Longitudinal associations of binge eating with internalized weight stigma and eating self-efficacy.

INTRODUCTION: Internalized weight stigma (IWS) is linked to binge eating disorder (BED) symptoms and reduced self-efficacy, yet it unknown how changes in these factors may interrelate. The current study examined cross-sectional and longitudinal associations of BED with IWS and eating self-efficacy among treatment-seeking adults with high body weight. Disinhibited eating was explored as a mediator. METHODS: Seventy-one adults with high weight and elevated IWS were included in this secondary analysis of a clinical trial that provided 26 weeks of behavioral weight loss (BWL) treatment with (versus without) an additional IWS intervention. Participants underwent a BED diagnostic interview at screening and completed validated measures of binge eating, IWS (including weight bias internalization, self-devaluation, and stereotype endorsement), eating self-efficacy, and disinhibited eating at baseline and week-26. Cross-sectional mediation models tested associations of BED with IWS and eating self-efficacy, explained by disinhibited eating. Linear and logistic regression models, controlling for treatment condition, tested if baseline BED predicted changes in IWS, self-efficacy, and disinhibited eating, and if decreased binge episodes were associated with improved outcomes. RESULTS: At baseline, disinhibited eating mediated the relationship between BED and weight self-devaluation (95 % CI = 0.66,3.58), stereotype endorsement (CI = 0.15,0.56), and eating self-efficacy (CI:-14.40,-4.29). Baseline BED did not predict changes in outcomes. Participants with decreased binge episodes reported greater improvements in weight bias internalization (p = 0.04) and eating self-efficacy (p < 0.001). CONCLUSION: This study provides novel evidence of longitudinal associations between binge eating, IWS, and eating self-efficacy. IWS warrants further consideration as a treatment target and outcome in studies of BWL and BED.

Refining the conceptualization and assessment of internalized weight stigma: A mixed methods approach.

Internalized weight stigma has gained increasing attention in empirical studies, though questions remain about the adequacy of existing measures. The current study utilized a mixed methods approach, including a novel semi-structured interview, to revisit the conceptualization of internalized weight stigma and explore in more depth the stereotypes and impacts of weight reported by individuals with high scores on the widely-used Weight Bias Internalization Scale. All participants were interviewed as part of the screening procedures for two clinical trials (Study 1 n = 84, mean age=47.8 years, 83.3% women, 67.9% Black, mean BMI=39.2 kg/m2; Study 2 n = 129, mean age=50.0 years, 88.4% women, 65.1% white, mean BMI=37.8 kg/m2). The most common weight stereotypes identified were being lazy, lacking willpower or self-control, and having poor eating habits. Up to 66% of participants reported that they did not endorse negative weight stereotypes or apply them to themselves. The most highly identified impacts of weight were on self-image (>70%) and emotions (68-83%), followed by social (37-62%) and health concerns (20-25%). Approximately 60% of participants indicated that weight affected their self-directed thoughts and feelings "very much" to "extremely." Findings have implications for understanding and assessing internalized weight stigma in research and in clinical settings where interventions are needed.

Proof-of-Concept Feasibility Trial of a Dissonance-Based Sun Safety Intervention for Young Adult Tanners.

BACKGROUND: Melanoma is the second most common cancer in young adults. Social media may be a means to conduct interventions to increase sun safety in young adults. PURPOSE: We conducted a randomized proof-of-concept pilot trial to evaluate the feasibility and acceptability of a dissonance-based social media intervention designed to promote sun safety in young adult tanners. METHODS: Young adult tanners (N = 66) were randomized into two 4-week interventions in which participants were incentivized to create content for a social media campaign on healthy skin or healthy lifestyle. Feasibility outcomes included retention, participation, acceptability, and contamination. We also examined the impact of participation on motivation to engage in the target health behaviors and outdoor tanning intentions. RESULTS: Retention was 100%. Most Healthy Skin (88%) and Healthy Lifestyle participants (91%) created ≥1 post. Acceptability was high with 94% and 97% of participants in Healthy Skin and Healthy Lifestyle conditions, respectively, agreeing they would recommend the campaign to a friend. At 4 weeks, Healthy Skin participants reported greater declines in motivation to tan indoors (p = .0017) and outdoors (p = .0003), and greater increases in motivation to wear sunscreen (p = .0009) and protective clothing (p = .0342). Healthy Skin participants reported greater declines in intentions to tan outdoors in the next year (p = .0286). CONCLUSIONS: A dissonance-based, social media sun safety intervention was feasible and acceptable. Future research should examine the efficacy and longer-term effects of this intervention in young adults at elevated risk for skin cancer. TRIAL REGISTRATION: Clinicaltrials.gov NCT03834974 https://clinicaltrials.gov/ct2/show/NCT03834974.