Internalized weight stigma and psychological distress mediate the association of perceived weight stigma with food addiction among young adults: A cross-sectional study.

Background: Perceived weight stigma (PWS) and internalized weight stigma (IWS) are both associated with psychological distress and food addiction (FA). Using the previously proposed 'cyclic obesity/weight-based stigma' (COBWEBS) model, the present study extended the framework to investigate the mediating effects of IWS and psychological distress in the association between PWS and FA among young adults. Given that individuals who are overweight/have obesity have different vulnerabilities, this population was separately analyzed alongside the total study population. Methods: An online survey comprising the Perceived Weight Stigma Scale, Weight Bias Internalization Scale (WBIS), Depression, Anxiety and Stress Scale-21 (DASS-21), and modified Yale Food Addiction Scale Version 2 was completed by 601 participants (59.6% females; mean age 29.3 years [SD = 6.07]). A total of 219 participants were categorized as being overweight/having obesity. Results: A direct correlation was found between PWS and FA (standardized coefficient [β] = 0.28, p < 0.001) among both populations, and was mediated by IWS and psychological distress (β [95% CI] = 0.03 [0.01, 0.05] for WBIS score and 0.10 [0.06, 0.14] for DASS-21 score) among the total participants, but only mediated by psychological distress among participants who were overweight/had obesity (β [95% CI] = 0.14 [0.06, 0.24]). Conclusions: The results demonstrated novel perspectives by showing the direct association between PWS and FA and the mediating roles of IWS and psychological distress. Treatment strategies such as psychological acceptance and psychoeducation could be used to reduce weight stigma, which could have positive downstream benefits of ameliorating FA. Future research may seek to study strategies for reducing weight stigma and psychological distress, to investigate their efficacy in improving disordered eating. Plain English summary: The present study proposed a model to understand the association between weight stigma and food addiction with the following considerations: (i) subdividing weight stigma into perceived weight stigma and internalized weight stigma; and (ii) adding psychological distress in the association between weight stigma and food addiction. Analysis was carried out on two populations of young adults: the total sample, and participants who were overweight/had obesity. The results supported the direct association between perceived weight stigma and food addiction among both samples. This association was mediated by internalized weight stigma and psychological distress among the total participants, but only mediated by psychological distress among participants who were overweight/had obesity. The findings provided novel evidence regarding the effect of perceived weight stigma, as well as the mediating roles of internalized weight stigma and psychological distress in the development of food addiction. Such findings might be implemented into strategies aimed at reducing food addiction. [ABSTRACT FROM AUTHOR]