Weight Bias Internalization and Psychosocial,Physical, and Behavioral Health: A Meta-Analysis of Cross-Sectional and Prospective Associations

Coinciding with widespread efforts to address obesity, weight bias internalization (a process of self-devaluation wherein individuals apply weight-biased stereotypes to themselves) has gained increased attention as a robust correlate of poor health outcomes. The present meta-analysis aimed to provide the largest quantitative synthesis of associations between weight bias internalization and health-related correlates. Studies that provided zero-order correlations for cross-sectional or prospective associations between weight bias internalization and physical, psychosocial, and behavioral health correlates were included in the meta-analysis. Meta-regression determined whether these associations differed based on demographic (sex/gender, race, age), anthropometric (body mass index), and study-level (publication status, sample type, study quality) moderators. Data for 149 (sub)samples were identified that included between 14 and 18,766 participants (M sample size = 534.96, SD = 1,914.43; M age = 34.73, SD = 12.61, range = 9.95–65.70). Results indicated that greater weight bias internalization was concurrently associated with worse psychosocial (e.g., negative and positive mental health, social functioning), physical (e.g., BMI, weight maintenance, health-related quality of life [HRQoL]), and behavioral health (e.g., disordered eating behaviors, healthy eating, physical activity) across most constructs, with effects ranging from small to very large in magnitude. Preliminary evidence also suggested that greater weight bias internalization was subsequently associated with less weight loss and increased negative mental health. Notable variations in the nature and magnitude of these associations were identified based on the health-related correlate and moderator under consideration. These findings indicate that weight bias internalization is linked to multiple adverse health-related outcomes and provide insight into priorities for future research, theory building, and interventions in this area.     

Emerging Adulthood in American and British Samples: Individuals' Personality and Health Risk Behaviors

The purpose of this study was to examine the relationship between instrumental and expressive traits, and health-related behaviors among individuals in emerging adulthood (18–25 years old) in two Western societies. Individuals (100 males, 100 females) in an American sample and a British sample (36 males, 75 females) completed the Personal Attributes Questionnaire, a measure of neuroticism, the Health Behaviors Inventory, and two measures of perceived physical health. As hypothesized, in support of the androgyny model, individuals in both samples who scored high on both instrumental and expressive traits reported better health practices (i.e. safety belt use, less smoking) than individuals who scored low on both sets of traits or high on only one set of traits, after controlling for neuroticism. As hypothesized, for both samples, neuroticism explained more variance in perceived physical health than the other personality traits.     

Physical illness and symptoms of depression among elderly outpatients.

Elderly outpatients were assessed to clarify relations between symptoms of depression and physical illness, disability, pain, and selected psychosocial variables. Three types of assessments were made: (a) medical evaluations by physicians, (b) self-reported symptoms of depression and physical health, and (c) demographic and psychosocial data relating to participants' life circumstances. Both objective (physician-rated illness symptoms) and subjective (self-reported health, activity restriction, and use of pain medications) indicators of health accounted for independent variance in symptoms of depression. After controlling for these factors, additional variance was explained by health-related concerns (e.g., health care expenses, service needs), social support, and "other worries" (e.g., feeling useless, becoming a burden to others).     

Relationship between peer status and health behaviors.

Over the past decade, univariate studies have identified peer-rated popularity/sociability as a correlate of individual health practices (e.g., alcohol and drug use, exercise habits). Yet, the relationship between multiple health habits and broader social competencies rarely has been systematically examined. Accordingly, using a multivariate approach, the present study investigated the relative influence of background characteristics (i.e., age, gender, race, family type, and socioeconomic status) and peer status on health-related behaviors (i.e., physical activity, eating habits, smoking, alcohol use, and stress-related behaviors) in 589 junior high school students (ages 11-13). In this sample, peer popularity provided no significant increment in the prediction of health habits over and above the effects explained by demographics. These results are consistent with current perspectives on health and interpersonal behaviors, and have important practical implications for the initiation and maintenance of healthful and risky practices in the natural environment.     

Gender,gender role,and body image

The relationship between gender role and body image was examined in this research. Females and males who differed in their gender roles (i.e., masculine, feminine, androgynous, or undifferentiated) completed the Body-Self Relations Questionnaire (B. A. Winstead & T. F. Cash, Reliability and Validity of the Body-Self Questionnaire: A New Measure of Body Image, paper presented at the meeting of the Southeastern Psychological Association, New Orleans, Louisiana, 1984) and a measure of self-esteem. Results indicated that feminine females evaluated their physical appearance less favorably than androgynous females, although physical appearance was equally important to both groups. The importance of the masculine component of gender role was reflected in the favorable body-image ratings of androgynous and masculine females in all domains (i.e., physical appearance, physical fitness, and physical health), and in the unfavorable ratings of feminine males in the physical fitness domain. Regression analyses to predict body-image ratings indicated that while self-esteem was an important predictor, it did not account for the relationships between gender, gender role, and body image. Implications of the findings for future research on the relationships between gender role, body image, and indices of mental health are discussed.The authors would like to thank the consulting editor for her invaluable comments on earlier drafts of this article.     

Gender role identity and dating behavior: What is the relationship?

The influence of gender role identity on dating behaviors of college students was examined using the Bem Sex Role Inventory and a behavioral questionnaire constructed by the author. One hundred and ninety-seven students were classified as androgynous, undifferientated, feminine, or masculine based on their Bem Sex Role Inventory scores. A behavioral questionnaire was used to generate two self-report behavioral indexes: the masculine dating behavior and feminine dating behavior indexes. Results indicated that high-masculine individuals (androgynous and masculine individuals) scored higher on the masculine dating behavior index and that high-feminine individuals (androgynous and feminine individuals) scored higher on the feminine interactional index. The results of this study support the hypothesis that gender role identity influences self-reported dating behavior of college students.     

The relationship between instrumental and expressive traits,health behaviors,and perceived physical health

Relations between instrumental and expressive traits, health behaviors, and self-reported physical health were examined among young adults. Individuals (169 men, 167 women) completed two measures of instrumental and expressive traits, the Bem Sex Role Inventory (BSRI) and the Personal Attributes Questionnaire (PAQ). Ethnic background of the sample included 72% European Americans, 13% Latin Americans, 6% Asian Americans, 5% African Americans, less than 1% Native American, and 4% did not specify a particular category. Expressive traits from the BSRI, and expressive and instrumental traits from the PAQ were associated with health behaviors, after controlling for neuroticism. Neuroticism explained 43% of the variance in perceived physical health. Separation of individuals into four groups on the basis of instrumental and expressive traits showed that androgynous individuals reported significantly better health practices than other individuals providing support for the androgyny model.     

Patterns of sedentary behavior among adolescents.

OBJECTIVE: Reducing certain sedentary behaviors (e.g., watching television, using a computer) can be an effective weight loss strategy for youth. Knowledge about whether behaviors cluster together could inform interventions. STUDY DESIGN: Estimates of time spent in 6 sedentary behaviors (watching television, talking on the telephone, using a computer, listening to music, doing homework, reading) were cluster analyzed for a sample of 878 adolescents (52% girls, mean age = 12.7 years, 58% Caucasian). MAIN OUTCOME MEASURES: The clusters were based on the sedentary behaviors listed above and compared on environmental variables (e.g., household rules), psychosocial variables (e.g., self-efficacy, enjoyment), and health behaviors (e.g., physical activity, diet). RESULTS: Four clusters emerged: low sedentary, medium sedentary, selective high sedentary, and high sedentary. Analyses revealed significant cluster differences for gender (p < .002), age (p < .002), body mass index (p < .001), physical activity (p < .01), and fiber intake (p < .01). CONCLUSIONS: Results suggest a limited number of distinct sedentary behavior patterns. Further study is needed to determine how interventions may use cluster membership to target segments of the adolescent population.     

Marital Status and Adjustment 1 Year Post-Spinal-Cord-Injury

The current study employed a case-control design to examine the impact of marital status on adjustment among individuals with spinal cord injury (SCI) 1 year post-injury. Two groups of 53 individuals (i.e., single versus married individuals) were matched case-for-case on age (i.e., within 10 years), education, gender, race, and lesion level. Although not specifically matched, etiology of SCI, and number of rehospitalizations and days rehospitalized during the past year were not significantly different between groups. Outcome measures included the Satisfaction With Life Scale, the Craig Handicap Assessment and Reporting Technique (CHART), and the SF-12. Results indicated that overall self-reported QOL was significantly lower among single individuals as compared to their matched married counterparts. Similarly, self-reported handicap was significantly higher among single individuals, particularly in the areas of social integration and economic self-sufficiency. In contrast, overall physical and mental health were not different across groups.     

Religious Involvement and Health Over Time: Predictive Effects in a National Sample of African Americans

In this study, two telephone interviews that assessed both religious involvement and health‐related quality of life were conducted approximately 2.5 years apart in a national sample of 290 African Americans. Religious involvement was assessed with an instrument that measured both personal religious beliefs (e.g., having a personal relationship with God) and more public religious behaviors (e.g., attending church services). Health‐related quality of life was measured with version 2 of the Medical Outcomes Study 12‐item short form (SF‐12v2). Structural equation models indicated that higher religious beliefs at baseline predicted better physical and mental health 2.5 years later. Higher religious behaviors at baseline contributed smaller, complementary suppression effects. Physical and mental health indicators from the SF‐12v2 at baseline did not predict changes in either religious beliefs or religious behaviors over time. These findings indicate that, for African Americans, personal religious beliefs lead to beneficial health effects over time, whereas individual differences in health do not appear to predict changes in religious involvement.     

LGBTQ and Heterosexual Adolescents’ Use of Indirect Forms of Aggression

In this study, researchers investigated whether lesbian, gay, bisexual, transgender, and questioning (LGBTQ) adolescents use indirect aggression and exhibit prosocial behavior in their relationships at rates comparable to their heterosexual peers. In a sample of 666 college students (median age = 19.5 years), LGBTQ adolescents (N = 22) used relationally and socially aggressive behaviors at a level consistent with their heterosexual peers. This suggests that sexual orientation identification does not appear to differentially affect the use of indirectly aggressive behaviors during social interactions. There were also no differences in self-reported interpersonally mature behaviors (e.g., use of prosocial skills) exhibited by heterosexual and LGBTQ adolescents in this sample, which indicates that sexual and gender identity were also unrelated to the use of prosocial behaviors.     

The evolution of challenges to researchers in health psychology

One of the keynote addresses presented at the National Working Conference on Research in Health and Behavior. This address is a historical review of current challenges to researchers in health psychology. Current challenges discussed include (a) creation of physical pathology, (b) physical symptoms of physical pathology in the absence of true pathology, (c) increased or decreased vulnerability to infectious disease, (d) intensify, prolong, or diminish existing pathology, (e) individuals' preoccupation with illness or disease, (f) voluntarily engaging in health-threatening behavior (e.g., allowing toxic agents to enter the body or engaging in accident-prone behavior or high-risk sexual practices), (g) engaging in health-enhancing life-style behaviors, and (h) involuntarily becoming the victim of toxic agents. The shift in public health policy as related to psychological research--from mental health to physical illness--reflects societal support for such areas of research by health psychologists.     

Weighed Down by Stigma: How Weight‐Based Social Identity Threat Contributes to Weight Gain and Poor Health

Weight stigma is pervasive, and a number of scholars argue that this profound stigma contributes to the negative effects of weight on psychological and physical health. Some lay individuals and health professionals assume that stigmatizing weight can actually motivate healthier behaviors and promote weight loss. However, as we review, weight stigma is consistently associated with poorer mental and physical health outcomes. In this article, we propose a social identity threat model elucidating how weight stigma contributes to weight gain and poorer mental and physical health among overweight individuals. We propose that weight‐based social identity threat increases physiological stress, undermines self‐regulation, compromises psychological health, and increases the motivation to avoid stigmatizing domains (e.g., the gym) and escape the stigma by engaging in unhealthy weight loss behaviors. Given the prevalence of overweight and obesity in the US, weight stigma thus has the potential to undermine the health and wellbeing of millions of Americans.     

Interactive Effects of Chronic Health Conditions And Financial Hardship On Episodic Memory Among Older Blacks: Findings From The Health And Retirement Study

Previous research links chronic health conditions and financial hardship to cognitive outcomes among older Blacks. However, few studies have explored the moderating effect of financial hardship on chronic disease burden and specific cognitive domains. This study examined whether financial hardship (as measured by difficulty paying monthly bills) modifies the impact of self-reported chronic health conditions (e.g., diabetes, stroke) on episodic memory among 871 older Blacks (50+ years) in the 2006 Health and Retirement Study . Financial hardship modified the association between chronic disease burden and episodic memory performance such that individuals who reported very little difficulty paying their monthly bills had significantly lower memory scores at high levels of disease burden compared to those reporting high financial difficulty after controlling for age, gender and education (F 2, 49 = 5.03, p = .010). This cross-sectional study suggests that both financial and physical wellbeing may have joint effects on cognitive health in older Blacks.     

Relationship of seat belt use to health and driver behaviors

Seat belts are effective safety devices for protecting car occupants from injuries and fatalities in road vehicle accidents. Seat belt use has been reported to be related to some health and driving-related behaviors. The aim of the present study was to investigate to what degree seat belt use can be seen as health behavior or driver behavior. Participants were 252 licensed Turkish drivers (180 males, 72 females) with the mean age of 30.8 (SD = 12.15). A questionnaire including questions related to health-related behaviors, driver behaviors and seat belt use was used. Results of factor analysis showed that seat belt use in front seat grouped with driver behaviors (e.g., driving errors and violations) but not with health-related behaviors (e.g., healthy diet and sports participation). Regression analyses showed that seat belt use in back seat; and, regular walking and adequate sleep were positively related to seat belt use in front seat, whereas being male, driving errors and smoking frequency were negatively related to seat belt use in front seat. The present findings suggest that seat belt use can be considered in the context of driver behaviors such as driving errors and violations.     

Employee age and health

One particularly persistent and prevalent negative age stereotype is that older workers experience more health problems. This study examines whether this negative age stereotype is evidence-based or not. In a meta-analysis of previous studies on the relationship between age and health, we found that older employees suffered no declines in either mental health or self-reported physical health problems, but did experience modest declines on clinical indices of physical health (e.g., blood pressure, cholesterol level, and body mass index). The article concludes with directions for future research on the role of health in the age–performance relationship and its implications for management practice.     

Employee age and health

One particularly persistent and prevalent negative age stereotype is that older workers experience more health problems. This study examines whether this negative age stereotype is evidence-based or not. In a meta-analysis of previous studies on the relationship between age and health, we found that older employees suffered no declines in either mental health or self-reported physical health problems, but did experience modest declines on clinical indices of physical health (e.g., blood pressure, cholesterol level, and body mass index). The article concludes with directions for future research on the role of health in the age–performance relationship and its implications for management practice.     

Gender Role Development and Body Image among Male and Female First Year College Students

In the current study we examined associations between gender role development and body image. Male and female first-semester college students (N = 434) who identified as African American, Latino/a American, and European American completed surveys about gendered personality traits (instrumentality/expressivity), gender role attitudes, and aspects of body image (e.g., satisfaction, orientation). Gendered traits were more frequently associated with body image than were gender role attitudes. In particular, individuals who were more instrumental and less inauthentic in their relationships felt more positive about their bodies. Gender role attitudes were also associated with body image, but sometimes in an unexpected direction. These findings highlight the importance of examining multiple components of gender role development and body image in both men and women.An earlier version of this paper was presented at the 2004 Biennial Meeting of the Society for Research on Adolescence, Baltimore, MD. This research was supported by grant R01 HD 41720 from the National Institute of Child Health and Human Development to Eva S. Lefkowitz.