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01-08-2021 | Obesity | Original Contributions

Examining Weight Bias and Loss-of-Control Eating among Individuals Seeking Bariatric Surgery

Authors: Jessica L. Lawson, Leslie M. Schuh, David B. Creel, Rebecca M. Blackinton, Stefanie A. Giambrone, Carlos M. Grilo, Valentina Ivezaj

Published in: Obesity Surgery | Issue 8/2021

Abstract

Objective

Externalized weight bias (EWB), directed towards others, and internalized weight bias (IWB), directed towards the self, are thought to exacerbate obesity and disordered eating and may be important factors to assess and understand among individuals seeking bariatric surgery. This study examined clinical correlates (pre-surgical BMI, depressive symptoms, weight self-efficacy, and shape/weight overvaluation) of both EWB and IWB among individuals presenting for bariatric surgery with and without regular loss-of-control eating (LOC eating).

Methods

A total of 316 adults presenting for bariatric surgery completed established self-report measures to assess EWB, IWB, depressive symptoms, weight self-efficacy, and core symptoms of disordered eating including LOC eating and overvaluation of shape/weight.

Results

IWB and EWB were not associated with pre-surgical BMI, age, or sex, but were both significantly higher among White than non-White participants. Adjusting for race, IWB and EWB were significantly associated with greater eating disorder psychopathology and depressive symptoms and with less weight-related self-efficacy. Participants who endorsed regular LOC eating (53.5% of the sample) endorsed significantly lower weight self-efficacy and higher IWB, EWB, depressive symptoms, and overvaluation of shape/weight.

Conclusions

Findings suggest that regular LOC eating is common among individuals seeking bariatric surgery and associated with a range of heightened eating disorder and psychosocial concerns including both IWB and EWB. Future research exploring the longitudinal significance of the relationship between these two forms of weight bias and LOC eating is indicated.

Pearl RL, Puhl RM. Weight bias internalization and health: a systematic review. Obes Rev. 2018;19(8):1141–63. https://doi.org/10.1111/obr.12701.CrossRefPubMedPubMedCentral

Lent MR, Napolitano MA, Wood GC, et al. Internalized weight bias in weight-loss surgery patients: psychosocial correlates and weight loss outcomes. Obes Surg. 2014;24(12):2195–9. https://doi.org/10.1007/s11695-014-1455-z.CrossRefPubMed

Latner JD, Barile JP, Durso LE, et al. Weight and health-related quality of life: the moderating role of weight discrimination and internalized weight bias. Eat Behav. 2014;15(4):586–90. https://doi.org/10.1016/j.eatbeh.2014.08.014.CrossRefPubMed

Raves DM, Brewis A, Trainer S, et al. Bariatric surgery patients’ perceptions of weight-related stigma in healthcare settings impair post-surgery dietary adherence. Front Psychol. 2016;7:1497. https://doi.org/10.3389/fpsyg.2016.01497.CrossRefPubMedPubMedCentral

Lewis S, Thomas SL, Blood RW, et al. How do obese individuals perceive and respond to the different types of obesity stigma that they encounter in their daily lives? A qualitative study. Soc Sci Med. 2011;73(9):1349–56. https://doi.org/10.1016/j.socscimed.2011.08.021.CrossRefPubMed

Udo T, Grilo CM. Perceived weight discrimination, childhood maltreatment, and weight gain in U.S. adults with overweight/obesity. Obesity (Silver Spring). 2016;24(6):1366–72. https://doi.org/10.1002/oby.21474.CrossRef

Udo T, Grilo CM. Cardiovascular disease and perceived weight, racial, and gender discrimination in U.S. adults. J Psychosom Res. 2017;100:83–8. https://doi.org/10.1016/j.jpsychores.2017.07.007.CrossRefPubMedPubMedCentral

Rosenberger PH, Henderson KE, Bell RL, et al. Associations of weight-based teasing history and current eating disorder features and psychological functioning in bariatric surgery patients. Obes Surg. 2007;17(4):470–7. https://doi.org/10.1007/s11695-007-9082-6.CrossRefPubMed

Schwartz MB, Vartanian LR, Nosek BA, et al. The influence of one's own body weight on implicit and explicit anti-fat bias. Obesity (Silver Spring). 2006;14(3):440–7. https://doi.org/10.1038/oby.2006.58.CrossRef

10.

Friedman KE, Ashmore JA, Applegate KL. Recent experiences of weight-based stigmatization in a weight loss surgery population: psychological and behavioral correlates. Obesity (Silver Spring). 2008;16(Suppl 2):S69–74. https://doi.org/10.1038/oby.2008.457.CrossRef

11.

Puhl RM, Himmelstein MS, Quinn DM. Internalizing weight stigma: prevalence and sociodemographic considerations in us adults. Obesity (Silver Spring). 2018;26(1):167–75. https://doi.org/10.1002/oby.22029.CrossRef

12.

Puhl R, Suh Y. Health consequences of weight stigma: implications for obesity prevention and treatment. Curr Obes Rep. 2015;4(2):182–90. https://doi.org/10.1007/s13679-015-0153-z.CrossRefPubMed

13.

Mensinger JL, Calogero RM, Tylka TL. Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program. Appetite. 2016;102:32–43. https://doi.org/10.1016/j.appet.2016.01.033.CrossRefPubMed

14.

Sikorski C, Luppa M, Luck T, et al. Weight stigma “gets under the skin”-evidence for an adapted psychological mediation framework: a systematic review. Obesity (Silver Spring). 2015;23(2):266–76. https://doi.org/10.1002/oby.20952.CrossRef

15.

Opolski M, Chur-Hansen A, Wittert G. The eating-related behaviours, disorders and expectations of candidates for bariatric surgery. Clin Obes. 2015;5(4):165–97. Epub 2015/07/16. https://doi.org/10.1111/cob.12104.CrossRefPubMed

16.

Koball AM, Clark MM, Collazo-Clavell M, et al. The relationship among food addiction, negative mood, and eating-disordered behaviors in patients seeking to have bariatric surgery. Surg Obes Relat Dis. 2016;12(1):165–70. https://doi.org/10.1016/j.soard.2015.04.009.CrossRefPubMed

17.

Roberto CA, Sysko R, Bush J, et al. Clinical correlates of the weight bias internalization scale in a sample of obese adolescents seeking bariatric surgery. Obesity (Silver Spring). 2012;20(3):533–9. https://doi.org/10.1038/oby.2011.123.CrossRef

18.

Barnes RD, Ivezaj V, Grilo CM. An examination of weight bias among treatment-seeking obese patients with and without binge eating disorder. Gen Hosp Psychiatry. 2014;36(2):177–80. https://doi.org/10.1016/j.genhosppsych.2013.10.011.CrossRefPubMed

19.

Batsis JA, Clark MM, Grothe K, et al. Self-efficacy after bariatric surgery for obesity. A population-based cohort study. Appetite. 2009;52(3):637–45. https://doi.org/10.1016/j.appet.2009.02.017.CrossRefPubMed

20.

Corrigan PW, Larson JE, Rusch N. Self-stigma and the “why try” effect: impact on life goals and evidence-based practices. World psychiatry : official journal of the World Psychiatric Association (WPA). 2009;8(2):75–81. https://doi.org/10.1002/j.2051-5545.2009.tb00218.x.CrossRef

21.

Mensinger JL, Meadows A. Internalized weight stigma mediates and moderates physical activity outcomes during a healthy living program for women with high body mass index. Psychol Sport Exerc. 2017;30:64–72. https://doi.org/10.1016/j.psychsport.2017.01.010.CrossRef

22.

Hilbert A, Braehler E, Haeuser W, et al. Weight bias internalization, core self-evaluation, and health in overweight and obese persons. Obesity (Silver Spring). 2014;22(1):79–85. https://doi.org/10.1002/oby.20561.CrossRef

23.

O'Brien KS, Latner JD, Puhl RM, et al. The relationship between weight stigma and eating behavior is explained by weight bias internalization and psychological distress. Appetite. 2016;102:70–6. https://doi.org/10.1016/j.appet.2016.02.032.CrossRefPubMed

24.

Lawson JL, LeCates A, Ivezaj V, et al. Internalized weight bias and loss-of-control eating following bariatric surgery. Eat Disord. 2020:1–14. https://doi.org/10.1080/10640266.2020.1731920.

25.

White MA, Kalarchian MA, Masheb RM, et al. Loss of control over eating predicts outcomes in bariatric surgery patients: a prospective, 24-month follow-up study. J Clin Psychiatry. 2010;71(2):175–84. https://doi.org/10.4088/JCP.08m04328blu.CrossRefPubMed

26.

Devlin MJ, King WC, Kalarchian MA, Hinerman A, Marcus MD, Yanovski SZ, et al. Eating pathology and associations with long-term changes in weight and quality of life in the longitudinal assessment of bariatric surgery study. Int J Eat Disord. 2018. doi: https://doi.org/10.1002/eat.22979.

27.

Bannon KL, Hunter-Reel D, Wilson GT, et al. The effects of causal beliefs and binge eating on the stigmatization of obesity. Int J Eat Disord. 2009;42(2):118–24. https://doi.org/10.1002/eat.20588.CrossRefPubMed

28.

Puhl RM, Masheb RM, White MA, et al. Attitudes toward obesity in obese persons: a matched comparison of obese women with and without binge eating. Eat Weight Disord. 2010;15(3):e173–9. https://doi.org/10.3275/6797.CrossRefPubMedPubMedCentral

29.

Ivezaj V, Barnes RD, Cooper Z, et al. Loss-of-control eating after bariatric/sleeve gastrectomy surgery: similar to binge-eating disorder despite differences in quantities. Gen Hosp Psychiatry. 2018;54:25–30. https://doi.org/10.1016/j.genhosppsych.2018.07.002.CrossRefPubMedPubMedCentral

30.

Ivezaj V, Kessler EE, Lydecker JA, et al. Loss-of-control eating following sleeve gastrectomy surgery. Surg Obes Relat Dis. 2017;13(3):392–8. https://doi.org/10.1016/j.soard.2016.09.028.CrossRefPubMed

31.

Boswell RG, White MA. Gender differences in weight bias internalisation and eating pathology in overweight individuals. Adv Eat Disord. 2015;3(3):259–68. https://doi.org/10.1080/21662630.2015.1047881.CrossRefPubMedPubMedCentral

32.

Durso LE, Latner JD. Understanding self-directed stigma: development of the weight bias internalization scale. Obesity (Silver Spring). 2008;16(Suppl 2):S80–6. https://doi.org/10.1038/oby.2008.448.CrossRef

33.

Palmeira L, Pinto-Gouveia J, Cunha M. The role of weight self-stigma on the quality of life of women with overweight and obesity: a multi-group comparison between binge eaters and non-binge eaters. Appetite. 2016;105:782–9. Epub 2016/07/18. https://doi.org/10.1016/j.appet.2016.07.015.CrossRefPubMed

34.

Durso LE, Latner JD, White MA, et al. Internalized weight bias in obese patients with binge eating disorder: associations with eating disturbances and psychological functioning. Int J Eat Disord. 2012;45(3):423–7. https://doi.org/10.1002/eat.20933.CrossRefPubMed

35.

Durso LE, Latner JD, Ciao AC. Weight bias internalization in treatment-seeking overweight adults: Psychometric validation and associations with self-esteem, body image, and mood symptoms. Eat Behav. 2016;21:104–8. https://doi.org/10.1016/j.eatbeh.2016.01.011.CrossRefPubMed

36.

Wagner AF, Butt M, Rigby A. Internalized weight bias in patients presenting for bariatric surgery. Eat Behav. 2020;39:101429. https://doi.org/10.1016/j.eatbeh.2020.101429.CrossRefPubMed

37.

Allison DB, Basile VC, Yuker HE. The measurement of attitudes toward and beliefs about obese persons. Int J Eat Disord. 1991;10:599–607. https://doi.org/10.1002/1098-108X(199109)10:5<599::AID-EAT2260100512>3.0.CO;2-#CrossRef

38.

Puhl RM, Brownell KD. Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity (Silver Spring). 2006;14(10):1802–15. Epub 2006/10/26. https://doi.org/10.1038/oby.2006.208.CrossRef

39.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.CrossRef

40.

Clark MM, Abrams DB, Niaura RS, et al. Self-efficacy in weight management. J Consult Clin Psychol. 1991;59(5):739–44. https://doi.org/10.1037/0022-006X.59.5.739.CrossRefPubMed

41.

Grilo CM, Henderson KE, Bell RL, et al. Eating disorder examination-questionnaire factor structure and construct validity in bariatric surgery candidates. Obes Surg. 2013;23(5):657–62. https://doi.org/10.1007/s11695-012-0840-8.CrossRefPubMedPubMedCentral

42.

Ivezaj V, Wiedemann AA, Grilo CM. Overvaluation of weight or shape and loss-of-control eating following bariatric surgery. Obesity. 2019;27(8):1239–43.CrossRef

43.

Machado PPP, Grilo CM, Crosby RD. Replication of a modified factor structure for the eating disorder examination-questionnaire: extension to clinical eating disorder and non-clinical samples in Portugal. Eur Eat Disord Rev. 2018;26(1):75–80. https://doi.org/10.1002/erv.2569.CrossRefPubMed

44.

Machado PPP, Grilo CM, Rodrigues TF, et al. Eating Disorder Examination - Questionnaire short forms: a comparison. Int J Eat Disord. 2020;53(6):937–44. https://doi.org/10.1002/eat.23275.CrossRefPubMed

45.

Ivezaj V, Grilo CM. Accuracy of self-reported height and weight among sleeve gastrectomy patients with disordered eating. Obes Surg. 2017;27(1):267–70. https://doi.org/10.1007/s11695-016-2443-2.CrossRefPubMedPubMedCentral

46.

Christian NJ, King WC, Yanovski SZ, et al. Validity of self-reported weights following bariatric surgery. Jama. 2013;310(22):2454–6. https://doi.org/10.1001/jama.2013.281043.CrossRefPubMedPubMedCentral

47.

Association AP. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.CrossRef

48.

Puhl RM, Moss-Racusin CA, Schwartz MB. Internalization of weight bias: Implications for binge eating and emotional well-being. Obesity (Silver Spring). 2007;15(1):19–23. https://doi.org/10.1038/oby.2007.521.CrossRef

49.

Lydecker JA, Cotter E, Grilo CM. Associations of weight bias with disordered eating among Latino and White men. Obesity (Silver Spring). 2019. doi: https://doi.org/10.1002/oby.22632.

50.

Himmelstein MS, Puhl RM, Quinn DM. Intersectionality: an understudied framework for addressing weight stigma. Am J Prev Med. 2017;53(4):421–31. https://doi.org/10.1016/j.amepre.2017.04.003.CrossRefPubMed

51.

Gee GC, Ro A, Gavin A, et al. Disentangling the effects of racial and weight discrimination on body mass index and obesity among Asian Americans. Am J Public Health. 2008;98(3):493–500. https://doi.org/10.2105/ajph.2007.114025.CrossRefPubMedPubMedCentral

52.

Tomiyama AJ, Carr D, Granberg EM, et al. How and why weight stigma drives the obesity “epidemic” and harms health. BMC Med. 2018;16(1):123. https://doi.org/10.1186/s12916-018-1116-5.CrossRefPubMedPubMedCentral

53.

Baldofski S, Rudolph A, Tigges W, et al. Weight bias internalization, emotion dysregulation, and non-normative eating behaviors in prebariatric patients. Int J Eat Disord. 2016;49(2):180–5. https://doi.org/10.1002/eat.22484.CrossRefPubMed

54.

Young MT, Phelan MJ, Nguyen NT. A decade analysis of trends and outcomes of male vs female patients who underwent bariatric surgery. J Am Coll Surg. 2016;222(3):226–31. https://doi.org/10.1016/j.jamcollsurg.2015.11.033.CrossRefPubMed

55.

Connor Gorber S, Tremblay M, Moher D, et al. A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev. 2007;8(4):307–26. https://doi.org/10.1111/j.1467-789X.2007.00347.x.CrossRefPubMed

56.

White MA, Masheb RM, Burke-Martindale C, et al. Accuracy of self-reported weight among bariatric surgery candidates: the influence of race and weight cycling. Obesity (Silver Spring). 2007;15(11):2761–8. https://doi.org/10.1038/oby.2007.328.CrossRef

57.

Cochran WG. Planning and analysis of observational studies: John Wiley & Sons; 2009.

58.

Grilo CM, Sanislow CA, Shea MT, et al. Two-year prospective naturalistic study of remission from major depressive disorder as a function of personality disorder comorbidity. J Consult Clin Psychol. 2005;73(1):78–85.CrossRef

59.

Hubner C, Baldofski S, Zenger M, et al. Influences of general self-efficacy and weight bias internalization on physical activity in bariatric surgery candidates. Surg Obes Relat Dis. 2015;11(6):1371–6. https://doi.org/10.1016/j.soard.2014.11.013.CrossRefPubMed

60.

Pearl RL, Wadden TA, Chao AM, et al. Weight bias internalization and long-term weight loss in patients with obesity. Ann Behav Med. 2019;53(8):782–7. https://doi.org/10.1093/abm/kay084.CrossRefPubMed

61.

Pearl RL, White MA, Grilo CM. Weight bias internalization, depression, and self-reported health among overweight binge eating disorder patients. Obesity (Silver Spring). 2014;22(5):E142–8. https://doi.org/10.1002/oby.20617.CrossRef

Title: Examining Weight Bias and Loss-of-Control Eating among Individuals Seeking Bariatric Surgery
Authors: Jessica L. Lawson
Leslie M. Schuh
David B. Creel
Rebecca M. Blackinton
Stefanie A. Giambrone
Carlos M. Grilo
Valentina Ivezaj
Publication date: 01-08-2021
Publisher: Springer US
Keywords: Obesity
Obesity
Bariatric Surgery
Bariatric Surgery
Eating Disorder
Eating Disorder
Published in: Obesity Surgery / Issue 8/2021
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-021-05418-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Examining Weight Bias and Loss-of-Control Eating among Individuals Seeking Bariatric Surgery

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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