Simply too much: the extent to which weight bias internalization results in a higher risk of eating disorders and psychosocial problems

Abstract

Purpose: Weight bias internalization (WBI) is associated with negative health consequences such as eating disorders and psychosocial problems in children. To date, it is unknown to what extent WBI considerably raises the risk of negative outcomes.

Methods: Analyses are based on cross-sectional data of 1,061 children (9-13 years, M = 11, SD = 0.9; 52.1% female) who filled in the WBI scale (WBIS-C). First, ROC analyses were run to identify critical cut-off values of WBI (WBIS-C score) that identify those who are at higher risk for psychosocial problems or eating disorder symptoms (as reported by parents). Second, it was examined whether WBI is more sensitive than the relative weight status in that respect. Third, to confirm that the cut-off value is also accompanied by higher psychological strain, high- and low-risk groups were compared in terms of their self-reported depressive symptoms, anxious symptoms, body dissatisfaction, and self-esteem.

Results: WBIS-C scores ≥ 1.55 were associated with a higher risk of disturbed eating behavior; for psychosocial problems, no cut-off score reached adequate sensitivity and specificity. Compared to relative weight status, WBI was better suited to detect disturbed eating behavior. Children with a WBIS-C score ≥ 1.55 also reported higher scores for both depressive and anxious symptoms, higher body dissatisfaction, and lower self-esteem.

Conclusion: The WBIS-C is suitable for identifying risk groups, and even low levels of WBI are accompanied by adverse mental health. Therefore, WBI is, beyond weight status, an important risk factor that should be considered in prevention and intervention.

Level of evidence: Level III, cross-sectional analyses based on data taken from a well-designed, prospective cohort study.

Keywords: Children; Mental health; ROC; Self-stigmatization; Weight bias internalization.

Fig. 1

ROC curve for disturbed eating behavior (SCOFF). This figure illustrates the performance of WBIS-C scores to detect disordered eating behavior

Fig. 2

ROC curve for psychosocial problems (SDQ). This figure illustrates the performance of WBIS-C scores to detect psychosocial problems

Fig. 3

Self-esteem, depressive symptoms, anxious symptoms and body dissatisfaction: comparison of the WBIS-C high- and low-risk groups. This figure displays the mean scores for the low- (n = 647) versus high-risk group (n = 414). All differences were statistically significant (p < 0.001). The vertical lines display the standard deviation of the mean scores. Effect sizes are displayed as Cohen’s d