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Multicenter Study
. 2024 Feb 12;16(4):510.
doi: 10.3390/nu16040510.

Depressive Symptoms among Bariatric Surgery Candidates: Associations with Stigmatization and Weight and Shape Concern

Alexandra Fabrig  1 , Ricarda Schmidt  1 , Thomas Mansfeld  2 , Johannes Sander  3 , Florian Seyfried  4 , Stefan Kaiser  5 , Christine Stroh  6 , Arne Dietrich  7 , Anja Hilbert  1
Affiliations
Multicenter Study

Depressive Symptoms among Bariatric Surgery Candidates: Associations with Stigmatization and Weight and Shape Concern

Alexandra Fabrig et al. Nutrients. .

Abstract

Bariatric surgery candidates (BSC) are a highly vulnerable group for mental health impairments. According to the theoretical model of weight stigma, weight-related experienced stigmatization (ES) negatively influences mental health through weight bias internalization (WBI). This study tested this model among BSC and investigated whether this association depends on a negative body image in terms of weight and shape concern as a potential moderator. As part of a German multicenter study, ES, WBI, weight and shape concern, and depressive symptoms were assessed via self-report questionnaires among n = 854 BSC. Simple and moderated mediation analyses were applied to analyze whether WBI influences the relationship between ES and depressive symptoms, and whether this influence depends on weight and shape concern. WBI significantly mediated the relationship between ES and depressive symptoms by partially reducing the association of ES with depressive symptoms. Weight and shape concern emerged as significant moderators in the overall model and specifically for associations between WBI and depressive symptoms. The results suggest that the association between ES and depressive symptoms among BSC is stronger in those with high WBI. This association is strengthened by weight and shape concern, especially at low and mean levels. Studies evaluating longitudinal associations between weight-related stigmatization and mental health are indicated, as well as intervention studies targeting WBI in order to reduce adverse effects of ES on mental health in BSC.

Keywords: bariatric surgery candidates; depressive symptoms; weight and shape concern; weight bias internalization; weight-related experienced stigmatization.

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Conflict of interest statement

Dr. Hilbert reported receiving grants from the Federal Ministry of Education and Research, German Research Foundation, and Roland Ernst Foundation for Healthcare; royalties for books on the treatment of eating disorders and obesity with Hogrefe and Kohlhammer; honoraria for workshops and lectures on eating disorders and obesity and their treatment; honoraria as editor of the International Journal of Eating Disorders and the journal Psychotherapeut; honoraria as a reviewer from Mercator Research Center Ruhr, Oxford University Press, and the German Society for Nutrition; and honoraria as a consultant for WeightWatchers, Zweites Deutsches Fernsehen, and Takeda. No other competing interests were reported.

Figures

Figure 1
Figure 1
Moderated mediation model.
Figure 2
Figure 2
Moderated mediation model displayed with coefficients and standard errors. Mediation coefficients displayed are standardized. ** p < 0.01. *** p < 0.001.
Figure 3
Figure 3
Conditional effect of perception of teasing on weight bias internalization at values of weight and shape concern. Note. POTS = Perception of Teasing Scale; WBIS = Weight Bias Internalization Scale; EDE-Q WS = Eating Disorder Examination Questionnaire: composite of weight and shape concern.
Figure 4
Figure 4
Conditional effect of weight bias internalization on depressive symptoms at values of weight and shape concern. Note. WBIS = Weight Bias Internalization Scale; PHQ-D = Patient Health Questionnaire Depression Scale; EDE-Q WS = Eating Disorder Examination Questionnaire: composite of weight and shape concern.
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