online survey.

Results: Based on convergence of responses from the EDE-Q and QEWP-R, and using DSM-5 behavioral criteria, 10% and 15% of participants were classified into a binge eating and binge/purge group, respectively. WBIS scores were significantly higher among those with binge and/or purge behaviors compared to those without eating pathology. Bivariate correlations revealed positive associations between WBIS score and BMI, depression, and all EDE-Q subscales (restraint, eating concern, shape concern, weight concern). Logistic regressions indicated that internalized weight bias was significantly associated with binge/purge behaviors (OR = 4.67, 95% CI: 2.38–9.17, p < .001) and binge eating (OR = 2.29, 95% CI: 1.26–4.19,p < .01).

Discussion: These novel findings suggest that lean individuals may internalize weight bias. Importantly, the internalization of weight bias among lean individuals is associated with clinically significant eating pathology.

Full-text

Alex’s Notes: Stereotypes are subconscious attributes that people think characterize a group. We form them countless times throughout our life to help our brain make sense of the world. Even if they are not accurate, they still exist in the back of our minds to influence our thoughts and actions without awareness. Research has demonstrated that overweight individuals are faced with a consistent weight stigma across multiple domains such as health care, the legal system, employment, and interpersonal relationships.

Ironically, anti-fat attitudes are not limited to lean people, as overweight and obese persons show the same biases against others in their position. Perhaps this is because many overweight people consider themselves normal weight, or perhaps it is because we evolved to prefer leaner body shapes. Or perhaps overweight and obese people internalize this weight bias in a form of self-hate, which would be extended onto others as a consequence of the associated low self-esteem.

The internalization of weight bias is as interesting as it is significant. It has demonstrated strong associations with low self-esteem, depression, body dissatisfaction, and clinically significant eating disorders. Of particular importance is the fact that internalization of weight bias may counter 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. Additionally, formerly overweight individuals who have successfully lost weight still internalize weight bias, suggesting a pervasive nature of this mental attitude.

However, eating disorders and body dysmorphia are not restricted to overweight people. Individuals with anorexia are an excellent example. Yet, no research to date has examined the relationship between internalization of weight bias and eating pathology among lean individuals, leading the current study to expand on the existing literature through examination of 197 lean adult volunteers.

The subjects were recruited through an ad on Craigslist in major cities throughout the US, and completed self-reported questionnaires anonymously. These included several scales about weight bias internalization (WBIS), eating disorders (EDE-Q), eating and weight patterns (QEWP=R), depression (BDI-II), and basic demographic information.

Characteristics and relationships

The subjects were classified into one of three groups based on self-reported eating behaviors that had to have been performed at least once per week for 28 days: binge eating and purging (B/P), binge eating alone (BE), and no binging or purging (NBP). Accordingly, 15 and 10% of the subjects were classified as B/P and BE, respectively. As could be expected based upon previous work with overweight individuals, the disordered eating participants had significantly higher WBIS scores than NBP, with no differences between one another.

Interestingly, 38.6% of the subjects considered themselves overweight or obese despite the study population having a BMI range of 15.80-24.98 (avg. 22.28). Of course, subjects who believed themselves to be overweight/obese had significantly greater WBIS scores than those who accurately perceived themselves as normal weight. Additionally, subjects who were currently dieting had significantly greater WBIS scores, and WBIS scores were significantly associated with all domains of the EDE-Q. Further logistic regression analyses revealed that WBIS score statistically predicted classification in the B/P and BE groups so much so that for every one unit increase in WBIS score, the estimated odds of meeting the B/P criteria increase nearly five-fold, and the estimated odds of meeting the BE criteria increase by more than two.

Bottom line

It should be noted that the average age of the study population was 32 years, with the majority being female (89.3%) and Caucasian (77.2%) and Asian (13.7%). Moreover, the correlational nature of the study precludes causality. It may be that those who report disordered eating behaviors and who endorse distorted perception of shape and weight subsequently internalize weight bias since they believe themselves to be overweight. It also may be that those who internalize weight bias at a lower weight turn to unhealthy weight control practices, such as purging, to lose perceived excess weight.

Regardless of the direction, there is no doubt that the internalization of weight bias is associated with eating pathologies in lean individuals. Personally, coming from a sport where weight is incredibly important (wrestling), I can appreciate this concept and what it can lead to. I hope future work looks at its relationship in athletes and those who are clinically diagnosed with eating disorders.

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