Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.
Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
Obes Surg. 2021 Jul;31(7):3177-3187. doi: 10.1007/s11695-021-05392-z. Epub 2021 Apr 27.
Emotional eating in bariatric surgery patients is inconsistently linked with poor post-operative weight loss and eating behaviors, and much research to date is atheoretical. To examine theory-informed correlates of pre-operative emotional eating, the present cross-sectional analysis examined paths through which experienced weight bias and internalized weight bias (IWB) may associate with emotional eating among individuals seeking bariatric surgery.
We examined associations of experienced weight bias, IWB, shame, self-compassion, and emotional eating in patients from a surgical weight loss clinic (N = 229, 82.1% female, M. BMI: 48 ± 9). Participants completed a survey of validated self-report measures that were linked to BMI from the patient medical record. Multiple regression models tested associations between study constructs while PROCESS bootstrapping estimates tested the following hypothesized mediation model: IWB ➔ internalized shame ➔ self-compassion ➔ emotional eating. Primary analyses controlled for adverse childhood experiences (ACE), a common confound in weight bias research. Secondary analyses controlled for depressive/anxiety symptoms from the patient medical record (n = 196).
After covariates and ACE, each construct accounted for significant unique variance in emotional eating. However, experienced weight bias was no longer significant and internalized shame marginal, after controlling for depressive/anxiety symptoms. In a mediation model, IWB was linked to greater emotional eating through heightened internalized shame and low self-compassion, including after controlling for depressive/anxiety symptoms.
Pre-bariatric surgery, IWB may signal risk of emotional eating, with potential implications for post-operative trajectories. Self-compassion may be a useful treatment target to reduce IWB, internalized shame, and related emotional eating in bariatric surgery patients. Further longitudinal research is needed.
在接受减重手术的患者中，情绪化进食与术后体重减轻和饮食行为不良的相关性不一致，而且迄今为止，大多数研究都是非理论性的。为了检验与术前情绪性进食相关的理论依据，本横断面分析研究了经历体重偏见和内化体重偏见（IWB）与接受减重手术的个体的情绪性进食之间的关联途径。
我们检查了手术减肥诊所患者（N=229，82.1%为女性，平均 BMI：48±9）中经历体重偏见、IWB、羞耻感、自我同情和情绪性进食之间的关联。参与者完成了一份经过验证的自我报告量表的调查，这些量表与患者病历中的 BMI 相关联。多元回归模型测试了研究结构之间的关联，而 PROCESS 引导估计测试了以下假设的中介模型：IWB→内化羞耻感→自我同情→情绪性进食。主要分析控制了不良童年经历（ACE），这是体重偏见研究中的一个常见混杂因素。二级分析控制了患者病历中的抑郁/焦虑症状（n=196）。
在控制了混杂因素和 ACE 后，每个结构都对情绪性进食有显著的独特影响。然而，在控制了抑郁/焦虑症状后，经历体重偏见不再显著，内化羞耻感则变得边缘显著。在中介模型中，IWB 通过增加内化羞耻感和降低自我同情与更高的情绪性进食相关联，包括在控制了抑郁/焦虑症状后。
在接受减重手术之前，IWB 可能预示着情绪性进食的风险，这可能对术后轨迹产生影响。自我同情可能是减少 IWB、内化羞耻感和相关情绪性进食的一个有用的治疗靶点，需要进一步的纵向研究。
