Relationships between weight bias internalization and biopsychosocial health outcomes: A prospective study in Chinese adolescents

Abstract

Objective: An extensive literature has documented the deleterious effects of weight bias internalization (WBI) on biopsychosocial health outcomes. Still, this research is largely confined to the Western context. Furthermore, few studies have explored associations between WBI and biopsychosocial health outcomes, including in non-Western adolescent populations.Method: The present study explored the longitudinal relationships between WBI and body dissatisfaction, disordered eating, psychosocial impairment related to eating disorder features, and psychological and physical well-being in a sample (N = 1549; aged 11-18 years at baseline) of Chinese adolescents. Relationships between study variables were examined between two waves of data measurement (Time 1, baseline, and Time 2, 6-month). Cross-lagged and multivariate models were used to explore prospective relationships between WBI and biopsychosocial correlates.Results: Bidirectional relationships were observed between WBI and biopsychosocial correlates in Chinese adolescents. Adjusting for covariates and other predictor variables, higher body dissatisfaction, disordered eating, psychosocial impairment, and psychological distress at Time 1 predicted higher WBI at Time 2. Furthermore, higher WBI at Time 1 predicted higher body dissatisfaction, disordered eating, psychosocial impairment, and psychological distress at Time 2.Discussion: Weight bias internalization and psychosocial correlates were interrelated across time in Chinese adolescents. Improving WBI might be promising in the prevention of eating and body image disturbances and diminished psychosocial well-being.Similarly, reducing eating and body image disturbances and improving psychosocial well-being might be useful prevention targets in reducing WBI in Chinese adolescents.

Exploring the prospective relationships between food addiction symptoms, weight bias internalization, and psychological distress in Chinese adolescents

“…The lack of prospective evidence for food addiction symptoms and weight bias internalization (hypotheses 1 and 3) in relation to outcomes across time should be contextualized in relevant literature. Specifically, recent research diverges from the present findings in suggesting that higher weight bias internalization was prospectively related to higher psychological distress in the Chinese adolescent context (Barnhart et al, 2023). However, there were consistencies across these studies with the observation that higher psychological distress was prospectively associated with higher weight bias internalization in Chinese adolescents.…”

“…Informed by empirical and theoretical research supporting the links between food addiction symptoms, weight bias internalization, and psychological distress (Barnhart et al, 2023;Burrows et al, 2018;Huang et al, 2022;Meadows & Higgs, 2020;Reid et al, 2018), the present study adds to this literature by exploring the prospective nature of relationships between these variables in adolescents from a non-Western cultural context.…”

“…To address these gaps in the literature, the present study examined the prospective relationships between food addiction symptoms, weight bias internalization, and psychological distress in a large sample of Chinese adolescents. Building on existing empirical and theoretical support (Barnhart et al, 2023;Burrows et al, 2018;Huang et al, 2022;Meadows & Higgs, 2020;Reid et al, 2018), we hypothesized that food addiction symptoms, weight bias internalization, and psychological distress would be bi-directionally related in Chinese adolescents. Specifically, we hypothesized that (1) higher weight bias internalization would longitudinally predict higher psychological distress and food addiction symptoms at the following time points; (2) higher psychological distress would longitudinally predict higher weight bias internalization and food addiction symptoms at the following time points; and (3) higher food addiction symptoms would longitudinally predict higher weight bias internalization and psychological distress at the following time points.…”

“…Food addiction symptoms have also been found to be prevalent in adolescent populations (Yekaninejad et al, 2021) and associated with negative outcomes (Horsager et al, 2023;Pipová et al, 2021;Skinner et al, 2021). Growing crosssectional (Huang et al, 2022) and longitudinal (Meadows & Higgs, 2020) research attention, primarily in adults (see Reid et al, 2018, for a review), has been paid to the overlap between food addiction symptoms and weight bias internalization, or self-directed and stereotypically derogative beliefs about one's weight status (Durso & Latner, 2008) that exert noxious effects on biological, psychological, and social well-being in diverse populations across development (e.g., adolescents, adults; Barnhart et al, 2023;Bidstrup et al, 2022;Pearl et al, 2017;Purton et al, 2019). Continued research on the bi-directional nature of relationships between weight bias internalization and food addiction symptoms, especially in adolescent contexts, may be promising in better understanding the nature of these associations over time.…”

“…Specifically, the increased prevalence of elevated weight status in Chinese children and adolescents may be associated with greater experiences of weight stigma, weight bias internalization (Chan et al, 2019), and food addiction symptoms. Recent research in the Chinese context suggests bi-directional relationships between disordered eating, psychological distress, and weight bias internalization in Chinese adolescents such that higher baseline disordered eating and psychological distress predicted higher weight bias internalization at follow-up (i.e., 6-months after baseline) and higher baseline weight bias internalization predicted higher disordered eating and psychological distress at follow-up (Barnhart et al, 2023). Thus, the increased prevalence of disordered eating, elevated weight status, and psychological distress (see Huang et al, 2009) Recent cross-sectional research provides initial support for meaningful relationships between food addiction symptoms, weight bias internalization, and psychological distress in university students from Taiwan (Huang et al, 2022).…”