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Romano KA, Peterson CB, Anderson LM, Anker J, Heron KE. Trajectories of negative affect prior to and following disordered eating behaviors among women with eating disorder pathology: An examination of the role of state-interoception. J Psychosom Res 2024; 185:111878. [PMID: 39128183 DOI: 10.1016/j.jpsychores.2024.111878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/11/2024] [Accepted: 08/04/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE Affect regulation theories of eating disorders (ED) posit that negative affect increases in the hours before and decreases following disordered eating behaviors (DEBs) in daily life, yet findings from studies assessing affective changes post-DEBs are mixed. This inconsistency may be due to the previously unassessed role of other transdiagnostic processes in these associations, such as interoception (the ability to sense and integrate information from bodily sensations). To address this research gap, the present study examined whether different interoception dimensions moderated negative affect trajectories surrounding DEBs in the natural environment. METHOD 150 women with ED pathology (Mage = 21.0, SD = 4.1) completed 4 surveys targeting affect and DEBs each day for a 10-day ecological momentary assessment period. Polynomial multilevel models examined negative affect trajectories pre- and post-DEBs (dietary restriction, overeating, loss of control eating), and whether these trajectories varied based on daily interoception dimensions (not distracting, self-regulation, body listening and trust). RESULTS Negative affect increased prior to loss of control eating-but not dietary restriction or overeating-and decreased following all DEBs. Further, the magnitude of the decrease in negative affect that emerged post-dietary restriction decreased in strength as daily "not distracting" interoception increased. The other interoception dimensions did not moderate negative affect trajectories surrounding DEBs. CONCLUSIONS Allowing oneself to experience (vs. distract from) uncomfortable bodily sensations may weaken affect dysregulation processes that follow dietary restriction in daily life and are theorized to maintain DEBs. These results provide insight that may strengthen EDs theories, research, and inform interoception-focused interventions.
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Affiliation(s)
- Kelly A Romano
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA; Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA.
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Lisa M Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Justin Anker
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kristin E Heron
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA; Department of Psychology, Old Dominion University, Norfolk, VA, USA
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Borgatti A, Morgan C, Stager L, Dutton GR. Associations between weight bias internalization, weight status, and health among a diverse cohort of freshman college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-10. [PMID: 38875131 DOI: 10.1080/07448481.2024.2346351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 04/09/2024] [Indexed: 06/16/2024]
Abstract
Mental health concerns are common among college students, especially students with higher body mass index (BMI). Weight bias internalization (WBI) is thought to contribute to these mental health disparities. However, little is known about how WBI differs among more diverse students, and to what extent WBI may explain associations between BMI and health in college populations. This study compared rates of WBI in Freshman college students (N = 1289) across gender, race/ethnicity, and sexual orientation, and assessed whether WBI mediated associations between BMI and mental health (depression, self-esteem, stress, loneliness) and behavioral health (disordered eating, physical activity, gym use). Black students and men demonstrated reduced WBI while bisexual women showed increased WBI. Further, WBI mediated the association of BMI with mental health and disordered eating, but not physical activity. These findings suggest that stigma may account for mental health disparities among higher-BMI students, and that minoritized groups are disproportionately impacted.
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Affiliation(s)
- Alena Borgatti
- Division of Preventive Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Casie Morgan
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lindsay Stager
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychiatry, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gareth R Dutton
- Division of Preventive Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
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Hunger JM, Montoya AK, Edrosolan K, Tan J, Hubbard AS, Tomiyama AJ. Ecological Momentary Assessment of Weight Stigma and Eating Behavior in Everyday Life. Ann Behav Med 2024; 58:457-462. [PMID: 38591715 DOI: 10.1093/abm/kaae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Weight stigma is widespread, but the existing literature on its harmful consequences remains largely limited to lab-based experiments and large-scale longitudinal designs. PURPOSE The purpose of this study was to understand how weight stigma unfolds in everyday life, and whether it predicts increased eating behavior. METHODS In this event-contingent ecological momentary assessment study, 91 participants reported every time they experienced weight stigma and documented whether they ate, how much they ate, and what they ate. These reports were compared against a timepoint when they did not experience stigma. RESULTS Participants reported a wide variety of stigmatizing events from a variety of sources, with the most common ones being the self, strangers, the media, and family. Multilevel models showed that participants were no more likely to eat post-stigma (vs. the comparison point), but if they did eat, they ate more servings of food (on average consuming 1.45 more servings, or 45% more). Moderation analyses indicated that this effect was amplified for men versus women. CONCLUSION Experiencing weight stigma appears to beget behavioral changes, potentially driving future weight gain, placing individuals at ever more risk for further stigmatization.
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Affiliation(s)
| | - Amanda K Montoya
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kristienne Edrosolan
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Juanyi Tan
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Anne S Hubbard
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - A Janet Tomiyama
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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Levinson JA, Kinkel-Ram S, Myers B, Hunger JM. A systematic review of weight stigma and disordered eating cognitions and behaviors. Body Image 2024; 48:101678. [PMID: 38278088 PMCID: PMC11180546 DOI: 10.1016/j.bodyim.2023.101678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/28/2024]
Abstract
Weight stigma is persistent across contexts and is associated with disordered eating cognitions and behaviors. This systematic review aimed to examine the existing literature that has explored the relationship between weight stigma and disordered eating cognitions and behaviors. We specifically examined three dimensions of weight stigma - experienced, anticipated, and internalized - and adopted an inclusive conceptualization of outcomes related to disordered eating (including constructs such as binge eating, body dissatisfaction, and other cognitions and behaviors such as dietary restraint, unhealthy weight control behaviors, and drive for thinness). We searched PubMed, Embase, CINAHL, Web of Science, Sociological Abstracts, and PsycINFO for English-language, peer-reviewed articles and dissertations with quantitative methodology published through October 2023. The search resulted in 242 articles meeting inclusion criteria. A narrative review found a consistent relationship between greater weight stigma and more disordered eating cognitions and behaviors. Methodological and theoretical limitations are discussed, as are critical avenues for future research and potential clinical implications stemming from this body of research. Given the widespread nature and impact of weight stigma on disordered eating, it is imperative that we intervene to address weight stigma at all levels, from the structural to the intrapersonal.
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Affiliation(s)
- Jordan A Levinson
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095, United States
| | - Shruti Kinkel-Ram
- Department of Psychology, Miami University, 90 N Patterson Avenue, Oxford, OH 45056, United States
| | - Bethany Myers
- University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Jeffrey M Hunger
- Department of Psychology, Miami University, 90 N Patterson Avenue, Oxford, OH 45056, United States.
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Bidstrup H, Brennan L, Kaufmann L, Meadows A, de la Piedad Garcia X. A systematic review of ecological momentary assessment studies on weight stigma and a call for a large-scale collaboration. Obes Rev 2024; 25:e13676. [PMID: 38115555 DOI: 10.1111/obr.13676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 09/21/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Weight stigma is associated with poor mental health correlates in cross-sectional research. Researchers are increasingly using Ecological Momentary Assessment (EMA) methods, collecting comprehensive within-person data to understand the temporal nature of weight stigma and its biopsychosocial correlates. AIM To systematically review EMA studies on the effect of weight stigma on biopsychosocial correlates and integrate the findings. METHOD PsycINFO, CINAHL, Embase, Medline Complete, and Web of Science were searched and studies were doubled screened (H.B. and X.P.G.). RESULTS Twelve studies (N = 615) met our inclusion criteria. For both between- and within-subject effects, experienced and internalized weight stigmas were associated with negative correlates/outcomes (e.g., higher disordered eating and lower positive mood). However, studies differed in the correlate measures assessed, EMA methods used, and participant instructions provided. Given these inconsistencies, comparison across studies was difficult, and findings could not be reliably integrated. CONCLUSIONS Consistent with previous research, studies from this review suggest weight stigma leads to adverse outcomes. EMA has the potential to overcome many of the limitations present in cross-sectional research on weight stigma and provide more ecologically valid and reliable results. We argue for a collaborative data-sharing consortium with standardized EMA methodologies, so researchers worldwide can contribute to and make use of a large, collective dataset on weight stigma and health correlates (see osf.io/s5ru6/).
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Affiliation(s)
- Hugh Bidstrup
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Albury/Wodonga, Victoria, Australia
| | - Leah Brennan
- School of Psychology and Public Health, La Trobe University, Albury/Wodonga, Victoria, Australia
- Centre for Eating, Weight, and Body Image, East Melbourne, Victoria, Australia
| | - Leah Kaufmann
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Angela Meadows
- Department of Psychology, University of Essex, Colchester, UK
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Williamson G, Cotter EW, Cao L, Guidinger C, Kelly NR. Ecological momentary assessment of state affect prior to and following loss of control eating in young men. Eat Behav 2023; 50:101782. [PMID: 37517107 DOI: 10.1016/j.eatbeh.2023.101782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/14/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Loss of control (LOC) eating is prevalent but understudied among young men. Affect regulation models propose that LOC eating functions as a maladaptive effort to escape from distressing affective states. As such, negative affect is thought to increase before and decrease after LOC eating. However, examinations with young men are lacking and it remains unclear whether specific emotional experiences are differentially implicated in their LOC eating. METHODS The current study examined the temporal roles of affect in LOC eating in 31 young men (18-35 years; Mage = 25.74 ± 5.61y; 46.7 % White; 30 % Black/African American; 10 % Hispanic/Latino, 10 % South Asian) who reported engaging in recurrent LOC eating. Participants completed a 14-day ecological momentary assessment protocol and recorded all eating episodes each day and their state affect five times per day. Generalized linear mixed models were conducted to examine the trajectories of global and item-level negative and positive affect pre- and post-LOC eating episodes. RESULTS Negative affect did not change significantly before or after LOC eating (ps > .05). Positive affect did not change significantly before LOC eating (ps > .05). Global positive affect, excitement, and happiness decreased significantly after LOC eating (ps ≤ .001). DISCUSSION Study findings contradict extant theory and empirical data largely from female samples. Negative affect did not increase risk for LOC eating, nor did LOC eating function to improve participants' mood; rather, positive mood slightly decreased after LOC eating. Further investigation around the observed decline in positive affect after LOC eating will clarify if this is a relevant intervention point in this population.
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Affiliation(s)
- Gina Williamson
- Counseling Psychology and Human Services, University of Oregon, United States of America; The Prevention Science Institute, University of Oregon, United States of America.
| | - Elizabeth W Cotter
- Department of Health Studies, American University, United States of America.
| | - Li Cao
- Sanford Center for Biobehavioral Research, United States of America.
| | - Claire Guidinger
- Counseling Psychology and Human Services, University of Oregon, United States of America; The Prevention Science Institute, University of Oregon, United States of America.
| | - Nichole R Kelly
- Counseling Psychology and Human Services, University of Oregon, United States of America; The Prevention Science Institute, University of Oregon, United States of America.
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