Internalized Weight Bias, Weight-Related Experiences, And Peripartum Weight

Abstract

Introduction: The purpose of this study was to investigate internalized weight bias (IWB) and its relationship with pregnancy-related weight changes and postpartum depression. IWB is defined as the internalization of negative attitudes and beliefs about people due to their weight. Although IWB has been linked with weight change and depression in other samples, it has never been investigated in the postpartum period.

Methods: We used a cross-sectional survey design. Participants were 251 women recruited via social media who were living in the United States and 6 to 12 months postpartum. We calculated percentage of body weight gained during pregnancy and percentage of that weight that was retained postpartum from self-reported weights. Participants completed self-report measures of IWB (modified version of the Weight Bias Internalization Scale) and postpartum depression (Edinburgh Postnatal Depression Scale).

Results: Gestational weight gain was not significantly associated with IWB or depression. Postpartum retention of gestational weight was significantly positively associated with both IWB and depressive symptoms. Furthermore, IWB mediated the relationship between postpartum weight retention and depressive symptoms.

Discussion: Postpartum retention of weight gained during pregnancy, but not weight gain itself, was related to both IWB and depressive symptoms. The relationship between pregnancy-related weight changes and psychological distress is complex. Sociocultural pressures to return to a prepregnancy physical state swiftly after giving birth may increase risk for IWB during a time in life when stress is already likely to be high, posing additional psychological risk. IWB existing prepregnancy may also worsen postpartum self-concept, contributing to depression. This is the first study, to our knowledge, to directly assess associations among gestational weight change, IWB, and postpartum depression. In addition to discussing weight in pregnancy, perinatal care providers could improve postpartum health by helping women set realistic, body-positive goals postpartum.

Keywords: depression; internalized weight bias; maternal health; perinatal; postpartum; pregnancy; weight.

Figure 1.. Mean Internalized Weight Bias and Depression Scores Stratified by Postpartum BMI (n = 206).

Results of analysis of covariances controlling for infant age at the time of study participation to evaluate differences in internalized weight bias (mean Weight Bias Internalization Scale score) and depression symptoms (mean Edinburgh Postnatal Depression Scale score) among participants belonging to different body mass index (BMI) categories. BMI used in these analyses is postpartum BMI (ie, BMI at time of study participation).

Figure 2.. Simple Mediation Analysis of the Indirect Effects of Postpartum Weight Retention on Postpartum Depression Symptoms Through Internalized Weight Bias (n = 207).

Results of a simple mediation analysis with postpartum weight retention as the independent variable, postpartum depression symptoms as the dependent variable, and internalized weight bias as the mediator. Covariates included participant age, level of education, marital status, annual household income, parity, route of birth, gestational age of infant at birth, and child’s age at time of study participation.