Health and Health-Related Quality of Life among Treatment-Seeking Overweight and Obese Adults: Associations with Internalized Weight Bias

By Latner, Janet D.; Durso, Laura E. et al. | Journal of Eating Disorders, January 22, 2013 | Go to article overview

Health and Health-Related Quality of Life among Treatment-Seeking Overweight and Obese Adults: Associations with Internalized Weight Bias


Latner, Janet D., Durso, Laura E., Mond, Jonathan M., Journal of Eating Disorders


Author(s): Janet D Latner[sup.1], Laura E Durso[sup.2] and Jonathan M Mond[sup.3,4]

Background

Increased body weight is associated with impairments in health-related quality of life (HRQoL) [1]. Findings from population studies in different countries such as the U.S. [2, 3], Sweden [4], Germany [5], and Taiwan [6] suggest that higher body mass index (BMI; kg/m[sup.2]) is correlated with greater physical impairment in HRQoL. HRQoL, which refers to the effects of physical and mental health on everyday functioning, is increasingly regarded as a key outcome of health promotion programs and in clinical practice [7].

Overweight and obese individuals are far more likely to experience discrimination than their non-overweight peers [8]. This discrimination occurs in a range of settings, including medical, educational, and interpersonal contexts, and it is associated with a range of adverse personal, social, and economic outcomes [9, 10]. One of the most pernicious aspects of weight-based discrimination is its tendency to become internalized. The term internalized weight bias (IWB), namely, the belief that weight-based stereotypes and prejudices are accurate and apply to the self, was introduced to describe this process [11]. In clinical and non-clinical obese samples, higher levels of IWB have been found to be associated with greater body dissatisfaction, more severe eating disturbances, higher levels of general psychological distress, and lower self-esteem [11-14].

In view of these associations, it is reasonable to hypothesize that IWB may be associated with impairment in HRQoL. Findings from one recent study suggested that IWB may be associated with poorer HRQoL among individuals with serious mental illness [15]. IWB was recently shown to mediate the relationship between BMI and weight-related quality of life, suggesting that weight-related impairments may be accounted for, in part, by weight-related self-stigma [16]. There is also evidence that discrimination is associated with adverse health outcomes in minority populations [17, 18]. For example, perceived anti-gay discrimination predicted increased physician visits and medication use [19], while among African-American adolescents, perceived unfair treatment based on physical appearance was associated with elevated ambulatory blood pressure [20].

Research is needed to examine impairment in general HRQoL associated with IWB among individuals who are overweight or obese. In view of the multiple health-related conditions associated with obesity [21, 22] and the impairment in HRQoL [1-6], it may be important to examine whether IWB predicts poorer physical and mental health outcomes. The goal of the present study was to address this gap in the literature by examining the associations between IWB and HRQoL in a treatment-seeking sample of overweight and obese individuals. We were particularly interested in considering whether any observed associations between obesity and impairment in HRQoL would still be apparent after controlling for the occurrence of those chronic medical conditions known to be associated with obesity and with physical and mental health impairment. We also wanted to test whether the health impairments associated with obesity are more closely associated with the psychological sequelae of being overweight in a stigmatizing society, than with body weight itself [23-25]. Therefore, the present cross-sectional study examined the association between IWB and HRQoL, while controlling for body mass index, as well as age and medical comorbidity.

Methods

Participants and procedures

Participants were individuals (n = 120) who were screened for a behavioral weight-loss treatment program, recruited from nine community centres across the Honolulu-metro area of Hawaii. Leaders of community centres who wished to participate in an obesity treatment program assisted the researchers in conducting recruitment among members via email, flyers, and announcements at group meetings. …

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