Skip to main content
SpringerLink
Log in

Associations Among Stress, Internalized Weight Stigma, Emotional Eating, and Body Composition in Active-Duty Service Members Enrolling in a Randomized Controlled Trial of a Weight Management Program

  • Brief Report
  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Background

Obesity is a critical public health concern with particular relevance to US military personnel. Stress and internalized weight stigma (“stigma”) may contribute to and maintain obesogenic processes and behaviors, including emotional eating. In this secondary cross-sectional analysis, we examined (1) associations among stress and stigma with emotional eating and body fat percentage (BF%), (2) whether stress explains the association between stigma and emotional eating, and (3) whether emotional eating explains associations between stress and stigma with BF%.

Method

Active-duty military service members (N = 178) completed BF% assessment and questionnaires assessing stress, stigma, and emotional eating.

Results

Structural equation modeling path analyses showed that stress and stigma were both significantly associated with emotional eating (b = 0.35, p < 0.001 and b = 0.23, p < 0.001, respectively) and with BF% (b = 0.38, p < 0.001 and b = 0.29, p < 0.001, respectively) such that individuals who reported higher stress and stigma tended to report more emotional eating and had higher BF%. Stress partially explained the association between internalized weight stigma and emotional eating, and emotional eating partially explained the relationship between stress and BF% but did not significantly mediate the association between stigma and BF%.

Conclusion

Greater stress and internalized weight stigma were associated with more emotional eating and higher BF%; however, emotional eating only partially explained the association between stress and BF%. Results highlight the importance of interventions targeting stress management skills, but additional research is needed to identify mechanisms that explain the association between stigma and BF%.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Data Availability

A de-identified, anonymized limited dataset will be created and shared with other researchers who can specifically request use of these data through a Data Use Agreement.

References

  1. Haslam DW, James WPT. Obesity. The Lancet. 2005;366:1197–209.

    Article  Google Scholar 

  2. Meadows SO, Engel CC, Collins RL, et al. 2015 Department of Defense Health Related Behaviors Survey (HRBS). Rand Health Q. 2018;8:5.

    PubMed  PubMed Central  Google Scholar 

  3. Rush T, LeardMann CA, Crum-Cianflone NF. Obesity and associated adverse health outcomes among US military members and veterans: findings from the millennium cohort study: obesity in the US Military. Obesity. 2016;24:1582–9.

    Article  PubMed  Google Scholar 

  4. Friedl KE. Body composition and military performance—many things to many people. J Strength Cond Res. 2012;26:S87.

    Article  PubMed  Google Scholar 

  5. Heinrich KM, Jitnarin N, Suminski RR, et al. Obesity classification in military personnel: a comparison of body fat, waist circumference, and body mass index measurements. Mil Med. 2008;173:67–73.

    Article  PubMed  Google Scholar 

  6. Morse JL, Dochat C, Wooldridge JS, et al. Baseline characteristics and their associations with body composition of active-duty service members enrolling in a randomized controlled trial of a weight management program. Mil Med. 2022;usac242.

  7. Cuevas AG, Chen R, Thurber KA, Slopen N, Williams DR. Psychosocial stress and overweight and obesity: findings from the Chicago Community Adult Health Study. Ann Behav Med. 2019;53:NP.

  8. Tomiyama AJ, Carr D, Granberg EM, et al. How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Med. 2018;16:123.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jayne JM, Ayala R, Karl JP, et al. Body weight status, perceived stress, and emotional eating among US Army soldiers: a mediator model. Eat Behav. 2020;36:101367.

    Article  PubMed  Google Scholar 

  10. Schvey NA, Barmine M, Bates D, et al. Weight stigma among active duty U.S. military personnel with overweight and obesity. Stigma Health. 2017;2:281–291.

  11. Block JP, He Y, Zaslavsky AM, Ding L, Ayanian JZ. Psychosocial stress and change in weight among US adults. Am J Epidemiol. 2009;170:181–92.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bidstrup H, Brennan L, Kaufmann L, de la Piedad GX. Internalised weight stigma as a mediator of the relationship between experienced/perceived weight stigma and biopsychosocial outcomes: a systematic review. Int J Obes. 2022;46:1–9.

    Article  Google Scholar 

  13. Lee KM, Hunger JM, Tomiyama AJ. Weight stigma and health behaviors: evidence from the Eating in America Study. Int J Obes. 2021;45:1499–509.

    Article  Google Scholar 

  14. Vartanian LR, Novak SA. Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise. Obesity. 2011;19:757–62.

    Article  PubMed  Google Scholar 

  15. Sutin AR, Stephan Y, Terracciano A. Weight discrimination and risk of mortality. Psychol Sci. 2015;26:1803–11.

    Article  PubMed  Google Scholar 

  16. Klatzkin RR, Nolan LJ, Kissileff HR. Self-reported emotional eaters consume more food under stress if they experience heightened stress reactivity and emotional relief from stress upon eating. Physiol Behav. 2022;243:113638.

    Article  CAS  PubMed  Google Scholar 

  17. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96.

    Article  CAS  PubMed  Google Scholar 

  18. Palmeira L, Cunha M, Pinto-Gouveia J, Carvalho S, Lillis J. New developments in the assessment of weight-related experiential avoidance (AAQW-Revised). J Context Behav Sci. 2016;5:193–200.

    Article  Google Scholar 

  19. Brownell KD, Hager DL, Leermakers E. The weight loss readiness test II, version 4.1. American Health Publishing Company. 2004.

  20. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: The Guilford Press. 2013.

    Google Scholar 

  21. Fritz MS, MacKinnon DP. Required sample size to detect the mediated effect. Psychol Sci. 2007;18:233–9.

    Article  PubMed  Google Scholar 

  22. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model Multidiscip J. 1999;6:1–55.

    Article  Google Scholar 

  23. Hunter GR, Gower BA, Kane BL. Age related shift in visceral fat. Int J Body Compos Res. 2010;8:103–8.

    PubMed  PubMed Central  Google Scholar 

  24. Meeuwsen S, Horgan GW, Elia M. The relationship between BMI and percent body fat, measured by bioelectrical impedance, in a large adult sample is curvilinear and influenced by age and sex. Clin Nutr. 2010;29:560–6.

    Article  CAS  PubMed  Google Scholar 

  25. Schvey NA, Puhl RM, Brownell KD. The stress of stigma: exploring the effect of weight stigma on cortisol reactivity. Psychosom Med. 2014;76:156–62.

    Article  CAS  PubMed  Google Scholar 

  26. Chew HSJ, Lau ST, Lau Y. Weight-loss interventions for improving emotional eating among adults with high body mass index: a systematic review with meta-analysis and meta-regression. Eur Eat Disord Rev. 2022;30:304–27.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Frayn M, Khanyari S, Knäuper B. A 1-day acceptance and commitment therapy workshop leads to reductions in emotional eating in adults. Eat Weight Disord - Stud Anorex Bulim Obes. 2020;25:1399–411.

    Article  Google Scholar 

  28. U.S. Department of Defense. 2020 Demographics profile: Navy active duty members. 2020.

Download references

Funding

This project was supported by a National Institute of Diabetes and Digestive and Kidney Diseases grant R01DK106415 and registered at ClinicalTrials.gov (NCT01757847). Dr. Morse is supported by the VA Office of Academic Affairs Advanced Fellowship in Women’s Health. Dr. Wooldridge is supported by a Career Development Award [1IK2RX003634] from the United States (US) Department of Veterans Affairs Rehabilitation Research and Development Service. Dr. Herbert is supported by a Career Development Award [1IK2RX002807] from the US Department of Veterans Affairs Rehabilitation Research and Development Service.

Author information

Authors and Affiliations

  1. VA San Diego Healthcare System, San Diego, CA, USA

    Jessica L. Morse, Jennalee S. Wooldridge, Matthew S. Herbert & Niloofar Afari

  2. Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA

    Jessica L. Morse, Jennalee S. Wooldridge, Matthew S. Herbert & Niloofar Afari

  3. Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA

    Jennalee S. Wooldridge, Matthew S. Herbert & Niloofar Afari

  4. San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, 9500 Gilman Drive, 0737, La Jolla, CA, 92093, USA

    Mara Tynan & Cara Dochat

Authors
  1. Jessica L. Morse
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennalee S. Wooldridge
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew S. Herbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mara Tynan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cara Dochat
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Niloofar Afari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Niloofar Afari.

Ethics declarations

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the IRB and with 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all participants included in the intervention study in which secondary data analysis was performed.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morse, J.L., Wooldridge, J.S., Herbert, M.S. et al. Associations Among Stress, Internalized Weight Stigma, Emotional Eating, and Body Composition in Active-Duty Service Members Enrolling in a Randomized Controlled Trial of a Weight Management Program. Int.J. Behav. Med. 31, 145–150 (2024). https://doi.org/10.1007/s12529-023-10157-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12529-023-10157-2

Keywords

Search

Navigation