Abstract
Background
Peer victimization is linked to social anxiety (SA), and rates of bullying are significantly higher for individuals at higher weights. However, research has yet to examine whether implicit weight bias exacerbates this link.
Methods
This study examined the relationships between body mass index (BMI), SA, and implicit weight bias in undergraduate women (N = 186; 54.8% White; MBMI = 25.97). Participants completed questionnaires pertaining to SA, stigmatizing attitudes toward weight, and two implicit association tests (IATs) used to measure anti-fat attitudes. IATs required categorization of words into attribute category pairs good vs. bad and motivated vs. lazy.
Results
BMI and SA were not significantly related. Implicit weight bias assessed by the good/bad IAT moderated the relationship between BMI and SA. Implicit weight bias assessed by the lazy/motivated IAT moderated the relationship between BMI and SA at the trend level (p = .06). Higher BMI was associated with higher SA in individuals with high, but not low, implicit weight bias. Implicit weight bias was associated with internalization of the thin ideal but not explicit weight bias.
Conclusions
Therapeutic interventions for SA among individuals with high BMI should explore internalized weight stigma, which may take the form of implicit attitudes or beliefs.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
1In the present study, we chose to examine these questions in women only due to a number of gender differences in the relevant areas of research. First, there are gender differences in implicit weight identity: both men and women explicitly reported accurate appraisals of their weight, whereas men (but not women) implicitly self-identified as “light” regardless of their actual weight (Grover et al., 2003). In addition, some forms of weight stigma are more prominent in women compared to men: wage and employment discrimination and weight stigma in dating and sexual relationships were found more frequently in women compared to men (Puhl & Heuer, 2009). Additionally, studies suggest that girls and women (as compared to boys and men) are at greater risk of not being liked, having fewer friends, and having more relationship difficulties due to being at higher weights (e.g., Boyes & Latner, 2009; Penny & Haddock, 2007; Sarlio-Lahteenkorva, 2001). Thus, we chose to limit our investigation to women, who seem to be at greatest risk for stigma, exclusion, body image issues, and resulting psychopathology.
A note about SA and the SA measures: The SIAS-S and SPS were used to examine prevalence rates of SAD. If an individual met the clinical cutoff on either the SIAS-S or SPS, then that individual was classified as having a probable diagnosis of SAD. The SA composite measure was utilized for all remaining analyses examining SA as a continuous construct.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing Inc. https://doi.org/10.1176/appi.books.9780890425787
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Author.
Boyes, A. D., & Latner, J. D. (2009). Weight stigma in existing romantic relationships. Journal of Sex & Marital Therapy, 35, 282–293. https://doi.org/10.1080/00926230902851280
Brixval, C. S., Rayce, S. L. B., Rasmussen, M., Holstein, B. E., & Due, P. (2011). Overweight, body image and bullying: An epidemiological study in 11- to 15-year olds. European Journal of Public Health, 22, 126–130. https://doi.org/10.1093/eurpub/ckr010
Brown, E. J., Turovsky, J., Heimberg, R. G., Juster, H. R., Brown, T. A., & Barlow, D. H. (1997). Validation of the social interaction anxiety scale and the social phobia scale across the anxiety disorders. Psychological Assessment, 9, 21–27. https://doi.org/10.1037/1040-3590.9.1.21
Brownstein, M., Madva, A., & Gawronski, B. (2019). What do implicit measures measure? Wiley Interdisciplinary Reviews: Cognitive Science, 10(5), 1501. https://doi.org/10.1002/wcs.1501
Centers for Disease Control and Prevention. (2022). Defining adult overweight & obesity. Retrieved from https://www.cdc.gov/obesity/basics/adult-defining.html
Cohen, J. N., & Kaplan, S. C. (2020). Understanding and treating anxiety disorders: a psychodynamic approach. In E. Bui, A. Baker, & M. Charney (Eds.), Clinical handbook of anxiety disorders (pp. 315–332). Springer International Publishing, Inc. https://doi.org/10.1007/978-3-030-30687-8_17
Davison, K. K., Schmalz, D. L., Young, L. M., & Birch, L. L. (2008). Overweight girls who internalize fat stereotypes report low psychosocial well-being. Obesity, 16(S2), S30–S38. https://doi.org/10.1038/oby.2008.451
DeBoer, L. B., Medina, J. L., Davis, M. L., Presnell, K. E., Powers, M. B., & Smits, J. A. J. (2013). Associations between fear of negative evaluation and eating pathology during intervention and 12-month follow-up. Cognitive Therapy and Research, 37, 941–952. https://doi.org/10.1007/s10608-013-9547-y
Egloff, B., & Schmukle, S. C. (2002). Predictive validity of an implicit association test for assessing anxiety. Journal of Personality and Social Psychology, 83, 1441–1445. https://doi.org/10.1037/0022-3514.83.6.1441
Engstrom, J. L., Paterson, S. A., Doherty, A., Trabulsi, M., & Speer, K. L. (2003). Accuracy of self-reported height and weight in women: An integrative review of the literature. Journal of Midwifery and Women’s Health, 48, 338–345. https://doi.org/10.1016/s1526-9523(03)00281-2
Greenwald, A. G., Brendl, M., Cai, H., Cvencek, D., Dovidio, J. F., Friese, M., & Wiers, R. W. (2021). Best research practices for using the implicit association test. Behavior Research Methods. https://doi.org/10.3758/s13428-021-01624-3
Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: The implicit association test. Journal of Personality and Social Psychology, 74, 1464–1480. https://doi.org/10.1037/0022-3514.74.6.1464
Greenwald, A. G., Nosek, B. A., & Banaji, M. R. (2003). Understanding and using the implicit association test: I. An improved scoring algorithm. Journal of Personality and Social Psychology, 85, 197–216. https://doi.org/10.1037/h0087889
Grover, V. P., Keel, P. K., & Mitchell, J. P. (2003). Gender differences in implicit weight identity. International Journal of Eating Disorders, 34, 125–153. https://doi.org/10.1002/eat.10167
Hatzenbuehler, M. L., Keyes, K. M., & Hasin, D. S. (2009). Associations between perceived weight discrimination and the prevalence of psychiatric disorders in the general population. Obesity, 17, 2033–2039. https://doi.org/10.1038/oby.2009.131
Hebl, M. R., & Heatherton, T. F. (1998). The stigma of obesity: The difference is black and white. Personality and Social Psychology Bulletin, 24, 417–426. https://doi.org/10.1177/0146167298244008
Hope, D. A., Heimberg, R. G., & Turk, C. L. (2019). Managing social anxiety: A cognitive-behavioral therapy approach (3rd ed.). Oxford University Press.
Jackson, S. E., Steptoe, A., Beeken, R. J., Croker, H., & Wardle, J. (2015). Perceived weight discrimination in England: A population-based study of adults aged ≥ 50 years. International Journal of Obesity, 39, 858–864. https://doi.org/10.1038/ijo.2014.186
Kaplan, S. C., Levinson, C. L., Rodebaugh, T. L., Menatti, A., & Weeks, J. W. (2015). Social anxiety and the big five personality traits: The interactive relationship of trust and openness. Cognitive Behaviour Therapy, 44, 212–222. https://doi.org/10.1080/16506073.2015.1008032
Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21, 169–184. https://doi.org/10.1002/mpr.1359
Levinson, C. A., Langer, J. K., & Rodebaugh, T. L. (2013). Reactivity to exclusion prospectively predicts social anxiety symptoms in young adults. Behavior Therapy, 44, 470–478. https://doi.org/10.1016/j.beth.2013.04.007
Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455–470. https://doi.org/10.1016/s0005-7967(97)10031-6
McCabe, R. E., Antony, M. M., Summerfeldt, L. J., Liss, A., & Swinson, R. P. (2003). Preliminary examination of the relationship between anxiety disorders in adults and self- reported history of teasing. Cognitive Behaviour Therapy, 32, 187–193. https://doi.org/10.1080/16506070310005051
Mirijello, A., D’Angelo, C., Iaconelli, A., Capristo, E., Ferrulli, A., Leccesi, L., & Addolorato, G. (2015). Social phobia and quality of life in morbidly obese patients before and after bariatric surgery. Journal of Affective Disorders, 179, 95–100. https://doi.org/10.1016/j.jad.2015.03.030
Nosek, B. A., Greenwald, A. G., & Banaji, M. R. (2007). The Implicit Association Test at age 7: A methodological and conceptual review. In J. A. Bargh (Ed.), Automatic processes in social thinking and behavior (pp. 265–292). Psychology Press.
Ogden, C. L., Lamb, M. M., Carroll, M. D., & Flegal, K. M. (2010). 3 NCHS Data Brief 50 Obesity and socioeconomic status in adults, United States (pp. 1–8). National Center for Health Statistics.
Ozkan, E. A., Gul, A. I., Ozdemir, Z. T., Husrevsahi, H., Yildirim, Z., Domur, E., & Gecit, U. A. (2016). Evaluation of depression and social anxiety symptoms in obese children. Dusunen Adam the Journal of Psychiatry and Neurological Sciences, 29, 8–14. https://doi.org/10.5350/DAJPN2016290101
Özşahin, A. K., & Altintaş, E. (2018). Factors associated with social anxiety disorder in a group of obese Turkish female patients. Turkish Journal of Medical Sciences, 48, 391–398. https://doi.org/10.3906/sag-1709-85
Penny, H., & Haddock, G. (2007). Anti-fat prejudice among children: The “mere proximity” effect in 5–10 year olds. Journal of Experimental Social Psychology, 43, 678–683. https://doi.org/10.1016/j.jesp.2006.07.002
Puhl, R. M., & Heuer, C. A. (2009). The stigma of obesity: A review and update. Obesity, 17, 941–964. https://doi.org/10.1038/oby.2008.636
Puhl, R. M., & King, K. M. (2013). Weight discrimination and bullying. Best Practice & Research: Clinical Endocrinology & Metabolism, 27, 117–127. https://doi.org/10.1016/j.beem.2012.12.002
Puhl, R. M., Peterson, J. L., & Luedicke, J. (2013). Weight-based victimization: Bullying experiences of weight loss treatment–seeking youth. Pediatrics, 131, e1–e9. https://doi.org/10.1542/peds.2012-1106
Puhl, R. M., Schwartz, M. B., & Brownell, K. D. (2005). Impact of perceived consensus on stereotypes about obese people: A new approach for reducing bias. Health Psychology, 24, 517–525. https://doi.org/10.1037/0278-6133.24.5.517
Ranta, K., Kaltiala-Heino, R., Fröjd, S., & Marttunen, M. (2012). Peer victimization and social phobia: A follow-up study among adolescents. Social Psychiatry and Psychiatric Epidemiology, 48, 533–544. https://doi.org/10.1007/s00127-012-0583-9
Rodebaugh, T. L., Heimberg, R. G., Brown, P. J., Fernandez, K. C., Blanco, C., Schneier, F. R., & Liebowitz, M. R. (2011). More reasons to be straightforward: Findings and norms for two scales relevant to social anxiety. Journal of Anxiety Disorders, 25, 623–630. https://doi.org/10.1016/j.janxdis.2011.02.002
Rodebaugh, T. L., Woods, C. M., & Heimberg, R. G. (2007). The reverse of social anxiety is not always the opposite: The reverse-scored items of the social interaction anxiety scale do not belong. Behavior Therapy, 38, 192–206. https://doi.org/10.1016/j.beth.2006.08.001
Rodebaugh, T. L., Woods, C. M., Heimberg, R. G., Liebowitz, M. R., & Schneier, F. R. (2006). The factor structure and screening utility of the social interaction anxiety scale. Psychological Assessment, 18, 231–237. https://doi.org/10.1037/1040-3590.18.2.231
Rosik, C. H. (2005). Psychiatric symptoms among prospective bariatric surgery patients: Rates of prevalence and their relation to social desirability, pursuit of surgery, and follow-up attendance. Obesity Surgery, 15, 677–683. https://doi.org/10.1381/0960892053923815
Roth, D. A., Coles, M. E., & Heimberg, R. G. (2002). The relationship between memories for childhood teasing and anxiety and depression in adulthood. Journal of Anxiety Disorders, 16, 149–164. https://doi.org/10.1016/s0887-6185(01)00096-2
Sarlio-Lahteenkorva, S. (2001). Weight loss and quality of life among obese people. Social Indicators Research, 54, 329–354. https://doi.org/10.1023/A:1010939602686
Schwartz, M. B., Vartanian, L. R., Nosek, B. A., & Brownell, K. D. (2006). The influence of one’s own body weight on implicit and explicit anti-fat bias. Obesity, 14, 440–447. https://doi.org/10.1038/oby.2006.58
Siegel, R. S., La Greca, A. M., & Harrison, H. M. (2009). Peer victimization and social anxiety in adolescents: Prospective and reciprocal relationships. Journal of Youth and Adolescence, 38, 1096–1109. https://doi.org/10.1007/s10964-009-9392
Soares, F. C., Barros, M. V. G., Bezerra, J., Santos, S. J., Machado, L., & Lima, R. A. (2019). The synergic relationship of social anxiety, depressive symptoms and waist circumference in adolescents: Mediation analysis. Journal of Affective Disorders, 245, 241–245. https://doi.org/10.1016/j.jad.2018.10.366
Stangor, C., Sechrist, G. B., & Jost, J. T. (2001). Changing racial beliefs by providing consensus information. Personality and Social Psychology Bulletin, 27, 486–496. https://doi.org/10.1177/0146167201274009
Stice, E. (2001). A prospective test of the dual-pathway model of bulimic pathology: Mediating effects of dieting and negative affect. Journal of Abnormal Psychology, 110, 124–135. https://doi.org/10.1037/0021-843X.110.1.124
Stice, E., & Agras, W. S. (1998). Predicting onset and cessation of bulimic behaviors during adolescence: A longitudinal grouping analysis. Behavior Therapy, 29, 257–276. https://doi.org/10.1016/S0005-7894(98)80006-3
Stice, E., Telch, S. L., & Rizvi, S. (2000). Development and validation of the eating disorder diagnostic scale: A brief self-report measure of anorexia, bulimia, and binge-eating disorder. Psychological Assessment, 12, 123–131. https://doi.org/10.1037/1040-3590.12.3.252
Stice, E., Ziemba, C., Margolis, J., & Flick, P. (1996). Ideal-body stereotype scale—revised. International Journal of Eating Disorders. https://doi.org/10.1037/t04549-000
Storch, E. A., Masia-Warner, C., Crisp, H., & Klein, R. G. (2005). Peer victimization and social anxiety in adolescence: A prospective study. Aggressive Behavior, 31, 437–452. https://doi.org/10.1002/ab.20093
Teachman, B., & Brownell, K. (2001). Implicit anti-fat bias among health professionals: Is anyone immune? International Journal of Obesity, 25, 1525–1531. https://doi.org/10.1038/sj.ijo.0801745
Teachman, B. A., Gapinski, K. D., Brownell, K. D., Rawlins, M., & Jeyaram, S. (2003). Demonstrations of implicit anti-fat bias: The impact of providing causal information and evoking empathy. Health Psychology, 22, 68–78. https://doi.org/10.1037/0278-6133.22.1.68
Wang, S. S., Brownell, K. D., & Wadden, T. A. (2004). The influence of the stigma of obesity on overweight individuals. International Journal of Obesity, 28, 1333–1337. https://doi.org/10.1038/sj.ijo.0802730
Warren, C. S., Gleaves, D. H., Cepeda-Benito, A., del Carmen Fernandez, A., & Rodriguez-Ruiz, S. (2005). Ethnicity as a protective factor against internalization of a thin ideal and body dissatisfaction. International Journal of Eating Disorders, 37, 241–249. https://doi.org/10.1002/eat.20102
Yang, L., & Colditz, G. A. (2015). Prevalence of overweight and obesity in the United States, 2007–2012. JAMA Internal Medicine, 175, 1412. https://doi.org/10.1001/jamainternmed.2015.2405
Yen, C. F., Liu, T. L., Ko, C. H., Wu, Y. Y., & Cheng, C. P. (2014). Mediating effects of bullying involvement on the relationship of body mass index with social phobia, depression, suicidality, and self-esteem and sex differences in adolescents in Taiwan. Child Abuse & Neglect, 38, 517–526. https://doi.org/10.1016/j.chiabu.2013.07.015
Zeller, R. A., & Carmines, E. G. (1980). Measurement in the social sciences: The link between theory and data. Cambridge University Press.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Simona C. Kaplan, Rachel M. Butler and Richard G. Heimberg have no known conflict of interest to disclose.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Animal Rights
No animal studies were carried out by the authors for this article.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The content of this manuscript reports on previously unpublished work from Dr. Simona C. Kaplan’s dissertation: Kaplan, S.C. (2020). Body mass index and social anxiety: Effects of implicit weight bias and body salience in undergraduate women [Unpublished doctoral dissertation]. Temple University.
Positionality Statement: As our identities can influence our approach to science, the authors would like to disclose that all three authors identify as White, two authors identify as cisgender females, and one author identifies as a cisgender male.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Kaplan, S.C., Butler, R.M. & Heimberg, R.G. The Relationship Between Body Mass Index, Implicit Weight Bias, and Social Anxiety in Undergraduate Women. Cogn Ther Res 47, 761–771 (2023). https://doi.org/10.1007/s10608-023-10404-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10608-023-10404-6