(PS5-42) A Network Analysis of Internalized Weight Bias, Core Eating Disorders Symptoms, and Shared Vulnerabilities

Abstract Text: Weight stigma is a form of stigmatization and discrimination that targets people based on their body size (Keast et al., 2023). When weight stigma becomes internalized (i.e., internalized weight stigma), negative weight related stereotypes become part of one’s identity. Internalized weight bias is adversely related to positive health outcomes and is associated with binge eating and body dissatisfaction (Romano et al., 2023). However, the precise pathways through which internalized weight bias and EDs relate are unknown. One way to investigate how internalized weight stigma relates to EDs is through network analysis. Network analysis is a methodology that explores how specific symptoms relate to other symptoms (Borsboom, 2017). Previous research found that exposure avoidance, dissatisfaction with shape, and wanting an empty stomach were the most central symptoms in a network of internalized weight bias and ED symptoms for people seeking treatment for obesity (Calugi et al., 2023). However, this work has not been replicated in other populations, nor was there assessment of how these symptoms are maintained (e.g., through which transdiagnostic mechanisms). Shame, guilt, and worry are moral emotions that are core ED symptoms (Cusack et al., 2024). Internalized weight bias is associated with these emotions, particularly with increased body-related shame and guilt (Lucibello et al., 2021) and could be maintaining mechanisms. In the current study (N = 1276) we aimed to replicate prior networks of internalized weight bias and ED symptoms and assess moral emotions as bridge symptoms. We hypothesized that internalized weight bias and ED symptoms would be highly interconnected, and that moral emotions shame, guilt, and worry connect internalized weight stigma and ED symptoms.
Participants (N = 1276) were undergraduate students. Data was measured using the Weight Bias Internalization Scale (WBIS), the Eating Disorder Examination Questionnaire (EDE-Q), the State Shame and Guilt Scale (SGSS), and the Penn State Worry Questionnaire (PSWQ). Using network analysis, we created two models, one of ED symptoms and internalized weight bias and the second including the moral emotions shame, guilt, and worry, to identify bridge symptoms. We also conducted a network comparison test to determine if the models varied based on body size.
In Model 1, results indicate “I hate myself for my weight” (strength (S) = 1.51, expected influence (EI) = 1.28), weight concerns (S = 0.77, EI = 1.11), and shape concerns (S = 0.78, EI =1.12) are the most central symptoms. In Model 2 shame (bridge strength (BS) = 0.37), worry (BS = 0.35), and “I hate myself for my weight” (BS = 0.31) were bridge symptoms between ED symptoms and internalized weight bias. Our findings suggest that shame, worry, and self-hatred due to weight are key pathways between internalized weight bias and ED symptoms. Future research is needed to identify if interventions focused on shame, worry, and self-hatred based on weight disrupt the relationship between internalized weight bias and ED symptoms.