Assessing Experiences of Weight Stigma and Disordered Eating Among New England-based and Latinx Young People

Abstract

Background: Experiencing weight stigma and discrimination has significant impacts on our long-term health. Understanding exposure over the life course, especially during childhood and adolescence, are crucial to unravel how these experiences impact health outcomes. When weight stigma intersects with other marginalized identities (i.e. race/ethnicity, gender identity etc), it may create unique experiences that amplify negative physical and psychological impacts. While racial/ethnic differences in weight stigma have been explored in adult populations, less in known about these experiences for young people. These experiences may drive maladaptive coping, such as disordered eating behavior (DEB). DEB has historically been a research topic focused on white, affluent young women; however, growing evidence shows that minority young people of all genders are engaging in similar, if not higher, rates of DEB. A clear picture of who is experiencing weight stigma and DEB, as well as how these experiences differ by gender and race/ethnicity is critical to understand health inequities, as well as illuminate modifiable areas for intervention and prevention. Objectives: (1) Identify how being exposed to a weight-centric environment impacts eating behaviors and self-reported health in adolescents, with an emphasis on Latinx young people. (2) Quantify these relationships as well as explore previously unidentified differences in experiences for Latinx young people. Methods: (i) A cross-sectional analysis using data from Project VIVA, a New England-based cohort of over 2,000 mother-child dyads, analyzes the association between weight talk (a measure of how often young people receive comments about their weight from various social sources) and DEB (binging, loss of control eating, and unhealthy weight control behaviors), controlling for known confounders, such as bullying and healthy eating, and testing for effect modification by gender and weight status. (ii) A cross-sectional analysis using data from SOL Youth, a nationwide multi-site study of cardiometabolic risk among US Hispanic/Latino children, to examine the association between internalization of thin ideals, as measured by the Social Attitudes Toward Appearance Questionnaire, and binge eating, purging, and dieting, controlling for known confounders and testing for effect modification by gender, weight status and acculturation status. (iii) Peso y Cuerpo (PyC), a project of qualitative interviews with 15-20 Latinx young people aged 12-18y in the Boston Metro area to explore experiences of attitudes toward body weight and shape within their culture, as well as experiences of weight stigma. Results: Preliminary results indicate that both increased experiences of weight talk in Project VIVA and internalization of the thin ideal in SOL Youth are significantly associated with DEB, even after controlling for known confounders. Among adolescents in Project VIVA and SOL, the observed association between the exposure of interest and different forms of DEB was not significantly modified by any of the tested variables. Qualitative findings from Peso y Cuerpo, however, indicate more pressure on female Latinx young people around body shape and higher internalization of thin ideals for US-born Latinx young people. Emerging themes from the qualitative interviews were tensions between health and body positivity and the perception that weight comments from family demonstrate love and/or encouragement, whereas those from peers and extended family are received as bullying or criticism. Conclusion: Comments on body weight and internalization of the thin ideal are both associated with increased binge and restrictive disordered eating among adolescents. These results help to identify the drivers of disordered eating in adolescent young people, especially Latinx young people, within the context of the US society’s weight ideals. Future research should account for these culturally-specific concepts and recognize the deleterious effects of focusing on body weight for young people.