The Weight-Related Abuse Questionnaire (WRAQ): Reliability, validity, and clinical utility

Examining adverse life experiences, disordered eating behaviors and cognitions and weight loss treatment in Peru

OBJECTIVE

Studies conducted in the US indicate that exposure to trauma, and stigma related to weight are environmental factors associated with the development of disordered eating. Few studies have explored psychosocial and contextual factors surrounding disordered eating in Latin American populations. This study examined everyday discrimination, verbal weight-related abuse, adverse childhood experiences, and disordered eating across individuals seeking versus not seeking weight loss treatment in Peru.

METHOD

Participants (N = 420) were recruited via social media and a weight management clinic in Peru. Participants completed disordered eating, everyday discrimination, verbal weight-related abuse, and adverse childhood experiences measures.

RESULTS

The weight loss treatment seeking group showed greater disordered eating behaviors (dietary restraint) and cognitions (body dissatisfaction, overvaluation of shape/weight) compared to the non-weight loss treatment seeking group. Increased experiences of everyday discrimination, adverse childhood experiences, and verbal weight-related abuse were associated with greater levels of disordered eating behaviors and cognitions in both samples. Weight loss treatment seeking status was not a moderator of the relationships among disordered eating behaviors and cognitions, and everyday discrimination.

DISCUSSION

Results suggest discrimination, adverse childhood experiences, and verbal weight-related abuse are associated with eating pathology, and more disordered eating and behaviors are seen in individuals seeking or engaged in weight loss treatment. Findings highlight the importance of evaluating eating pathology for individuals reporting, or at high risk for discrimination, childhood trauma or weight-related abuse.

Verbal Weight-Related Abuse and Binge Eating Behavior: The Mediating Role of Attentional Bias to Threat Cues and Difficulties in Emotion Regulation

INTRODUCTION

Previous studies investigated the impact of weight-related abuse (WRA) on eating pathology. However, the circumstances of such an effect are still unclear. Our study aimed to examine the relationship between verbal WRA and binge eating (BE) behavior via attentional bias (AB) to threat cues and difficulties in emotion regulation.

METHOD

We conducted a parallel mediation model. On the basis of the purposive sampling method, 183 individuals with obesity and overweight (70.5% female and 28.4% male; Meanage = 32.78), from February to June 2019, were recruited from a nutrition clinic in Tehran. The participants completed the BE scale (BES), the weight-related abuse questionnaire (WRAQ), the difficulties in emotion regulation scale (DERS), and the dot probe task (DPT).

RESULTS

AB to threat cues had a significantly negative association with verbal WRA and BE. Difficulties in emotion regulation showed a significant positive association with verbal WRA and BE. The parallel mediation model showed a direct effect of verbal WRA on BE. Moreover, the bootstrap analysis revealed that difficulties in emotion regulation could mediate the association between verbal WRA and BE.

CONCLUSIONS

Our findings suggest that experiences of verbal WRA can contribute to cognitive bias to negative emotion, maladaptive emotion regulation strategies, and behavioral problems like BE.

Race/Ethnicity as a Moderator of the Association Between Weight-Related Abuse and Disordered Eating

OBJECTIVES

Extant research supports a positive relationship between weight-related abuse (WRA) and disordered eating constructs. Individuals who face marginalization and who are more likely to live in larger bodies, such as Black and Hispanic individuals in the United States (U.S.), may be at a heightened risk of WRA. This study is aimed at understanding whether the relationship between WRA and disordered eating constructs varies by race/ethnicity. We hypothesized that individuals from marginalized backgrounds would have differential levels of dietary restraint, body dissatisfaction, and shape/weight overvaluation with increased experiences of WRA compared to non-Hispanic White individuals.

METHODS

Two thousand one hundred sixteen undergraduates were recruited from two U.S. universities for a survey-based study assessing psychosocial functioning. Participants completed a demographics questionnaire assessing race/ethnicity, the Weight-Related Abuse Questionnaire assessing WRA experiences, and the Eating Disorders Examination-Questionnaire assessing disordered eating constructs.

RESULTS

Results showed positive relationships between verbal (vWRA) and physical (pWRA) WRA and disordered eating behaviors and cognitions. Moreover, at higher levels of vWRA, Asian and multiracial individuals showed greater dietary restraint compared to White individuals. No other tested models were moderated by race/ethnicity.

CONCLUSION

WRA is positively associated with disordered eating behaviors and cognitions across racial/ethnic identities, and vWRA may be differentially related to increased dietary restraint in Asian and multiracial individuals compared to White individuals. Further research utilizing intersectional analyses (e.g., examining how this relationship varies according to the intersection of race/ethnicity, gender, and weight status) would help clarify this relationship.

Factor structure and measurement invariance of the Weight-Related Abuse Questionnaire (WRAQ)

Weight-related abuse is defined as verbal or physical maltreatment specific to one's weight. The Weight-Related Abuse Questionnaire (WRAQ) is an instrument specifically designed to measure weight-related abuse. The main goal of this research was to study the factor structure and measurement invariance of the Spanish version of the WRAQ in a non-clinical and a clinical sample. The clinical sample included 150 participants with obesity (60 % women) from the Hospital de Valme (Sevilla, Spain). The non-clinical sample included 301 students (79 % women) from the Spanish Open University (UNED). Scales to measure weight self-stigma and fear of gaining weight were used to analyze the convergent validity of the WRAQ. A confirmatory factor analysis showed that a two-factor model (verbal and physical abuse) was an acceptable fit for the data in both the clinical and non-clinical samples. Multigroup Confirmatory Factor Analysis revealed scalar measurement invariance by sample and gender. Cronbach's alpha coefficients and composite reliability for both samples were found to be good, with values ranging from 0.83 to 0.96. Fear of gaining weight was correlated to verbal (r = 0.36, p < .01) and physical (r = 0.12, p < .05) abuse, and weight self-stigma was also related to physical (r = 0.21, p < .01) and verbal (r = 0.41, p < .01) abuse. These results suggest that the WRAQ can be used in clinical and non-clinical samples to assess verbal and physical abuse in both men and women.

Examining weight bias before and/or after bariatric surgery: A systematic review

Research examining weight bias in the bariatric population, who may be at greater risk of weight stigma, is scarce. The present study aimed to systematically review the literature for quantitative evidence that explores the medical, psychosocial, and behavioral sequelae associated with experienced, internalized, and/or externalized weight bias in patients seeking or who have undergone bariatric surgery. Five databases were systematically searched for English peer-reviewed quantitative studies, which examined weight bias in a sample of individuals seeking or who had undergone bariatric surgery. Risk of bias was assessed. Twenty-nine studies were included, of which 13 examined internalized weight bias, 12 examined experienced weight bias, 4 examined both, and 0 examined externalized weight bias. Most studies were cross-sectional, and the results showed high risk of bias. The results suggested that both experienced and internalized weight bias were associated with a host of negative psychosocial, behavioral, and medical sequelae. The findings of this review underscore the need for more rigorous research to better understand the relationship between weight bias and bariatric surgery, particularly longitudinally. Future patients may benefit from research developing interventions for reducing weight bias prior to and following bariatric surgery in order to reduce the associated negative correlates and improve outcomes.

The development and validation of the Conscious Objectification Questionnaire

OBJECTIVE

Self-objectification is linked to disordered eating (DE) behaviors in women. However, the awareness of objectification by the self and others, not just the objectifying experiences themselves, may be differentially related to DE. The proposed study examines the development and validity of the Conscious Objectification Questionnaire (COQ), which seeks to evaluate awareness of objectification by others and intentional self-objectification.

METHOD

In Study 1, 24 participants who identify as women (≥18 years) will provide qualitative feedback on COQ items, and survey items will be updated based on participant feedback. In Study 2, separate participants will complete the COQ and questionnaires assessing DE, self-objectification, and mental health correlates. Exploratory factor analyses will be conducted on the COQ, and reliability and convergent and divergent validity will be assessed.

RESULTS

Results will clarify whether the COQ is a reliable and valid instrument that measures the distinct construct of awareness of objectification.

DISCUSSION

If proven psychometrically sound, the COQ may be useful for future research on the link between awareness of objectification and disordered eating.

PUBLIC SIGNIFICANCE

The novel Conscious Objectification Questionnaire (COQ) assesses the degree to which women recognize and act upon being objectified. The COQ will be reviewed by self-objectification experts and pilot participants before being psychometrically evaluated with data from a larger sample. The COQ is expected to differentially relate to disordered eating above and beyond existing self-objectification measures and accurately represent the distinct construct of conscious awareness of societal and self-objectification.

History of abuse and bariatric surgery outcomes: a systematic review

BACKGROUND

Although there is evidence to support the relationship between abuse history and obesity, the association between abuse history and outcomes after bariatric surgery is not well-established. We aimed to summarize the current literature examining this relationship, as well as provide clinical recommendations to optimize postoperative outcomes.

METHODS

PubMed and SCOPUS databases were queried to identify relevant published studies.

RESULTS

Overall, 20 studies were included. Rates of the various types of abuse reported in the bariatric surgery population varied widely across studies, as did the methodology used to assess it. The majority of studies found no significant associations between abuse history and postoperative weight loss outcomes. The literature examining the relationship between abuse history and postoperative psychiatric outcomes was less conclusive.

CONCLUSIONS

Most current evidence demonstrates that abuse history is not associated with weight loss outcomes after bariatric surgery. Literature on postoperative psychiatric outcomes is mixed, and more robust studies are needed to further investigate the relationship between abuse history and postoperative psychiatric outcomes. Importantly, abuse history should not preclude patients from undergoing bariatric surgery. Of note, patients may benefit from careful monitoring for emotional distress and worsening of psychiatric comorbidities after surgery and psychiatric counseling and treatment when indicated.

Weight stigma and disordered eating behaviors in Pakistani overweight adolescents: the mediating role of body esteem

PURPOSE

Weight stigma has been described as social devaluation of people on the basis of their weight and it is associated with negative consequences. The present study was designed to investigate weight stigma and its relationship with disordered eating behaviors in overweight adolescents. One of the main objectives of this study is to investigate the mediating role of body esteem between weight stigma and disordered eating behaviors in overweight adolescent girls.

METHODS

Through cross-sectional research design and purposive sampling technique, a sample of 200 overweight adolescent girls was recruited from Lahore, Pakistan. Participants were asked to fill self-report measures related to weight stigma, body esteem, and disordered eating behaviors.

RESULTS

SPSS and AMOS were used to analyze the data. Pearson product moment correlation showed that experiences of weight stigma were negatively related to body esteem and positively related to disordered eating behaviors in overweight adolescent girls. Furthermore, structural equation modeling (SEM) showed that body esteem was significantly mediating the relationship between weight stigma and disordered eating behaviors in adolescent girls.

CONCLUSION

It is concluded that weight stigma and body esteem play a significant role in the development and maintenance of disordered eating behaviors in overweight adolescents. Awareness/educational programs could be designed to empower adolescent girls in combating negative consequences of weight stigma. Furthermore, specific programs could be designed at college or university level to boost one's body esteem and reduce disordered eating behaviors.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire

BACKGROUND

Researchers have documented that child maltreatment is associated with adverse long-term consequences for mental health, including increased risk for depression. Attempts to conduct meta-analyses of the association between different forms of child maltreatment and depressive symptomatology in adulthood, however, have been limited by the wide range of definitions of child maltreatment in the literature.

OBJECTIVE

We sought to meta-analyze a single, widely-used dimensional measure of child maltreatment, the Childhood Trauma Questionnaire, with respect to depression diagnosis and symptom scores.

PARTICIPANTS AND SETTING

192 unique samples consisting of 68,830 individuals.

METHODS

We explored the association between total scores and scores from specific forms of child maltreatment (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and depression using a random-effects meta-analysis.

RESULTS

We found that higher child maltreatment scores were associated with a diagnosis of depression (g = 1.07; 95 % CI, 0.95-1.19) and with higher depression symptom scores (Z = .35; 95 % CI, .32-.38). Moreover, although each type of child maltreatment was positively associated with depression diagnosis and scores, there was variability in the size of the effects, with emotional abuse and emotional neglect demonstrating the strongest associations.

CONCLUSIONS

These analyses provide important evidence of the link between child maltreatment and depression, and highlight the particularly larger association with emotional maltreatment in childhood.

Impact of the I2AO2 interdisciplinary program led by nursing on psychological comorbidity and quality of life: Randomized controlled clinical trial

OBJECTIVE

Obesity is an entity of highly prevalent multifactorial origin with associated metabolic and psychological comorbidity, causing a negative impact on the quality of life of those who suffer from it. The objective is to evaluate the impact of an interdisciplinary program for nurse-led obesity on quality of life related to health and anxiety.

METHODS

Randomized controlled clinical trial with a sample of 74 subjects diagnosed with obesity (EG: n=37; CG: n=37). The intervention consisted of a 12-month interdisciplinary program (with pre-test, 12month and 24month follow-up) coordinated by nurses.

RESULTS

The anxiety analysis shows that there is no effect of the intervention on S-STAI (F2; 144=0.246; p=0.782), which has increased in both groups. However, there is an effect on T-STAI (F2; 144=8872; p<0.001), which only increases in the control group. The interdisciplinary program has significantly improved health-related quality of life (SF-36), both in physical health parameters as well as in mental health.

CONCLUSION

The interdisciplinary program led by nursing professionals has improved the quality of life related to health and has prevented the increase of anxiety-trait in participants, maintaining the long-term effects.