The weight of weight self-stigma in unhealthy eating behaviours: the mediator role of weight-related experiential avoidance
Weight stigma plays a damaging role in the life of the individuals with overweight and obesity who may internalise the widespread stigmatisation messages. Weight self-stigma is defined as personal experiences of shame, negative self-evaluations as well as perceived discrimination. It has been found to be related to experiential avoidance patterns and poorer outcomes. The current study aims to conduct a confirmatory factor analysis (CFA) on the Weight Self-Stigma Questionnaire (WSSQ) and explore its psychometric properties. Furthermore, the mediator role of weight-related experiential avoidance on the relationship between weight self-stigma and unhealthy eating behaviour was analysed. Concerning the CFA, the sample comprised 331 women with overweight and obesity seeking nutritional treatment. A second independent sample of 58 overweight and obese women was used to assess WSSQ’s temporal validity and internal responsiveness. Results supported the WSSQ two-factor structure and good psychometric properties and responsiveness to change. Also, evidence was found for the mediator role of weight-related experiential avoidance on the relationship between BMI, weight self-stigma and unhealthy eating patterns in women with overweight and obesity. Overall, the current study showed that WSSQ is a reliable measure and highlights the important role of weight self-stigma and weight-related experiential avoidance in women with overweight and obesity.
Level of evidence: Level V, descriptive studies.
KeywordsWeight self-stigma Confirmatory factor analysis Obesity Eating behaviours Weight-related experiential avoidance
The authors would like to acknowledge the nutritionists from Figueira da Foz District Hospital (HDFF), Eiras and Figueira da Foz primary care units and Nutribalance for their valuable collaboration with the data collection. The authors would also like acknowledge Professor Bruno de Sousa from FPCE-UC for the statistical support.
This research was supported by the first author’s Ph.D. Grant (SFRH/BD/84452/2012), sponsored by FCT (Portuguese Foundation for Science and Technology).
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author declared that there is no conflict of interest.
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 was obtained from all participants included in the study.
- 9.Tylka TL, Annunziato RA, Burgard D, Daníelsdóttir S, Shuman E, Davis C, Calogero RM (2014) The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss. Journal of Obesity 2014:1–18. https://doi.org/10.1155/2014/983495 CrossRefGoogle Scholar
- 17.Palmeira L, Pinto-Gouveia J, Cunha M, Carvalho S. Finding the link between internalized weight-stigma and binge eating behaviors in Portuguese adult women with overweight and obesity: the mediator role of self-criticism and self-reassurance. Eat Behav 26:50–54. https://doi.org/10.1016/j.eatbeh.2017.01.006
- 18.Magallares A, Bolanos-Rios P, Ruiz-Prieto I, Benito de Valle P, Irles JA, Jauregui-Lobera I (2017) The mediational effect of weight self-stigma in the relationship between blatant and subtle discrimination and depression and anxiety. Span J Psychol 20:E4. https://doi.org/10.1017/sjp.2017.1 CrossRefPubMedGoogle Scholar
- 22.Durso LE, Latner JD, White MA, Masheb RM, Blomquist KK, Morgan PT, Grilo CM (2012) Internalized weight bias in obese patients with binge-eating disorder: associations with eating disturbances and psychological functioning. Int J Eat Disord 45(3):423–427. https://doi.org/10.1002/eat.20933 CrossRefPubMedGoogle Scholar
- 29.Palmeira L, Pinto-Gouveia J, Cunha M (2016) Exploring the efficacy of an acceptance, mindfulness and compassionate-based group intervention for women struggling with their weight (Kg-Free): a randomized controlled trial. Appetite 112:107–116. https://doi.org/10.1016/j.appet.2017.01.027 CrossRefGoogle Scholar
- 30.Hambleton RK, Merenda PF, Spielberger CD (2005) Adapting educational and psychological tests for cross-cultural assessment. Lawrence Earlbaum Associates, Inc, New JerseyGoogle Scholar
- 32.Palmeira L, Garcia T, Pinto-Gouveia J, Cunha M (2016) The revised Portuguese version of the Three-Factor Eating Questionnaire: a confirmatory factor analysis. In: Proceedings of the 3rd IPLeiria’s International Health Congress. BMC Health Services Research, 16:200Google Scholar
- 36.Silva I, Pais-Ribeiro J, Cardoso H (2008) Contributo para a adaptação portuguesa de uma escala de avaliação da qualidade de vida específica para doentes com obesidade: a Orwell-97. Psicologia Saúde Doenças 9(1):29–48Google Scholar
- 40.Muthén B, du Toit SHC, Spisic D (1997) Robust inference using weighted least squares and quadratic estimating equations in latent variable modeling with categorical and continuous outcomes. Psychometrika 75(1):1–45Google Scholar
- 41.Hsu HY (2009) Testing the effectiveness of various commonly used fit indices for detecting misspecifications in multilevel structural equation models. Doctoral dissertation, Texas A&M UniversityGoogle Scholar
- 43.Kline RB (2005) Principles and practice of structural equation modeling, 2nd edn. New York, GuilfordGoogle Scholar
- 44.Yu CY (2002) Evaluation of model fit indices for latent variable models with categorical and continuous outcomes. Unpublished dissertation. Retrieved 18 January from Mplus website http://www.statmodel.com/download/Yudissertation.pdf
- 45.Hair J, Anderson R, Tatham R, Black W (1998) Multivariate data analysis. Upper Saddle River, Prentice Hall, NJGoogle Scholar
- 47.Tabachnick B, Fidell L (2007) Using multivariate statistics. Pearson Education Inc., New YorkGoogle Scholar
- 48.Cohen J, Cohen P, West SG, Aiken LS (2003) Applied multiple regression/correlation analysis for the behavioral sciences, 3rd edn. Lawrence Erlbaum Associates, Mahwah, New JerseyGoogle Scholar
- 51.Schermelleh-Engel K, Moosbrugger H, Müller H (2003) Evaluating the fit of structural equation models: test of significance and descriptive goodness-of-fit measures. Methods Psychol Res Online 8(2):23–74Google Scholar