Relationship Between Weight Stigma,Eating Behaviors And Stress Among Adolescents In Wuhan,China

BackgroundWeight stigma,which refers to prejudice,stereotypes and discriminatory behaviors against overweight or obese people,has become a widespread social phenomenon and occurs in different groups.Adolescents are at a critical stage of physical and mental development,the experience of weight stigma can lead to harmful physical and psychological health consequences for adolescents,including stress,unhealthy eating behaviors,and so on.In China,more and more children and teenagers are overweight and obese,yet weight stigma has received little attention.ObjectiveThe purpose of this study was to examine the relationships between weight stigma,eating behaviors,and stress,as well as to analyze the effect of stress in mediating the association between weight stigma and eating behaviors among adolescents.MethodsA cross-sectional study using a convenience sampling was carried out in the first high school of Jiangxia District,Wuhan,China in May 2019.All students(n=2,395)were invited to participate in this survey.Weight stigma,eating behaviors(cognitive restraint,uncontrolled eating,and emotional eating),and stress were assessed by self-report questionnaires.The independent sample t test and univariate analysis of variance were used to investigate the gender and weight differences of weight stigma,eating behaviors,and stress.Pearson correlation analysis was used to examine the correlation between weight stigma,stress and eating behaviors.In order to test the influence of body weight stigma and pressure on eating behavior and explore the mediating effect of pressure on the relationship between body weight stigma and eating behavior,further analysis of mediating effect was carried out on the basis of correlation analysis.Taking body weight stigma as independent variable,eating behavior as dependent variable and stress as mediating variable,Process plug-in(model 4)was used for mediating effect analysis and Bootstrap was used to test the mediating effect.ResultsA total of 1818 participants were included in the analyses.Among them,there were 987(54%)boys aged 16.5 years(SD=0.98);there were 831(46%)girls aged 16.4 years(SD=0.98).T test showed that girls had higher weight stigma score,higher stress level,higher cognitive restraint score,uncontrolled eating score,and emotional eating score compared with boys(p<0.05).Mediation analyses showed that experiences of weight stigma significantly predicted uncontrolled eating and emotional eating regardless of body mass index(BMI)(underweight adolescents: uncontrolled eating: B=0.2435;emotional eating: B=0.1700,p<0.05;normal weight adolescents: uncontrolled eating: B=0.1412;emotional eating: B=0.0717,p<0.05;overweight or obese adolescents: uncontrolled eating: B=0.1761;emotional eating: B=0.0775,p<0.05);experiences of weight stigma significantly predicted cognitive restraint among underweight and normal weight adolescents(B=0.1613,B=0.0919,P<0.05).Bootstrap mediation analyses showed that stress mediated the associations between weight stigma and uncontrolled eating and emotional eating among non-overweight adolescents(uncontrolled eating: indirect effect coefficient=0.0370,95%CI=0.0252,0.0501;emotional eating: indirect effect coefficient=0.0142,95%CI=0.0092,0.0196).ConclusionsCompared with boys,girls had higher weight stigma score,higher stress level,higher cognitive restraint score,uncontrolled eating score,and emotional eating score;underweight and normal weight individuals can still experience weight stigma and its associated negative consequences;the relationship between weight stigma and eating behaviors is modulated by weight status;stress mediated the associations between weight stigma and uncontrolled and emotional eating among normal-weight adolescents.