Self-objectification, weight bias internalization, and binge eating in young women: Testing a mediational model

Body Image 24 (2018) 111–115

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Body Image journal homepage: www.elsevier.com/locate/bodyimage

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Self-objectification, weight bias internalization, and binge eating in young women: Testing a mediational model Adrienne Mehak a , Aliza Friedman a , Stephanie E. Cassin a,b,c,∗ a b c

Department of Psychology, Ryerson University, Toronto, Canada Department of Psychiatry, University of Toronto, Canada Centre for Mental Health, University Health Network, Canada

a r t i c l e

i n f o

Article history: Received 27 June 2017 Received in revised form 3 January 2018 Accepted 4 January 2018 Keywords: Appearance anxiety Body shame Disordered eating Eating pathology Internalization

a b s t r a c t Self-objectification and weight bias internalization are two internalization processes that are positively correlated with binge eating among young women. However, the mechanisms underlying these relationships are understudied. Consistent with objectification theory, this study examined appearance anxiety and body shame as mediators between self-objectification, weight bias internalization and binge eating. Female undergraduates (N = 102) completed self-report measures of self-objectification, weight bias internalization, appearance anxiety, body shame, and binge eating. Results indicated that women who self-objectified and internalized negative weight-related attitudes reported greater binge eating (rs = .43 and rs = .57, respectively) and these associations were mediated by the combined effects of body shame and appearance anxiety. The contrast between the two mediators was also significant, such that body shame emerged as a stronger mediator within both mediational models. Results demonstrated that these internalization processes contribute to negative affect in young women, which may in turn lead to binge eating. © 2018 Elsevier Ltd. All rights reserved.

1. Introduction Frequent exposure to messages emphasizing the desirability of a thin physique promotes their acceptance and internalization, thereby increasing the likelihood of disordered eating behaviours in an attempt to meet these ideals (Thompson & Stice, 2001). Objectification theory posits that, through a process of internalization, self-objectification occurs when a woman accepts that she is adequately defined as a body existing for another person’s use, such that she internalizes a third-person perspective of her body (Fredrickson & Roberts, 1997). Weight bias internalization (WBI) similarly occurs when a woman directs negative societal attitudes about fatness toward herself (Durso & Latner, 2008). Perceived discrepancy between one’s actual body and the idealized, thin body may increase negative affect and heighten the likelihood of binge eating in order to quell these negative experiences (Fairburn, Cooper, & Shafran, 2003). Accordingly, preliminary research has demonstrated that self-objectification and WBI positively corre-

∗ Corresponding author at: Department of Psychology Ryerson University, 350 Victoria St. Toronto, Ontario, M5B 2K3, Canada. E-mail addresses: [email protected] (A. Mehak), [email protected] (A. Friedman), [email protected] (S.E. Cassin). https://doi.org/10.1016/j.bodyim.2018.01.002 1740-1445/© 2018 Elsevier Ltd. All rights reserved.

late with binge eating (Burmeister, Hinman, Koball, Hofmann, & Carels, 2013; Dakanalis et al., 2015; Durso & Latner, 2008; Durso et al., 2012). Similarly, individuals who report binge eating have significantly greater WBI scores than those who do not (Durso & Latner, 2008; Schvey & White, 2015), suggesting that internalization of dominant cultural messages and their application towards oneself negatively impacts women’s relationship with food. Experimental induction of WBI has led to increased negative affect and decreased positive affect, suggesting that WBI is generally detrimental to one’s emotional wellbeing (Pearl & Puhl, 2016). Objectification theory proposes two negative, affect-related variables as potential mechanisms underlying the relationship between self-objectification and disordered eating behaviours, such as binge eating: appearance anxiety and body shame (Noll & Fredrickson, 1998; Tiggemann & Slater, 2001). Self-objectification may intensify a woman’s concern regarding her appearance, leading to increased body checking and appearance-related scrutiny, both of which are elements of appearance anxiety (Keelan, Dion, & Dion, 1992). Similarly, self-objectification is associated with feelings of shame regarding one’s physical shape or size (Choma, Shove, Busseri, Sadava, & Hosker, 2009; Fredrickson & Roberts, 1997). Given that both self-objectification and WBI reflect internalization of appearance-focused societal messages, it is plausible that WBI may lead to binge eating through similar mechanisms. Accord-

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Fig. 1. Unstandardized regression path coefficients between internalization processes, mediating variables, and binge eating, controlling for BMI. Panel A represents the unstandardized regression coefficients between self-objectification, the mediators (body shame, appearance anxiety), and binge eating controlling for BMI. Panel B represents the unstandardized regression coefficients between weight bias internalization, the mediators (body shame, appearance anxiety), and binge eating controlling for BMI. c = total effect (i.e., the relationship between the independent variable and binge eating), c’ = direct effect (i.e., the relationship between the independent variable and binge eating accounting for the effect of body shame and appearance anxiety) * p < .05, ** p < .00001.

ingly, WBI has been found to be positively associated with body shame (Burmeister et al., 2013). Both appearance anxiety and body shame may heighten the risk for binge eating, as some women engage in binge eating to regulate negative affect (Fairburn et al., 2003). Appearance anxiety and body shame also encourage dietary restriction in an attempt to modify one’s weight (McKinley & Hyde, 1996), in turn increasing the likelihood of binge eating (Stice, Akutagawa, Gaggar, & Agras, 2000). Thus, appearance anxiety and body shame may operate as both direct and indirect risk factors for binge eating. The present study examined the influence of self-objectification and WBI on binge eating in young women. The purpose of this study was to (a) provide support for the proposed mediational model of self-objectification (see Fig. 1, Panel 2), and (b) investigate whether this mediational model could also partially explain the relationship between WBI and binge eating (see Fig. 1, Panel 1). We hypothesized that both self-objectification and WBI would positively correlate with binge eating, and that these relationships would be mediated by the parallel influence of appearance anxiety and body shame. 2. Material and methods 2.1. Participants Undergraduate women (N = 102) participated in the study for course credit in an introductory psychology course. The research project was reviewed and approved by a Canadian university

Research Ethics Board (REB), and all participants provided informed consent. Participants had a mean age of 19.33 years (SD = 1.81). The sample was ethnically diverse, comprised of women identifying as Caucasian (41.6%), South Asian (16.8%), Southeast Asian (12.9%), Arab/West Asian (5.9%), East Asian (5.9%), Black/African American (3.0%), Latin/South American (2.0%), and Other (11.9%). Participants had a mean body mass index (BMI = kg/m2 ) of 22.84 kg/m2 (SD = 3.95). Most participants (59.7%) reported a healthy BMI, whereas 10.3% reported being underweight, 22.7% overweight, and 7.2% obese.

2.2. Measures 2.2.1. Modified Weight Bias Internalization Scale (WBIS-M; Pearl & Puhl, 2014) The WBIS-M is an 11-item self-report scale that assesses the experience of weight-related negative emotions, and respondents’ acceptance of their current weight. The original WBIS was developed for use with individuals who were overweight or obese; whereas the WBIS-M has been altered for use across the weight spectrum (e.g., “I hate myself for being overweight” was modified to “I hate myself for my weight”; Pearl & Puhl, 2014). Potential item scores range from 1 to 7, with higher scores indicating higher WBI. Participants’ responses were averaged to compute a mean score. The WBIS-M has strong psychometric properties, with high internal consistency in the current sample (␣ = .96).

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Table 1 Tests of mediation: Examination of indirect effects, bias corrected confidence intervals, significance, effect size, regression statistics and contrast. Indirect path WBI → body shame and appearance anxiety → binge eating Self objectification → body shame and appearance anxiety → binge eating

Indirect effect (ab)

95% BC CI

Significant mediation?

R2

F(df1, df2)

C1

Significant contrast?

1.83

0.60–3.26

Yes

.38

13.12(4, 93)

−0.99

Yes

2.16

1.20–3.48

Yes

.39

15.57(4, 93)

−0.99

Yes

Note: Body mass index was controlled for in all analyses. ab path = bootstrap estimates for the indirect effect (results presented for the combined indirect effects of body shame and appearance anxiety); BC CI = Bias corrected confidence intervals, R2 = amount of variance in the dependent variable (binge eating) accounted for by the independent variable and mediators, F(df1, df2) = regression statistics pertaining to the model being examined, C1 = contrast (i.e., the specific indirect effect of appearance anxiety minus the specific indirect effect of body shame. A significant contrast value indicates that body shame has emerged as a stronger mediator in the mediational model).

2.2.2. Objectified Body Consciousness Scale – Surveillance Subscale (OBCS-S; McKinley & Hyde, 1996) The OBCS-S is an 8-item self-report subscale measuring selfobjectification by assessing body monitoring and the extent to which participants evaluate their body in terms of how it looks as opposed to how it feels. Scores can range from 1 to 7, with higher scores indicating higher self-objectification. Participants’ scores were averaged to compute a mean score. The OBCS-S demonstrated high internal consistency in the current sample (␣ = .83). 2.2.3. Appearance Anxiety Scale (AAS; Keelan et al., 1992) The AAS is a 14-item self-report scale assessing appearance anxiety. Participants’ responses were summed to compute a total score. Scores can range from 14 to 70, with higher scores indicating greater appearance anxiety. The AAS demonstrated high internal consistency in the current sample (␣ = .94). 2.2.4. Objectified Body Consciousness Scale – Body Shame Subscale (OBCS-BS; McKinley & Hyde, 1996) The OBCS-BS is an 8-item self-report subscale used to assess body shame. Scores can range from 1 to 7, with higher scores indicating greater body shame. Participants’ ratings were averaged to compute a mean score. The OBCS-BS demonstrated high internal consistency in the current sample (␣ = .89). 2.2.5. Binge eating scale (BES; Gormally, Black, Datson, & Rardin, 1982) The BES is a 16-item self-report scale assessing cognitive and behavioral symptoms of binge eating. Ratings were summed to compute a total score. The total score can range from 0 to 48, with higher scores indicating greater binge eating severity. The BES showed high internal consistency in the current sample (␣ = .88). 2.2.6. Body mass index (BMI = kg/m2 ) BMI was calculated using self-reported height and weight, and included as a potential covariate in the statistical analyses. 3. Results Statistical analyses were performed using SPSS Statistics for Windows (Version 23.0; SPSS, IBM Corp, Armonk, NY). One participant was removed from the analyses due to random responding. Questionnaires were also examined for missing data, and an additional 3 participants were removed due to missing more than 10% of the items on one or more self-report measures (Final N = 98). Diagnostic analyses were conducted prior to proceeding with the following analyses, and revealed that thresholds for tolerance and VIF (indices of multicollinearity) were not violated, indicating a lack of multicollinearity. Consistent with the first hypothesis, selfobjectification and WBI were both positively correlated with binge eating (please refer to the supplementary online material, Table S1, for descriptive statistics and correlational results).

To test the second hypothesis that appearance anxiety and body shame would mediate the relationship between self-objectification and binge eating, two mediation analyses were performed using non-parametric bootstrapping procedures, more specifically using model 4 of the SPSS PROCESS Macro (Hayes, 2013). Each mediational model examined appearance anxiety and body shame as parallel mediators, and controlled for BMI as it was positively correlated with all measures except the OBCS-S (See Table S1). Ten thousand bootstrap samples were used to derive 95% biascorrected (BC) confidence intervals (CIs) to determine potential significance of the indirect effects. Mediation results were considered significant at p < .05 if a zero value was not present in the 95% CIs. Complete mediation results are presented in Fig. 1 and Table 1. As hypothesized, appearance anxiety and body shame were found to operate as parallel mediators in the relationship between selfobjectification and binge eating and in the relationship between WBI and binge eating. In addition, the contrast of the indirect effects was significant, highlighting body shame as a stronger mediator within both mediational models (See Table 1). These results demonstrate that the combined indirect effects of body shame and appearance anxiety significantly mediated the relationships between both measures of internalization and binge eating, with body shame also emerging as a stronger mediator within both mediational models. Post-hoc power analyses conducted using G*Power (version 3.1) indicated that both mediational models achieved a power of .99. 4. Discussion The current study examined the influence of self-objectification and WBI on binge eating symptoms in young women, as well as two potential mediators of these relationships: body shame and appearance anxiety. As hypothesized, both self-objectification and WBI demonstrated moderate positive correlations with binge eating symptomology, suggesting that young women who selfobjectify and who internalize weight bias are at heightened risk for binge eating. These findings replicate those obtained in previous investigations of both self-objectification and WBI (e.g., Dakanalis et al., 2015; Durso et al., 2012). These results also provide further support for objectification theory (Fredrickson & Roberts, 1997): not only do these findings indicate a positive association between self-objectification and binge eating, but they also support the mediating role of body shame and appearance anxiety, two mechanisms that have previously identified in the objectification literature. It is also notable that self-objectification and WBI displayed a moderate positive correlation, suggesting that young women who self-objectify are also at risk for experiencing internalized weight bias. In other words, certain individuals may be susceptible to internalization processes, which in turn may elevate risk for binge eating (Keel & Forney, 2013).

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Mediational analyses further supported the present study’s hypotheses, in that appearance anxiety and body shame were found to operate as parallel mediators in both the relationship between self-objectification and binge eating, and WBI and binge eating. This provides support for the proposition that both WBI and self-objectification are linked to binge eating through a combined pathway of appearance anxiety and body shame, and also suggests that WBI operates through a similar internalization process as self-objectification among young women. Accordingly, self-objectification and WBI foster negative affective states among young women (body shame and appearance anxiety) that may in turn contribute to binging in an attempt to dampen intense negative emotions (Fairburn et al., 2003). Importantly, these mediational models identify negative emotional states that are, in fact, directly associated with individuals’ perception of, and dissatisfaction with, their bodies. Even among a non-clinical sample, these body-related negative emotional experiences, in conjunction with disordered eating outcomes, likely reflect an overvaluation of shape and weight thought to be crucial in the etiology and maintenance of eating disorders (Fairburn et al., 2003). Further, the relationship between WBI, body shame and appearance anxiety, and binge eating is particularly notable, as it contributes to existing evidence contrary to the common belief that weight-based stigma will motivate individuals to make positive diet and lifestyle changes (e.g., Ashmore, Friedman, Reichmann, & Musante, 2008). Body shame emerged as a stronger mediator in both mediational models. This likely relates to body shame promoting binging both directly, as a means of affect regulation, and indirectly, by encouraging dietary restraint, in turn increasing one’s risk for engaging in binge eating (Stice et al., 2000). Additionally, previous research suggests that shame is a stronger predictor of eating disorder symptomology than other forms of negative affect (Gupta, Rosenthal, Mancini, Cheavens, & Lynch, 2008). 4.1. Strengths and limitations This study has a number of strengths. First, it contributes to the growing body of research on WBI across the weight spectrum (Schvey & White, 2015), and demonstrates that appearance anxiety and body shame are important explanatory mechanisms in the relationships between WBI and self-objectification with binge eating. Notably, the investigation of appearance anxiety and body shame as mediating variables related to WBI was novel to this study. Second, the current sample had greater ethnic diversity than typical samples of undergraduate women, suggesting that self-objectification and WBI are likely relevant risk factors for disordered eating among diverse groups of young women. However, these strengths should be interpreted in light of some limitations. First, WBIS scores were highly correlated with both AAS and OBCS-BS scores, and AAS scores were highly correlated with OBCS-BS scores, which together impacted interpretation of the mediation results. It is plausible that the strong correlations among these variables reflect at least some conceptual overlap in these measures; however, it is also likely that the experience of WBI does legitimately increase appearance anxiety and body shame. Second, the present study’s correlational design precludes determination of the direction of causality in the relationship between the internalizing variables and binge eating. Indeed, binge eating and compensatory behaviours are important factors that maintain the psychological components underlying eating disorders (Fairburn et al., 2003). Thus, it seems likely that there is a similar cyclical process occurring in these associations, in which disordered eating strengthens these internalizing processes. Prospective longitudinal studies and the experimental induction of WBI and self-objectification would elucidate the causal directions of these relationships. Finally, while power analyses indicated adequate

power for both models, to our knowledge, there is no established method of calculating power for a multiple mediator model evaluated using non-parametric bootstrapping, so power was examined using a regression model. Our sample is small when compared with some other studies employing non-parametric bootstrapping. Depending on the desired effect size, empirically estimated sample sizes required to achieve a power of 0.80 using bias-corrected bootstrapping with 2000 bootstrap samples range from 34 to 462 (Fritz & MacKinnon, 2007). Thus, this may limit the interpretation of mediation results. 4.2. Clinical implications The identification of appearance anxiety and body shame as significant parallel mediators in the relationship between these internalization processes and binge eating has important clinical implications. Given the high prevalence of binge eating among undergraduate women (Mitchell & Mazzeo, 2004), eating disorder prevention programs are especially relevant within this population. While previous iterations of prevention programs among undergraduate women have actually shown deleterious effects (e.g., Mann et al., 1997), an intervention including discussion of the thin ideal and self-objectification has shown promising results among university women (Mitchell, Mazzeo, Rausch, & Cooke, 2007). This finding, in combination with the results of the current study, suggests that education regarding internalization processes, body shame, and appearance anxiety, may be beneficial in addressing disordered eating among undergraduate women. 5. Conclusions The current study demonstrated that young women who selfobjectify and internalize negative attitudes about weight and shape may be at an increased risk of binge eating behavior. Appearance anxiety and body shame significantly mediated the relationship between self-objectification, WBI, and binge eating, suggesting that body-focused negative affect is an important explanatory mechanism in this model. These results suggest that processes of internalization may contribute to negative affect, which may in turn lead to increased likelihood of binge eating behaviour as a means of negative affect regulation. Accordingly, these results underscore the ramifications of exposure to weight-based stigma even among individuals with healthy BMIs. These findings may benefit programs aiming to prevent or decrease disordered eating in at-risk populations. Conflicts of interest None. Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at https://doi.org/10.1016/j.bodyim.2018.01. 002. References Ashmore, J. A., Friedman, K. E., Reichmann, S. K., & Musante, G. J. (2008). Weight-based stigmatization, psychological distress, & binge eating behavior among obese treatment-seeking adults. Eating Behaviors, 9, 203–209. http://dx. doi.org/10.1016/j.eatbeh.2007.09.006 Burmeister, J. M., Hinman, N., Koball, A., Hofmann, D. A., & Carels, R. A. (2013). Food addiction in adult seeking weight loss treatment. Implications for psychosocial health and weight loss. Appetite, 60, 103–110. http://dx.doi.org/10.1016/j. appet.2012.09.013 Choma, B. L., Shove, C., Busseri, M. A., Sadava, S. W., & Hosker, A. (2009). Assessing the role of body image coping strategies as mediators or moderators of the

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