Associations between weight-based teasing and disordered eating behaviors among youth

Highlights

• Among youth, weight-based teasing was associated with greater disordered eating.

• Youth who had experienced weight-based teasing were three times more likely to report recent loss-of-control eating.

• Weight-based teasing was associated with greater emotional eating and eating when not hungry.

• Negative affect mediated the relationships between teasing and disordered eating.

Abstract

Weight-based teasing (WBT) is commonly reported among youth and is associated with disinhibited and disordered eating. Specifically, youth who experience WBT may engage in disordered eating behaviors to cope with the resultant negative affect. Therefore, we examined associations between WBT and disordered eating behaviors among youth and assessed whether negative affect mediated these relationships. Two hundred one non-treatment seeking youth (8-17y) completed questionnaires assessing WBT, disinhibited eating, depression, and anxiety. Disordered eating and loss-of-control (LOC) eating were assessed via semi-structured interview. Analyses of covariance were conducted to examine relationships between WBT and eating-related variables, and bootstrapping mediation models were used to evaluate negative affect (a composite of depressive and anxiety symptoms) as a mediator of these associations. All models were adjusted for sex, race, age, and adiposity. Among 201 participants (13.1 ± 2.8y; 54.2% female; 30.3% Black; 32.8% with overweight/obesity), WBT was associated with emotional eating, eating in the absence of hunger, and disordered eating attitudes and behaviors (ps ≤ 0.02). These associations were all mediated by negative affect. WBT was also associated with a threefold greater likelihood of reporting a recent LOC eating episode (p = .049). Among boys and girls across weight strata, WBT was associated with multiple aspects of disordered eating and these relationships were mediated by negative affect. Longitudinal studies are needed to clarify the directionality of these associations and to identify subgroups of youth that may be particularly vulnerable to WBT and its sequelae.

Introduction

Weight-based teasing (WBT) is one of the most prevalent forms of peer victimization among children and adolescents (Puhl, Luedicke, & Heuer, 2011). Up to 60–78% of youth with high weight – and up to 20% of those without – report weight- or shape-based teasing (e.g., Goldfield et al., 2010; Puhl, Peterson, & Luedicke, 2013; Schvey et al., 2019). WBT may persist for years (Griffiths, Wolke, Page, Horwood, & Team, 2006; Puhl et al., 2013; Puhl & King, 2013), is experienced across settings and from numerous sources (e.g., family, peers, healthcare providers) (Puhl et al., 2013; Puhl & King, 2013), and is associated with adverse psychological correlates, including low self-esteem, depression, and suicidality (Puhl & Lessard, 2020).

WBT may also place youth at-risk for disordered eating attitudes and behaviors, including disinhibited eating [an umbrella term for eating behaviors involving a lack of restraint, such as emotional eating (i.e., eating in response to negative mood states), eating in the absence of hunger (i.e., initiating or continuing to eat when one is not hungry), and loss-of-control (LOC) eating (i.e., the subjective feeling of being unable to control what or how much one is eating)]. These behaviors are associated with excess weight gain among children and adolescents (Shomaker, Tanofsky-Kraff, & Yanovski, 2011). Studies have shown that WBT is associated with increased risk of LOC eating, unhealthy weight control behaviors, and dieting frequency (Eisenberg, Neumark-Sztainer, Haines, & Wall, 2006; Puhl et al., 2017). WBT is also prospectively associated with weight and adiposity gain (Puhl et al., 2017; Schvey et al., 2019; Suelter et al., 2018).

Research is needed to elucidate mechanisms and risk factors for the adverse consequences of WBT. One potential mechanism is negative affect. Affect theory posits that individuals may use food to cope with uncomfortable or distressing affective states (Heatherton & Baumeister, 1991; Kenardy, Arnow, & Agras, 1996). Negative affect has consistently been identified as a correlate of disinhibited eating (Jansen et al., 2008; Stice, Akutagawa, Gaggar, & Agras, 2000; Stice, Ng, & Shaw, 2010), and has been cross-sectionally linked to LOC eating (Glasofer et al., 2007; Haedt-Matt & Keel, 2011), disordered eating, and body image concerns among youth and adolescents (Rodgers, Paxton, & McLean, 2014). Research in adolescent girls suggests that negative affect mediates the relationship between WBT and self-reported binge-eating (Suisman, Slane, Burt, & Klump, 2008). Given these findings, the role of negative affect in the relationship between WBT and disordered eating warrants additional examination.

Previous studies of the relationship between WBT and disordered eating have primarily examined adolescents, particularly adolescent girls (e.g., Hunger & Tomiyama, 2018; Keery, Boutelle, van den Berg, & Thompson, 2005; E. Stice, Presnell, Shaw, & Rohde, 2005; Suisman et al., 2008); fewer have examined males who report similar rates of WBT from peers (Puhl et al., 2017), or younger children, who may show signs of disordered eating as early as eight years of age (Morgan et al., 2002; Tanofsky-Kraff et al., 2004; Tanofsky-Kraff, Faden, Yanovski, Wilfley, & Yanovski, 2005). Additionally, extant literature examining links between WBT and disordered eating has largely utilized self-report measures of eating pathology (Libbey, Story, Neumark-Sztainer, & Boutelle, 2008; Suisman et al., 2008) or has examined treatment-seeking populations (e.g., King, Puhl, Luedicke, & Peterson, 2013; Tomiyama et al., 2014). More research is needed in community-based samples of boys and girls, using well-validated measures of WBT and eating behaviors.

Therefore, the current study assessed associations between WBT and disinhibited and disordered eating among non-treatment seeking youth ages 8-17y, and whether negative affect mediated these relationships. It was hypothesized that youths reporting WBT would present with greater disinhibited (i.e., emotional eating, eating in the absence of hunger) and disordered eating, and would be more likely to report LOC eating, after adjusting for relevant covariates including adiposity. Further, it was hypothesized that these associations would be mediated by negative affect (Suisman et al., 2008).