An examination of weight bias among treatment-seeking obese patients with and without binge eating disorder

Summary & key facts

This paper is a systematic review of research on adults that looked at how eating disorders, body image, emotions, and self-esteem are linked. The authors searched three databases for papers from 2010–2024, screened 1,117 records, and included 6 studies, most of which had mostly female participants. The studies commonly found that people with eating disorders had more body dissatisfaction, lower self-esteem, and more emotional difficulties. Results also showed differences by diagnosis (for example, people with binge-eating disorder had more negative attitudes toward obesity) and by race in at least one study. The review says more adult research is needed in diverse, non-Western groups.

Key facts:

• The review searched PubMed, Scopus, and Web of Science for studies from 2010 to 2024, screened 1,117 articles, and included 6 studies that met the authors' criteria.
• Most included study samples were adults over 18 and were mostly female participants.
• Across the included studies, people with eating disorders showed higher body dissatisfaction that was linked with lower self-esteem and greater emotional dysregulation.
• One study reported that women with bulimia nervosa used more emotion-focused coping and had lower self-esteem than comparison groups (Wölfges et al., 2011).
• A study of obese patients found those with binge-eating disorder (BED) had more negative attitudes toward obesity than obese patients without BED; these attitudes correlated with higher depression and more disordered eating behaviors (Barne
• A study comparing racial groups found African American participants reported lower weight bias than white participants (Lewer et al., 2015).
• Research cited in the review found body dissatisfaction can affect disordered eating partly by reducing self-esteem and increasing depression (Brechan & Kvalem, 2015).
• The review notes limitations: only 6 studies met the criteria, most samples were female and from Western contexts, and the authors call for more research on adults in non-Western countries.
• The authors highlight that some reviewed studies suggested clinical approaches might focus on self-esteem, emotion regulation, and self-compassion, but the review reports these as recommendations from the studies rather than proven cures.

Abstract

Introduction & Purpose Eating disorders, body image, self-esteem, and emotional issues affect psychological and physical health and often co-occur. Disturbances in body image can trigger and worsen disordered eating behaviours. Emotions and self-esteem are influential factors in both eating disorders and body image issues, impacting their severity and manifestation. The interconnection of eating disorders, body image, emotions, and self-esteem has mostly been studied in adolescents, while there has been less research on the adult population. This systematic review seeks to synthesise existing literature on the comorbidity and coexistence of eating disorders, body image disturbance, emotion, and self-esteem in the adult population. Methods Following the PRISMA guidelines, a systematic search was conducted in scientific databases (PubMed, Scopus, and Web of Science) for articles published between 2010 and 2024 (Figure 1). The selected studies focused on the connections between eating disorders, body image, emotion, and self-esteem in adult populations. Six studies were selected from an initial collection of 1,117 articles, with most female participants representing different racial backgrounds. The study participants were required to be over 18 years old and use standard tools to measure the variables, and only original research with significant results was included. Results Individuals with eating disorders showed higher levels of body dissatisfaction, which was linked with lower self-esteem and emotional dysregulation. Women with bulimia nervosa displayed higher emotion-oriented coping strategies compared to controls, resulting in low self-esteem (Wölfges et al., 2011). Obese patients with binge-eating disorders (BED) had more negative attitudes towards obesity compared to obese individuals without BED, correlating with higher levels of depression and disordered eating behaviours (Barnes et al., 2014). The African American participants reported lower weight bias than white participants (Lewer et al., 2015). Furthermore, body image disturbances were a consistent theme, particularly their role in worsening eating disorders, with findings showing that body dissatisfaction indirectly influenced disordered eating behaviours through its effects on self-esteem and depression (Brechan & Kvalem, 2015). The findings revealed that women are more vulnerable to the negative impacts of body image dissatisfaction and emotional dysregulation on eating disorders (Barnes et al., 2014; Brechan & Kvalem, 2015). Additionally, the impact of weight bias and dissociative experiences during sexual activities, which were linked to binge eating and sexual dissatisfaction, was highlighted (Castellini et al., 2017). Discussion The findings emphasise the connections between self-esteem, body image, emotion, and eating disorders. Professional interventions for eating disorders should consider improving self-esteem and providing adaptive emotion techniques to enhance body image perception. The importance of self-compassion in improving body image and managing eating disorders was also noted (Kelly et al., 2014). More research on adult populations in non-Western countries is needed. Conclusion This review emphasises the relationships between eating disorders, body image, self-esteem, and emotion in adults. Moreover, the combination of strategies that improve emotional regulation, self-esteem, and body image perception within clinical interventions could lead to more practical management of eating disorders in adults. Future research should explore these variables across different cultures with varied research strategies. References Barnes, R. D., Ivezaj, V., & Grilo, C. M. (2014). An examination of weight bias among treatment-seeking obese patients with and without binge eating disorder. General Hospital Psychiatry, 36(2), 177–180. https://doi.org/10.1016/j.genhosppsych.2013.10.011 Brechan, I., & Kvalem, I. L. (2015). Relationship between body dissatisfaction and disordered eating: Mediating role of self-esteem and depression. Eating Behaviors, 17, 49–58. https://doi.org/10.1016/j.eatbeh.2014.12.008 Castellini, G., Lo Sauro, C., Ricca, V., & Rellini, A. H. (2017). Body esteem as a common factor of a tendency toward binge eating and sexual dissatisfaction among women: The role of dissociation and stress response during sex. The Journal of Sexual Medicine, 14(8), 1036–1045. https://doi.org/10.1016/j.jsxm.2017.06.001 Kelly, A. C., Vimalakanthan, K., & Miller, K. E. (2014). Self-compassion moderates the relationship between body mass index and both eating disorder pathology and body image flexibility. Body Image, 11(4), 446–453. https://doi.org/10.1016/j.bodyim.2014.07.005 Lewer, M., Nasrawi, N., Schroeder, D., & Vocks, S. (2015). Body image disturbance in binge eating disorder: A comparison of obese patients with and without binge eating disorder regarding the cognitive, behavioral and perceptual component of body image. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 21, 115–125. https://doi.org/10.1007/s40519-015-0200-5 Wölfges, R., Legenbauer, T., & Hiller, W. (2011). Überprüfung des aktuellen Stressbewältigungsverhaltens bulimischer Frauen in einer sozialen Interaktion [Examination of the current stress management behaviour of bulimic women in a social interaction]. Verhaltenstherapie, 21(1), 23–29. https://doi.org/10.1159/000324255

Topics

Eating Disorders and Behaviors Obesity and Health Practices Obesity, Physical Activity, Diet

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Health Professions Health Sciences Pharmacy

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Binge eating Binge-eating disorder Bulimia nervosa Clinical psychology Depression (economics) Disordered eating Eating disorders Economics Internal medicine Macroeconomics Medicine Obesity Psychiatry Psychology Weight loss