Food addiction and psychological distress may mediate the relationship between weight-related self-stigma and binge eating in adolescents, according to study data published in the International Journal of Eating Disorders. However, weight-related self-stigma had a no direct effect on binge eating.

Investigators conducted a survey of adolescents attending high school in Qazvin, Iran between September 2018 and May 2019. Eligible participants had an overweight or obese body mass index exceeding the 85th percentile range for their age and gender. The investigators captured demographic data and weight-related self-stigma with the Weight Bias Internalization Scale. After 3 and 6 months, participants completed the Depression, Anxiety, and Stress Scale-21 and the Yale Food Addiction Scale for Children, and the Binge Eating Scale, respectively.

In the final study cohort (N=1497; mean age, 15.1±6.0 years; 45.7% boys), self-stigma, psychological symptoms, food addiction, and binge eating behaviors were significantly correlated over time (all P <.01; Pearson’s r range, 0.10-0.27). Mediation analyses identified food addiction (unstandardized coefficient [UC], 0.38; 95% CI, 0.26-0.52) and psychological distress (UC, 0.20; 95% CI, 0.10-0.31) as significant mediators of the association between weight-related self-stigma and binge eating. In addition, significant direct effects of weight-related self-stigma were observed on psychological distress (UC, 1.58; P <.001) and food addiction (UC, 0.33; P <.001), but not binge eating. The total effect of weight-related self-stigma on binge eating was significant (UC, 0.75; P <.001).

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The study, although limited by generalizability and reliance on self-report data, underscores the complexity of the relationship between self-stigma and binge eating behaviors. The investigators suggested that “healthcare professionals may explore the management of binge eating among adolescents by designing interventions that help to reduce their weight-related self-stigma, food addiction, and psychological distress. Effective psychoeducational programs can be developed and implemented to help inform adolescents about binge eating and the role of stigma in influencing it.”


Ahorsu DK, Lin CY, Imani V, et al. A prospective study on the link between weight-related self-stigma and binge eating: role of food addiction and psychological distress [published online January 6, 2020]. Int J Eat Disord. doi:10.1002/eat.23219