Department of Psychiatry and Human Behavior, The Miriam Hospital and Alpert Medical School of Medicine, Brown University, Providence, Rhode Island, USA.
Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut, USA.
Obesity (Silver Spring). 2020 Oct;28(10):1974-1983. doi: 10.1002/oby.22920. Epub 2020 Aug 18.
Psychopathology in bariatric surgery patients may contribute to adverse postoperative sequelae, including weight regain, substance use, and self-harm. This cross-sectional study aimed to advance the understanding of the risk and protective paths through which weight bias associates with depressive and anxiety symptoms in bariatric surgery candidates (BSC).
BSC recruited from a surgical clinic (N = 213, 82.2% women, 43 [SD 12] years, mean BMI: 49 [SD 9] kg/m ) completed measures of experienced weight bias (EWB), internalized weight bias (IWB), body and internalized shame, and self-compassion; anxiety and depression screeners were accessed from medical charts. Multiple regression and PROCESS bootstrapping estimates tested our hypothesized mediation model as follows: EWB→IWB→body shame→shame→self-compassion→symptoms.
After accounting for EWB and IWB, internalized shame accounted for greater variance in both end points than body shame. EWB was associated with greater anxiety through risk paths implicating IWB, body shame, and/or internalized shame. Protective paths associated EWB with fewer depressive and anxiety symptoms among those with higher self-compassion.
The findings suggest a potentially important role for weight bias and shame in psychological health among BSC and implicate self-compassion, a trainable affect-regulation strategy, as a protective factor that may confer some resiliency. Future research using longitudinal and causal designs is warranted.
肥胖症患者的精神病理学可能导致不良的术后后果，包括体重反弹、物质使用和自残。本横断面研究旨在深入了解体重偏见通过哪些风险和保护途径与肥胖症手术候选者（BSC）的抑郁和焦虑症状相关。
从外科诊所招募 BSC（N=213，82.2%为女性，43 岁[标准差 12]，平均 BMI：49 千克/平方米[标准差 9]），完成经历体重偏见（EWB）、内化体重偏见（IWB）、身体和内化羞耻感以及自我同情的测量；焦虑和抑郁筛查从病历中获取。多元回归和 PROCESS 引导估计测试了我们假设的中介模型如下：EWB→IWB→身体羞耻→羞耻→自我同情→症状。
在考虑 EWB 和 IWB 后，内化羞耻感比身体羞耻感更能解释两个终点的差异。EWB 通过涉及 IWB、身体羞耻和/或内化羞耻的风险途径与更大的焦虑相关。在具有较高自我同情的个体中，保护途径与较少的抑郁和焦虑症状相关。
研究结果表明，体重偏见和羞耻感在 BSC 的心理健康中可能起着重要作用，并暗示自我同情作为一种可训练的情绪调节策略，是一种可能具有一定弹性的保护因素。未来的研究需要采用纵向和因果设计。
