Examining The Associations Between Dietary Intake And Experienced And Internalized Weight Bias

Abstract

Background: Weight bias (WB), defined as negative weight-based attitudes, stereotypes, judgments, and discriminatory acts because of an individual’s size, is perpetuated by many sources, including healthcare systems, the media, and close friends and family. Over time, individuals may internalize this bias and engage in self-stigma, known as internalized weight bias (IWB). The experience of weight stigma (EWS) and IWB may impact eating. Indeed, EWS and IWB have been associated with maladaptive eating patterns, disordered eating, and emotional eating. Despite these findings, no studies known to the authors have examined the impact of IWB and EWS on dietary intake from grocery purchases and fast-food intake. Thus, this study sought to examine the relationships between EWS, IWB, healthfulness of grocery purchases, and fast-food intake. Methods: Participants (N=435, 18+ years old, household’s primary grocery shopper) were recruited for a Qualtrics research panel. The sample was recruited to reflect the US population’s age, gender, race, ethnicity, education, and income. Two hierarchical linear regression analyses were conducted using bias corrected accelerated bootstrap sampling of 5000. The first model was fit with IWB and EWS predicting dietary intake from grocery purchases and the second model was fit with IWB and EWS predicting frequency of going out to eat. Covariates for the analyses included age, ethnicity, gender, income, subjective social status, education, BMI, and race (model two only). Two mediation models using PROCESS Macro model 4 were also conducted. The first model examined whether internalized weight bias mediates the relationship between EWS, and diet quality. The second model examined whether internalized weight bias mediates the relationship between EWS, and eating out frequency. Results: After controlling for covariates, internalized weight bias (p=.004), but not experienced weight stigma (p=.054), was statistically significant, with higher IWB predicting less healthy food intake from grocery store purchases. Experienced weight stigma (p<.001), but not internalized weight bias (p=.337), was statistically significant, with higher EWS predicting consumption of more fast-food. Conclusion: These findings suggest that more experiences of weight stigma are associated with increased fast-food intake, whereas higher internalized weight bias is associated with less healthy dietary intake from grocery purchases. Both EWS and IWB may impact food purchases whether in the grocery store or fast-food restaurants. This study revealed a reliable association between EWS/IWB and grocery store and fast-food purchases. Whether the type of weight stigma experience is associated with a particular purchasing pattern (EWS and fast-food and IWB and groceries) will be an important area of future inquiry. Future research should continue to examine the impact of IWB, EWS, and newer measures, such as fat microaggressions, on dietary intake. Examining eating patterns and their temporal relationship with IWB thoughts and EWS will provide necessary insight to create just-in-time adaptive interventions.