Positive Family Function Modifies Stigmatizing Experience Effects on Disordered Eating

The effects of weight-stigmatizing experiences on disordered eating behaviors (DEBs) in adolescents were in part offset by positive parental and family factors. These findings, from a longitudinal study, were published in the Journal of Adolescent Health.

Investigators from the University of Minnesota collected data for this analysis as part of the Eating and Activity over Time (EAT) study which was a population-based, longitudinal study conducted between 2010 and 2018 in Minneapolis. Pupils (N=1568) from 20 public middle and high schools were surveyed in 2010 and 2018 about weight-stigmatizing experiences, DEBs, sociodemographic characteristics, and family factors.

The study comprised individuals with a mean age of 14.4±2.0 years, 53.1% were girls, the average BMI-for-age percentile was 69.2%±27.9%, 29.1% were Black, 19.9% were Asian American, 18.8% were White, and 39.4% had low and 22.2% low-middle socioeconomic status.

Overall, 26.6% endorsed experiencing peer weight teasing, 24.2% family weight teasing, and 41.6% hurtful weight-related comments from family. Compared with adolescents who did not have such weight-stigmatizing experiences, those who had stigmatizing experiences had higher BMI-for-age percentile (all P <.001) and those reporting family weight teasing or hurtful weight-related comments were more likely to be Asian American (both P <.001).

Using data from 2010, all stigmatizing experiences increased the risk for unhealthy weight control behaviors (adjusted prevalence ratio [aPR] range, 1.37-1.50; all P <.05), extreme weight control behaviors (aPR range, 1.77-2.16; all P <.05), overeating (aPR range, 1.84-2.98; all P <.05), and binge eating (aPR range, 1.81-3.81; all P <.05), in which the largest effects were observed for hurtful weight comments from family.

Using longitudinal data, unhealthy weight control behaviors were related with family weight teasing (aPR, 1.14; 95% CI, 1.03-1.25; P <.05) and hurtful weight comments from family (aPR, 1.14; 95% CI, 1.03-1.26; P <.05) and extreme weight control behaviors with family weight teasing (aPR, 1.35; 95% CI, 1.02-1.78; P <.05).

In a cross-sectional analysis, higher family functioning and support for psychologic autonomy were associated with a lower prevalence of DEBs, however, this trend was driven by adolescents who did not report weight stigma.

Fewer adolescents had unhealthy weight control behaviors if they had high compared with low family functioning and did not experience peer weight teasing (28.7% vs 40.0%; P <.001) or family weight teasing (28.4% vs 38.1%; P <.001) or if they had high compared with low support for psychologic autonomy and did not experience peer weight teasing (28.9% vs 41.9%; P <.001), family weight teasing (28.4% vs 40.4%; P <.001), or hurtful family weight comments (25.1% vs 34.4%; P =.002), respectively. Similar trends were observed for the outcome of extreme weight control behaviors, overeating, and binge eating.

The major limitation of this study was the reliance on self-reports.

Study authors concluded, “This study found that weight-stigmatizing experiences in adolescents were cross sectionally and longitudinally associated with higher prevalence of DEBs. Additionally, higher family functioning and parental support for psychologic autonomy were found to be protective for DEBs, but primarily in young people who did not experience weight stigma.”

This article originally appeared on Psychiatry Advisor