Skip to main content
SpringerLink
Log in

The relative importance of social anxiety facets on disordered eating in pediatric obesity

  • Original Article
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

Children with obesity demonstrate increased risk for eating disorders and internalizing psychopathology. Research in adults indicates unique facets of social anxiety differentially relate to eating pathology. These associations remain understudied in pediatric samples. The current study evaluated associations between social anxiety and disordered eating, and tested the relative importance of distinct social anxiety constructs—fear of negative evaluation, social anxiety in general situations, and social anxiety in new situations—for disordered eating in weight-loss treatment-seeking youth with obesity.

Methods

One-hundred and thirty-five youth (Mage 12.6 years; Range 8–17 years; MBMIz = 2.6) from a multidisciplinary outpatient pediatric obesity clinic completed questionnaires assessing dimensions of social anxiety and the Children’s Eating Attitudes Test (ChEAT). Dominance analyses were used to evaluate the relative importance of social anxiety facets associated with ChEAT subscales.

Results

Social anxiety subscales did not correlate with Dieting scores. Dominance analyses indicated Fear of Negative Evaluation (FNE) evinced complete dominance, thus, emerging as the most important predictor relative to other social anxiety components for Body/Weight Concern and Food Preoccupation. General dominance weights for FNE accounted for more than twice the shared and unique variance, relative to other independent variables within the Body/Weight Concern and Food Preoccupation models, respectively.

Conclusions

Unique facets of social anxiety differentially relate to disordered eating in youth with obesity. Findings suggest nuanced assessment of anxiety constructs, such as FNE, in pediatric obesity treatment settings may aid in identifying youth at risk for disordered eating attitudes and behaviors.

Level of Evidence

Level V, cross-sectional descriptive study.

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

Similar content being viewed by others

References

  1. Ogden CL, Carroll MD, Lawman HG et al (2016) Trends in obesity prevalence among children and adolescents in the United States, 1988–1994 through 2013–2014. J Med Assoc 315:2292–2299. https://doi.org/10.1001/jama.2016.6361

    Article  CAS  Google Scholar 

  2. Pulgarón ER (2013) Childhood obesity: a review of increased risk for physical and psychological co-morbidities. Clin Ther 35:A18–A32. https://doi.org/10.1016/j.clinthera.2012.12.014

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cena H, Stanford FC, Ochner L et al (2017) Association of a history of childhood-onset obesity and dieting with eating disorders. Eat Disord. https://doi.org/10.1080/10640266.2017.1279905

    Article  PubMed  PubMed Central  Google Scholar 

  4. Goldschmidt AB, Passi Aspen V, Sinton MM, Tanofsky-Kraff M, Wilfley DE (2008) Disordered eating attitudes and behaviors in overweight youth. Obesity 16:257–264. https://doi.org/10.1038/oby.2007.48

    Article  PubMed  Google Scholar 

  5. Neumark-Sztainer D, Wall M, Guo J et al (2006) Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later? J Am Diet Assoc 106:559–568. https://doi.org/10.1016/j.jada.2006.01.003

    Article  PubMed  Google Scholar 

  6. Campbell K, Peebles R (2014) Eating disorders in children and adolescents: state of the art review. Pediatrics 134:582–592. https://doi.org/10.1542/peds.2014-0194

    Article  PubMed  Google Scholar 

  7. Braet C, O’Malley G, Weghuber D et al (2014) The assessment of eating behaviour in children who are obese: a psychological approach. A position paper from the European childhood obesity group. Obes Facts 7:153–164. https://doi.org/10.1159/000362391

    Article  PubMed  PubMed Central  Google Scholar 

  8. Neumark-Sztainer D, Story M, Hannan PJ, Perry CL, Irving LM (2002) Weight-related concerns and behaviors among overweight and nonoverweight adolescents: implications for preventing weight-related disorders. Arch Pediatr Adolsc Med 156:171–178. https://doi.org/10.1001/archpedi.156.2.171

    Article  Google Scholar 

  9. Tanofsky-Kraff M, Yanovski SZ, Wilfley DE et al (2004) Psychopathology in overweight and normal-weight children. J Consult Clin Psychol 72:53–61. https://doi.org/10.1037/0022-006X.72.1.53

    Article  PubMed  PubMed Central  Google Scholar 

  10. DeBoer LB, Medina JL, Davis ML et al (2013) Associations between fear of negative evaluation and eating pathology during intervention and 12-month follow-up. Cogn Ther Res 37:1–19. https://doi.org/10.1007/s10608-013-9547-y

    Article  Google Scholar 

  11. Levinson CA, Rodebaugh TL (2012) Social anxiety and eating disorder comorbidity: the role of negative social evaluation fears. Eat Behav 13:27–35. https://doi.org/10.1016/j.eatbeh.2011.11.006

    Article  PubMed  Google Scholar 

  12. Levinson CA, Rodebaugh TL (2015) Negative social evaluative fears produce social anxiety, food intake, and body dissatisfaction: evidence of similar mechanisms through different pathways. Clin Psychol Sci 3:744–757. https://doi.org/10.1177/2167702614548891

    Article  PubMed  Google Scholar 

  13. Ostrovsky NW, Swencionis C, Wylie-Rosett J, Isasi CR (2013) Social anxiety and disordered overeating: an association among overweight and obese individuals. Eat Behav 14:145–148. https://doi.org/10.1016/j.eatbeh.2013.01.009

    Article  PubMed  Google Scholar 

  14. Hudson JI, Hiripi E, Pope HG, Kessler RC (2007) The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatr 61:348–358. https://doi.org/10.1016/j.biopsych.2006.03.040

    Article  Google Scholar 

  15. Buckner JD, Silgado J, Lewinsohn PM (2010) Delineation of differential temporal relations between specific eating and anxiety disorders. J Psychiatr Res 44:781–787. https://doi.org/10.1016/j.jpsychires.2010.01.014

    Article  PubMed  PubMed Central  Google Scholar 

  16. Swinbourne JM, Touyez SW (2007) The co-morbidity of eating disorders and anxiety disorders: a review. Eur Eat Disord Rev 15:253–274. https://doi.org/10.1002/erv.784

    Article  PubMed  Google Scholar 

  17. Godart NT, Flament MF, Curt F et al (2003) Anxiety disorders in subjects seeking treatment for eating disorders: a DSM-IV controlled study. Psychiatry Res 117:245–258. https://doi.org/10.1016/S0165-1781(03)00038-6

    Article  PubMed  Google Scholar 

  18. Kaye WH, Bulik CM, Thornton L et al (2004) Comorbidity of anxiety disorders with anorexia nervosa and bulimia nervosa. Am J Psychiatry 161:2215–2221. https://doi.org/10.1176/appi.ajp.161.12.2215

    Article  PubMed  Google Scholar 

  19. Levinson CA, Rodebaugh TL (2016) Clarifying the prospective relationships between social anxiety and eating disorder symptoms and underlying vulnerabilities. Appetite 107:38–46. https://doi.org/10.1016/j.appet.2016.07.024

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wonderlich-Tierney AL, Vander Wal JS (2010) The effects of social support and coping on the relationship between social anxiety and eating disorders. Eat Behav 11:85–91. https://doi.org/10.1016/j.eatbeh.2009.10.002

    Article  PubMed  Google Scholar 

  21. Lundgren JD, Anderson DA, Thompson JK (2004) Fear of negative appearance evaluation: development and evaluation of a new construct for risk factor work in the field of eating disorders. Eat Behav 5:75–84. https://doi.org/10.1016/S1471-0153(03)00055-2

    Article  PubMed  Google Scholar 

  22. Hayden-Wade HA, Stein RI, Ghaderi A, Saelens BE, Zabinski MF, Wilfley DE (2005) Prevalence, characteristics, and correlates of teasing experiences among overweight children vs. non-overweight peers. Obes Res 13:1381–1392. https://doi.org/10.1038/oby.2005.167

    Article  PubMed  Google Scholar 

  23. La Greca AM, Lopez N (1998) Social anxiety among adolescents: linkages with peer relations and friendships. J Abnorm Child Psychol 26:83–94. https://doi.org/10.1023/A:1022684520514

    Article  PubMed  Google Scholar 

  24. Rancourt D, Barker DH, Sato AF, Lloyd-Richardson EE, Hart CN, Jelalian E (2014) Longitudinal associations among change in overweight status, fear of negative evaluation, and weight-related teasing among obese adolescents. J Pediatr Psychol 39:697–707. https://doi.org/10.1093/jpepsy/jsu033

    Article  PubMed  PubMed Central  Google Scholar 

  25. Thompson JE, Phillips BA, McCracken A, Thomas K, Ward WL (2013) Social anxiety in obese youth in treatment setting. Child Adolesc Soc Work J 30:37–47. https://doi.org/10.1007/s10560-012-0274-0

    Article  Google Scholar 

  26. Azen R, Budescu DV (2003) The dominance analysis approach for comparing predictors in multiple regression. Psychol Methods 8:129–148. https://doi.org/10.1037/1082-989X.8.2.129

    Article  PubMed  Google Scholar 

  27. Budescu DV (1993) Dominance analysis: a new approach to the problem of relative importance of predictors in multiple regression. Psychol Bull 114:542–551. https://doi.org/10.1037/0033-2909.114.3.542

    Article  Google Scholar 

  28. Centers for Disease Control and Prevention (2016) BMI for children and teens. https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html. Accessed 23 Mar 2017

  29. Achenbach TM, Edelbrock C (1991) Manual for the child behavior checklist and 1991 profile. Department of Psychiatry, University of Vermont, Burlington

    Google Scholar 

  30. Maloney MJ, McGuire JB, Daniels SR (1988) Reliability testing of a children’s version of the Eating Attitude Test. J Am Acad Child Psychol 27:541–543. https://doi.org/10.1097/00004583-198809000-00004

    Article  CAS  Google Scholar 

  31. Ranzenhofer LM, Tanofsky-Kraff M, Menzie C et al (2008) Structure analysis of the Children’s Eating Attitudes Test in overweight and at-risk-for-overweight children and adolescents. Eat Behav 9:218–227. https://doi.org/10.1016/j.eatbeh.2007.09.004

    Article  PubMed  Google Scholar 

  32. La Greca AM, Stone WL (1993) Social anxiety scale for children-revised: factor structure and concurrent validity. J Clin Child Psychol 22:17–27. https://doi.org/10.1207/s15374424jccp2201_2

    Article  Google Scholar 

  33. Tonidandel S, Le Breton JM (2011) Relative importance analysis: a useful supplement to regression analysis. J Bus Psychol 26:1–9. https://doi.org/10.1007/s10869-010-9204-3

    Article  Google Scholar 

  34. Smolak L, Levine MP (1994) Psychometric properties of the Children’s Eating Attitudes Test. Int J Eat Disord 16:275–282. https://doi.org/10.1002/1098-108X(199411)16:3<275::AID-EAT2260160308>3.0.CO;2-U

    Article  CAS  Google Scholar 

  35. Vander Wal T, Thomas N (2004) Predictors of body image dissatisfaction and disturbed eating attitudes and beahviors in African American and Hispanic girls. Eat Behav 5:291–301. https://doi.org/10.1016/j.eatbeh.2004.04.001

    Article  PubMed  Google Scholar 

  36. Gilbert N, Meyer C (2005) Fear of negative evaluation and the development of eating psychopathology: a longitudinal study among nonclinical women. Int J Eat Disord 37:307–312. https://doi.org/10.1002/eat.20105

    Article  PubMed  Google Scholar 

  37. Dakanalis A, Carrà G, Calogero R, Fida R, Clerici M, Zanetti MA, Riva G (2014) The developmental effects of media-ideal internalization and self-objectification processes on adolescents’ negative body-feelings, dietary restraint, and binge eating. Eur Child Adolesc Psychiatry 24:997–1010. https://doi.org/10.1007/s00787-014-0649-1

    Article  PubMed  Google Scholar 

  38. Wildes JE, Marcus MD, Kalachian et al (2010) Self-reported binge eating in severe pediatric obesity: impact on weight change in a randomized controlled trial of family-based treatment. Int J Obes 34:1143–1148. https://doi.org/10.1038/ijo.2010.35

    Article  CAS  Google Scholar 

  39. Decaluwé V, Braet C (2003) Prevalence of binge-eating disorder in obese children and adolescents seeking weight-loss treatment. Int J Obes 27:404–409. https://doi.org/10.1038/sj.ijo.802233

    Article  Google Scholar 

  40. Heatherton TF, Baumeister RF (1991) Binge eating as escape from self-awareness. Psychol Bull 110:86–108. https://doi.org/10.1037/0033-2909.110.1.86

    Article  CAS  Google Scholar 

  41. Dakanalis A, Carrà G, Calogero R et al (2016) The Social Appearance Anxiety Scale in Italian adolescent populations: construct validation and group discrimination in community and clinical eating disordered samples. Child Psychiatry Hum Dev 47:133–150. https://doi.org/10.1007/s10578-015-0551-1

    Article  PubMed  Google Scholar 

  42. Brunet J, Sabiston CM, Dorsch KD, McCreary DR (2010) Exploring a model linking social physique anxiety, drive for muscularity, drive for thinness and self-esteem among adolescent bodys and girls. Body Image 7:137–142. https://doi.org/10.1016/j.bodyim.2009.11.004

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by the Midwest T32 for Eating Disorders Research [T32 MH082761]. Funding sources had no role in in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. University of Minnesota, 2450 Riverside Avenue, F227, Minneapolis, MN, 55454, USA

    Lisa M. Anderson

  2. University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA

    Lisa M. Anderson, Sophie Lanciers & Crystal S. Lim

  3. Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC, 29401, USA

    Nina Wong

  4. Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA

    Nina Wong

  5. Tulane University, 4720 S. I-10 Service Rd W., Suite 501, Metairie, LA, 70001, USA

    Sophie Lanciers

Authors
  1. Lisa M. Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nina Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sophie Lanciers
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Crystal S. Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisa M. Anderson.

Ethics declarations

Conflict of interest

Dr. Anderson declares that she has no conflict of interest. Dr. Lanciers declares that she has no conflict of interest. Dr. Lim declares that she has no conflict of interest. Dr. Wong declares that she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anderson, L.M., Wong, N., Lanciers, S. et al. The relative importance of social anxiety facets on disordered eating in pediatric obesity. Eat Weight Disord 25, 117–126 (2020). https://doi.org/10.1007/s40519-018-0526-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-018-0526-x

Keywords

Search

Navigation