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Shame and Self-compassion as Risk and Protective Mechanisms of the Internalized Weight Bias and Emotional Eating Link in Individuals Seeking Bariatric Surgery

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Abstract

Background

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.

Methods

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).

Results

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.

Conclusions

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.

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Funding

This work was supported through a National Institutes of Health Cardiovascular Behavioral and Preventive Medicine Training Grant awarded to the Miriam Hospital, Providence, RI (T32 HL076134).

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Authors and Affiliations

  1. Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA

    Tosca D. Braun

  2. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA

    Tosca D. Braun, Ana M. Abrantes & Jessica Unick

  3. Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, CT, USA

    Tosca D. Braun, Amy A. Gorin & Diane M. Quinn

  4. Department of Human Development & Family Sciences, Rudd Center for Food Policy & Obesity, University of Connecticut, Storrs, CT, USA

    Rebecca M. Puhl

  5. Surgical Weight Loss Center, Hartford Hospital, Glastonbury, USA

    Andrea Stone, Darren Tishler & Pavlos Papasavas

  6. Institute of Living, Div. of Health Psychology, Hartford Hospital, Hartford, CT, USA

    Jennifer Ferrand

  7. Behavioral Medicine and Addiction Research, Butler Hospital, Providence, RI, USA

    Ana M. Abrantes

  8. Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA

    Jessica Unick

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  1. Tosca D. Braun
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Correspondence to Tosca D. Braun.

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Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

Dr. Braun, Dr. Gorin, Dr. Puhl, Ms. Stone, Dr. Quinn, Dr. Ferrand, Dr. Abrantes, Dr. Unick, and Dr. Papasavas declare no conflict of interest. Dr. Tishler reports personal fees from Medtronic, personal fees from Olympus, and personal fees from Conmed, outside the submitted work.

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Key Points

• Weight bias (WB), shame, and self-compassion associate with emotional eating.

• Indirect effect of internalized WB on emotional eating via shame, self-compassion.

• Most findings were held after accounting for adverse childhood experiences and distress.

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Braun, T.D., Gorin, A.A., Puhl, R.M. et al. Shame and Self-compassion as Risk and Protective Mechanisms of the Internalized Weight Bias and Emotional Eating Link in Individuals Seeking Bariatric Surgery. OBES SURG 31, 3177–3187 (2021). https://doi.org/10.1007/s11695-021-05392-z

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