Next Article in Journal
Postprandial Triglycerides, Flow-Mediated Dilation, and the Inflammatory Cytokine Milieu in Metabolically Healthy Obesity: A Cross-Sectional Pilot Study
Next Article in Special Issue
The Relationship of Internalized Weight Bias to Weight Change in Treatment-Seeking Overweight Adults
Previous Article in Journal
Obesity and Ideal Cardiovascular Health: Results from the My Research Legacy Study
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Brief Report

Adverse Childhood Experiences Associated with Greater Internalization of Weight Stigma in Women with Excess Weight

1
Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA
2
Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA
3
Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3108, Philadelphia, PA 19104, USA
4
Department of Psychology, University of California, A623 Franz Hall, 501 Portola Plaza, Los Angeles, CA 90095, USA
*
Author to whom correspondence should be addressed.
Obesities 2021, 1(1), 49-57; https://doi.org/10.3390/Obesities1010005
Submission received: 23 April 2021 / Revised: 28 May 2021 / Accepted: 31 May 2021 / Published: 3 June 2021
(This article belongs to the Special Issue Weight Stigma: Experiences, Consequences, Causes and Remedies)

Abstract

:
Adverse childhood experiences (ACEs) may be an early life factor associated with adult weight stigma via biological (e.g., stress response), cognitive (e.g., self-criticism/deprecation), and/or emotional (e.g., shame) mechanisms. This pilot study investigated relationships between ACEs and internalized and experienced weight stigma in adult women with overweight/obesity and explored differential relationships between weight stigma and ACE subtypes (i.e., abuse, neglect, household dysfunction). Adult women (68% white, Mage = 33 ± 10 years, MBMI = 33.7 ± 7.2 kg/m2) completed measures of ACEs (ACE Questionnaire), internalized weight stigma (IWS; Weight Bias Internalization Scale—Modified; WBIS—M), and lifetime experiences of weight stigma (yes/no). Data were analyzed with linear and logistic regression (n = 46), adjusting for age, race, and body mass index (BMI). Linear regressions revealed a positive association between ACE and WBIS—M scores (β = 0.40, p = 0.006), which was driven by Abuse-type ACEs (β = 0.48, p = 0.009). Relationships between WBIS—M scores and Neglect- and Household-Dysfunction-type ACEs did not reach significance (β = 0.20, p = 0.173; β = −0.16, p = 0.273). Though descriptive statistics revealed greater rates of experienced weight stigma endorsement by those with high-3+ ACEs (81%) vs. medium-1–2 ACEs (67%) or low/no-0 ACEs (60%), ACE scores were not significantly associated with experienced weight stigma in logistic regression (Wald = 1.36, p = 0.244, OR = 1.324, 95%, CI = 0.825–2.125). ACEs may be an early life factor that increase the risk for internalizing weight stigma in adulthood. Larger studies should confirm this relationship and follow-up on descriptive findings suggesting a potential association between ACEs and experienced weight stigma.

1. Introduction

Weight stigma, or the “social devaluation and denigration of people who are perceived to carry excess weight [1]” is endemic to Western societies [2]. While weight stigma is often directly experienced, it also may be internalized (i.e., applied to oneself); internalized weight stigma (IWS) is characterized by self-devaluation based on weight [3]. Experiencing and internalizing weight stigma is associated with consequences to both physical health (i.e., poorer overall health, mortality risk) and psychological well-being (i.e., depression, body dissatisfaction) [1,4,5,6,7]. Given these highly detrimental effects, it is imperative to understand risk factors for both experiencing and internalizing weight stigma.
One such risk factor may be adverse childhood experiences (ACEs)—chronic and pervasive events that occur in childhood, including experiences of abuse, deprivation or neglect, and household dysfunction [8]. The chronic stress of ACEs has been consistently related to biological changes which increase appetite and visceral fat accumulation, and ACEs are a well-established risk factor for both the development of adult obesity and for increasing severity of adult obesity levels [9,10]. Thus, these factors may put individuals with ACEs at risk for experiencing more weight stigma [11]. Furthermore, ACEs—and particularly experiences of childhood abuse—are linked to attention biases for threatening information [12], which could impact how individuals identify and perceive stigmatizing experiences when they are encountered. In other words, ACEs history may increase the likelihood that an individual will recognize instances of discriminatory or unfair weight-based treatment and identify them as stigmatizing. Still further, like weight stigma, ACEs are linked to the use of unhelpful coping strategies specific to eating (e.g., binge eating) and negative cognitive and emotional patterns, such as tendencies toward self-criticism and shame [10,13,14,15,16,17]. As self-criticism and shame center on negative self-evaluation, they are closely related to devaluing oneself based on weight or IWS [18,19,20,21]. Therefore, a proposed negative cycle may develop in which individuals experiencing ACEs are more likely to have greater obesity and consequent risk for experienced weight stigma. They may also be more likely to identify these stigmatizing experiences and to engage in maladaptive, obesogenic coping behaviors when under stress. Maladaptive coping responses and/or other’s criticisms may intersect with a tendency toward self-critical thoughts and feelings of shame, which may manifest as IWS, further exacerbate stress levels, and lead to continued maladaptive coping strategies and potential weight gain. Importantly, in this cycle, the development of IWS can be independent of both objective obesity and experienced weight stigma, as IWS is driven by self-perceived weight and self-application of weight-based stereotypes, and, therefore, can occur in the absence of excess weight and/or experienced weight stigma.
The hypotheses inherent to this cyclical model have not yet been tested, but preliminary evidence supports the proposed associations between ACEs and weight stigma. A small number of studies have identified a link between ACEs—and/or childhood maltreatment more generally—and weight stigma in adulthood [18,19,22]. Udo and Grilo [22] found that women with a history of childhood maltreatment (i.e., abuse or neglect) were more likely to report experiencing weight-based discrimination in the past year, and Braun et al. [18,19] observed positive correlations between ACEs and both experienced and internalized weight stigma in bariatric surgery patients. However, no study to date has investigated whether ACEs are robustly associated with IWS in broader populations or after considering related covariates (e.g., BMI). Understanding whether or not objective obesity level impacts the relationship between ACEs and weight stigma is important because—as mentioned above—many negative effects of weight stigma are linked to one’s self-perceived weight status and can occur in the absence of objectively measured overweight/obese BMI [23].
It is additionally unknown whether there may be differential associations of ACE types (i.e., abuse, neglect, household dysfunction) with weight stigma, as there is some evidence of abuse and neglect-type ACEs being more detrimental than household dysfunction for adult outcomes [24]. For instance, there is a more robust literature linking childhood abuse to feelings of shame in adulthood compared to the other ACE subtypes [25,26,27,28,29]. This evidence base may implicate pathways that contribute to the proposed relationship between ACEs and IWS by way of abuse leading to self-deprecation or negative self/body image.
The current pilot study takes initial steps in filling these gaps regarding the ACEs–weight stigma relationship by providing a preliminary investigation of the following two aims: (1) to explore whether a history of ACEs is associated with internalization of weight stigma, and (2) to explore whether a history of ACEs is associated with lifetime experiences of weight stigma. Secondary objectives include exploring potential differential associations of ACE types (e.g., abuse, neglect, household dysfunction) on internalized or experienced weight stigma.

2. Materials and Methods

2.1. Participants

Participants were adult women with overweight/obesity enrolled in the Neurotrophic Indicators of Cognition, Executive Skills, Plasticity, and Adverse Childhood Experiences Study (NICE SPACES), a pilot project examining weight, neurocognitive health, and stress reactivity in women with and without a history of ACEs (ClinicalTrials.gov, accessed on 2 June 2021, Identifier: NCT04076722). The primary aims of NICE SPACES were to assess the roles of brain health and ACEs in stress reactivity among women with excess adiposity. Participants were recruited from the university campus and surrounding community via email and social media. Participants with high (3+) and low/no (0) ACEs were preferentially recruited to increase ACEs variability, but individuals of all ACE levels were enrolled in the study, including “medium” ACE levels (1–2 ACEs). Eligibility criteria relevant to the current project include the following: (1) BMI ≥ 25 kg/m2, (2) English-speaking, (3) no use of weight-loss medications in the past 3 months, (4) no history of bariatric surgery, (5) not currently pregnant or breastfeeding, (6) not currently enrolled in a weight-loss program, and (7) no significant medical or psychiatric comorbidities.

2.2. Measures

2.2.1. Adverse Childhood Experiences (ACEs)

An expanded version of the Adverse Childhood Experiences Questionnaire was used to assess the occurrence of ACEs prior to participants’ eighteenth birthday [8,30]. This ACE Questionnaire assesses for the 10 traumatic childhood events identified by Felitti and colleagues [8] (i.e., physical, emotional, or sexual abuse (Abuse-type ACEs); emotional or physical neglect (Neglect-type ACEs); parental separation/divorce; parental domestic violence; parental incarceration; drug or alcohol use in the household; or mental illness or attempted suicide in the household (Household Dysfunction-type ACEs)) with 17 yes/no questions, resulting in possible total scores ranging from 0–17. This expanded, 17-item measure allows for a more nuanced assessment of the standard 10 ACEs. For example, the traditional questionnaire assesses for emotional abuse with one item asking, “Did a parent or other adult in the household often or very often push grab, slap, or throw something at you? Or ever hit you so hard that you had marks or were injured?” whereas the 17-item measure breaks this into two questions: “Did a parent or other adult in the household often push, grab, slap, or throw something at you?” and “Did a parent or other adult in the household ever hit you so hard that you had marks or were injured?” Additionally, unique effects of the three subtypes of ACEs (i.e., abuse, neglect, household dysfunction) [31] were explored. A list of the expanded ACEs Questionnaire items and their groupings into subscales can be found in Supplementary Materials: Table S1.

2.2.2. Internalized Weight Stigma (IWS)

The Weight Bias Internalization Scale—Modified (WBIS—M) was used to measure IWS [32,33]. The WBIS—M consists of 11 items that measure the extent to which individuals apply negative stereotypes to and devalue themselves because of their weight (e.g., “My weight is a major way that I judge my value as a person”). Response options range from 1 (Strongly Disagree) to 7 (Strongly Agree), and scores are represented by a mean of all responses. Higher average scores are indicative of greater internalization of weight stigma. In the current study, the WBIS—M displayed good reliability (α = 0.85), similar to the findings of the original validation sample (α = 0.94) [32].

2.2.3. Experienced Weight Stigma

To assess whether participants had ever experienced weight stigma, questions were adapted from Puhl, Luedicke, and Heuer (2011) [34]. In a series of three questions, participants were asked to indicate (yes/no) if they had ever been teased, treated unfairly, or discriminated against because of their weight. Responses of “yes” were coded as 1 and responses of “no” were coded as 0. Paralleling previous literature, a dichotomous measure of whether participants had ever experienced weight stigma was calculated as 1 (“yes” on at least one of the three items) or 0 (“no” to all three items) [35,36].

2.2.4. Covariates

Measured BMI and demographic variables (i.e., age, race) were included as covariates. BMI was calculated as kg/m2 from height and weight measured using a research-grade TANITA body composition analyzer. Demographic factors were collected via an online self-report questionnaire. Race was coded as follows: 1 = American Indian/Alaska Native, 2 = Asian, 3 = Native Hawaiian or Other Pacific Islander, 4 = Non-Hispanic Black or African American, 5 = Non-Hispanic White, 6 = White—Hispanic, 7 = Multiracial. Due to insufficient representation in each group, racial categories were dummy coded as 0 = historically oppressed/marginalized racial group and 1 = non-Hispanic white for analyses.

2.3. Procedure

All participants completed an online pre-screener survey in order to qualify for the study. Following enrollment, participants completed an at-home online survey and a 3 h in-lab assessment and were compensated 60 USD. ACEs, demographic variables, IWS, and lifetime-experienced weight stigma were assessed via online surveys. BMI was measured in-lab by a trained research assistant. All procedures were approved by the university’s IRB and adhered to APA ethical guidelines. Participants provided informed consent prior to study initiation.

2.4. Data Analysis Plan

All data were verified and checked for normality prior to analyses. Study aims were analyzed using linear or logistic regression. ACE subtype scores were entered simultaneously into regression models and multicollinearity checks (tolerance > 0.1, VIF < 10) were conducted to ensure the appropriateness of each model. Covariates in all analyses were age, race, and BMI; any non-significant covariates were retained in final models due to theoretical justification for their inclusion. All analyses were conducted in SPSS Version 25.

3. Results

3.1. Participant Characteristics

A total of 53 women (68% white, Mage = 33 ± 10 years) enrolled in the study. All women had a measured BMI in the overweight or obese range (≥25.0 kg/m2, MBMI = 33.7 ± 7.2 kg/m2). Among these participants, 51 responded to the ACE questionnaire: 11 (22%) endorsed 0 ACEs, 17 (33%) endorsed 1 or 2 ACEs, and 23 (45%) endorsed 3 or more ACEs. In the full sample, the most commonly endorsed ACE type was household dysfunction (60.4%), followed by abuse (52.8%) and neglect (34.0%). An additional five participants were excluded from analyses due to missing data on other key variables. Therefore, 46 participants were included in the analyzed sample. Table 1 includes participant characteristics for the full sample and by ACE group status.

3.2. Aim 1: Internalized Weight Stigma

3.2.1. Total ACE Score

Linear regression was used to analyze whether ACEs total score was associated with IWS, as measured by WBIS—M scores, after adjusting for covariates. The overall Step 2 model (including ACEs and covariates) was significant (F(4, 44) = 4.40, p = 0.005, R2 = 0.305). Having a higher number of ACEs was significantly associated with higher WBIS—M scores (β = 0.40, p = 0.006), and ACE score explained 14.6% of the variance in WBIS—M scores. Of the three covariates, only age was found to be significantly associated with WBIS—M scores (β = 0.37, p = 0.008), suggesting that younger individuals report a greater degree of IWS (see Table 2).

3.2.2. ACE Type Subscale Scores

A second linear regression was conducted to explore differential relationships between ACE-type subscales and IWS, as measured by WBIS—M scores. Multicollinearity checks confirmed the appropriateness of simultaneously including ACE-type subscales in a single model. Results indicated that the overall Step 2 model (including ACE types and covariates) was significant (F(6, 44) = 4.66, p = 0.001, R2 = 0.424). Altogether, the three ACE-type subscales explained 26.5% of the variance in WBIS—M scores. However, the Abuse subscale was the only ACE type to be uniquely and significantly associated with WBIS—M scores (β = 0.48, p = 0.009). Associations between WBIS—M scores and Neglect (β = 0.20, p = 0.173) or Household Dysfunction (β = −0.16, p = 0.273) did not reach significance. Younger age was associated with higher WBIS—M scores (β = −0.41, p = 0.003); neither race nor BMI displayed a significant relationship with WBIS—M scores. These results indicate that individuals who experience abuse-type ACEs and younger individuals reported higher levels of IWS (see Table 2).

3.3. Aim 2: Experienced Weight Stigma

3.3.1. Total ACE Score

To examine the association between ACEs history and experienced weight stigma, we conducted a logistic regression with whether or not an individual had ever experienced weight stigma (yes/no) as the dependent variable. Specifically, we evaluated if the total number of ACEs was associated with the odds of experiencing weight stigma, adjusting for age, race, and BMI. The overall Block 2 model (including ACEs and covariates) was significant (χ2(4) = 16.55, p = 0.002), although ACE score was not a significant predictor (Wald = 1.36, p = 0.244). That is, a higher ACE score was not associated with greater odds of experiencing weight stigma (OR = 1.324, 95%CI = 0.825–2.125). However, a descriptive pattern did emerge such that reported rates of lifetime experienced weight stigma were higher in those with high-3+ ACEs (81%) versus medium—1–2 ACEs (67%) or low/no-0 ACEs (60%) (see Table 1).

3.3.2. ACE Type Subscale Scores

An analogous logistic regression analysis was conducted to evaluate whether ACE-type subscale scores predicted the likelihood of experiencing weight stigma. Multicollinearity checks confirmed the appropriateness of simultaneously including ACE-type subscales in a single model. Logistic regression results indicated that although the overall Block 2 model (including ACE types and covariates) was significant (χ2(6) = 17.23, p = 0.008), no ACE types were significantly associated with experienced weight stigma. Specifically, Wald statistics for the three ACE type subscales were as follows: Abuse (Wald = 0.03, p = 0.854), Neglect (Wald = 0.85, p = 0.356), and Household Dysfunction (Wald = 1.11, p = 0.293). Therefore, neither Abuse (OR = 0.913, 95%CI = 0.346–2.405), Neglect (OR = 1.965, 95%CI = 0.469–8.239), nor Household Dysfunction (OR = 1.526, 95%CI = 0.694–3.356) was associated with the odds that an individual had ever experienced weight stigma.

4. Discussion

In a pilot sample of women with overweight/obesity, having a higher number of ACEs was associated with greater endorsement of internalized weight stigma (IWS). The relationship between ACEs and IWS was driven predominantly by experiences of abuse. Though associations between childhood adversity and the internalization of weight stigma have not been thoroughly investigated, previous positive bivariate correlations between ACEs and IWS have been observed [18,19]. The current study replicates and extends these findings by observing that ACEs are predictive of IWS after adjustment for age, race, and BMI. This study also adds to the evidence by showing that ACEs subtypes are differentially associated with IWS, with abuse potentially driving the ACEs–IWS relationship. Childhood physical, sexual, or emotional abuse often includes pervasive and unpredictable exposure to an acute stressor, which may result in more toxic stress and increased allostatic load, as well as having particular impacts on cognitive and emotional patterns (e.g., tendencies toward self-deprecation and shame), as compared to the other ACE types [12,37]. A post hoc sensitivity analysis exploring differences between abuse types (i.e., emotional, sexual, physical) revealed differences such that emotional and sexual abuse were significantly associated with greater IWS (βs = 0.380, 0.318; ps < 0.05), whereas physical abuse was not (β = 0.031, p = 0.85) Additional research on the unique effects of each individual ACE and their pathways to adverse outcomes for health and well-being throughout life is warranted.
The observed association between ACEs and IWS provides preliminary support for the theorized cycle between ACEs, negative cognitive/emotional responses related to shame/self-deprecation, and IWS. Based on this cycle, self-critical thoughts and feelings of shame may be potential mechanisms between ACEs and IWS that warrant further investigation. Emerging evidence has identified shame and (lack of) self-compassion as factors that may mediate relationships between IWS and negative outcomes (e.g., emotional eating, depression, anxiety), and negative self-evaluation has been proposed as a critical maintaining factor in IWS [13,14,18,19,20]. Therefore, after confirming these mechanisms with additional research, targeting these negative cognitive and affective patterns that can develop after experiencing ACEs may be a particularly important point of intervention for reducing the impact of early life adversity on IWS. Additionally, minimizing IWS for persons with a history of ACEs is imperative for promoting their long-term health and well-being. As some experts have suggested that IWS itself may be a chronic stressor [38], evidence-based stress-reduction techniques such as mindfulness and mindfulness-based therapies could be of particular relevance.
Of note, this pilot study did not observe significant relationships between ACEs and lifetime weight stigma experiences. This null finding contrasts previous investigations documenting associations between childhood adversity and greater self-reported frequency of experienced weight stigma [18,19,22]. Potential reasons for this discrepancy include limited power and methodological differences compared to previous investigations (e.g., childhood maltreatment vs. ACEs assessment, past-year weight discrimination vs. lifetime weight stigma experiences). Of note, at the descriptive level, greater rates of experienced weight stigma were endorsed by those with high-3+ ACEs (81%) vs. medium-1–2 ACEs (67%), or low/no-0 ACEs (60%), which suggests that additional investigations in larger samples are warranted.
Additional limitations that warrant follow-up include a relatively homogenous sample (i.e., adult, primarily white, treatment-seeking women with overweight/obesity), which limits generalizability to the larger population (e.g., adolescents and young adults, marginalized individuals). Further, with a small pilot sample, the current study is vulnerable to restriction of range in addition to lack of power. Over two-thirds (71%) of the sample endorsed ever experiencing weight stigma, and this limited variability may have further exacerbated difficulties achieving sufficient power to detect a significant effect of ACEs history on weight-stigma experiences. However, these preliminary results justify future, larger-scale studies with the resources to recruit larger, more diverse samples to more thoroughly investigate relationships between early life stressors, such as ACEs, and weight stigma.
In sum, the current study was a pilot investigation of ACEs and weight stigma in adult women with overweight/obesity. Experiencing a greater number of ACEs in childhood was associated with internalizing weight stigma to a greater degree in adulthood. This finding highlights childhood adversity as an early life factor that may contribute to internalized weight stigma in adulthood. Future research should confirm these relationships and identify mechanisms between experiences of adversity in childhood and adult experiences and the internalization of weight stigma.

Supplementary Materials

The following are available online at https://www.mdpi.com/article/10.3390/Obesities1010005/s1, Table S1: Adverse Childhood Experiences Questionnaire Subscale Items.

Author Contributions

Conceptualization, N.G.K., J.A.K., A.J.T. and M.A.W.H.; Methodology, N.G.K. and M.A.W.H.; Formal Analysis, N.G.K.; Investigation, N.G.K., C.E.T., S.A., H.M.L. and M.A.W.H.; Resources, M.A.W.H.; Data Curation, N.G.K.; Visualization, N.G.K.; Writing—Original Draft Preparation, N.G.K., C.E.T., S.A. and H.M.L.; Writing—Review and Editing, N.G.K., C.E.T., S.A., H.M.L., J.A.K., R.L.P., A.J.T. and M.A.W.H.; Supervision, J.A.K., R.L.P., A.J.T. and M.A.W.H.; Project Administration, N.G.K. and M.A.W.H.; Funding Acquisition, N.G.K. and M.A.W.H.; Software, N/A; Validation, N/A. All authors have read and agreed to the published version of the manuscript.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this work was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health [F31HL152620, K23HL140176]; the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health [K23DK103941]; and by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health [P20GM109097].

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of Oklahoma State University (IRB# AS-19–65, approved 06–18–2019).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Data are not publicly available but interested parties may contact the corresponding author for inquiries.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Tomiyama, A.J. Weight stigma is stressful. A review of evidence for the Cyclic Obesity/Weight-Based Stigma model. Appetite 2014, 82, 8–15. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  2. Rubino, F.; Puhl, R.M.; Cummings, D.E.; Eckel, R.H.; Ryan, D.; Mechanick, J.I.; Nadglowski, J.; Salas, X.R.; Schauer, P.R.; Twenefour, D.; et al. Joint international consensus statement for ending stigma of obesity. Nat. Med. 2020, 26, 485–497. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  3. Puhl, R.M.; Himmelstein, M.S.; Quinn, D.M. Internalizing Weight Stigma: Prevalence and Sociodemographic Considerations in US Adults. Obesity 2018, 26, 167–175. [Google Scholar] [CrossRef] [Green Version]
  4. Hunger, J.M.; Major, B. Weight stigma mediates the association between BMI and self-reported health. Health Psychol. 2015, 34, 172–175. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  5. Hunger, J.M.; Major, B.; Blodorn, A.; Miller, C.T. Weighed Down by Stigma: How Weight-Based Social Identity Threat Contributes to Weight Gain and Poor Health. Soc. Pers. Psychol. Compass 2015, 9, 255–268. [Google Scholar] [CrossRef] [Green Version]
  6. Puhl, R.M.; Heuer, C.A. The Stigma of Obesity: A Review and Update. Obesity 2009, 17, 941–964. [Google Scholar] [CrossRef] [PubMed]
  7. Pearl, R.L.; Puhl, R.M. Weight bias internalization and health: A systematic review. Obes. Rev. 2018, 19, 1141–1163. [Google Scholar] [CrossRef] [Green Version]
  8. Felitti, V.J.; Anda, R.F.; Nordenberg, D.; Williamson, D.F.; Spitz, A.M.; Edwards, V.; Koss, M.P.; Marks, J.S. Reprint of: Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. Am. J. Prev. Med. 2019, 56, 774–786. [Google Scholar] [CrossRef]
  9. Berens, A.E.; Jensen, S.K.G.; Nelson, C.A. Biological embedding of childhood adversity: From physiological mechanisms to clinical implications. BMC Med. 2017, 15, 1–12. [Google Scholar] [CrossRef]
  10. Palmisano, G.L.; Innamorati, M.; Vanderlinden, J. Life adverse experiences in relation with obesity and binge eating disorder: A systematic review. J. Behav. Addict. 2016, 5, 11–31. [Google Scholar] [CrossRef] [Green Version]
  11. Puhl, R.M.; Andreyeva, T.; Brownell, K.D. Perceptions of weight discrimination: Prevalence and comparison to race and gender discrimination in America. Int. J. Obes. 2008, 32, 992–1000. [Google Scholar] [CrossRef] [Green Version]
  12. McLaughlin, K.A.; Sheridan, M.A.; Lambert, H.K. Childhood adversity and neural development: Deprivation and threat as distinct dimensions of early experience. Neurosci. Biobehav. Rev. 2014, 47, 578–591. [Google Scholar] [CrossRef] [Green Version]
  13. Sachs-Ericsson, N.; Verona, E.; Joiner, T.; Preacher, K.J. Parental verbal abuse and the mediating role of self-criticism in adult internalizing disorders. J. Affect. Disord. 2006, 93, 71–78. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  14. Ratcliffe, D.; Ellison, N. Obesity and Internalized Weight Stigma: A Formulation Model for an Emerging Psychological Problem. Behav. Cogn. Psychother. 2013, 43, 239–252. [Google Scholar] [CrossRef]
  15. Hankin, B.L.; Snyder, H.R.; Gulley, L.D.; Schweizer, T.H.; Bijttebier, P.; Nelis, S.; Toh, G.; Vasey, M. Understanding comorbidity among internalizing problems: Integrating latent structural models of psychopathology and risk mechanisms. Dev. Psychopathol. 2016, 28, 987–1012. [Google Scholar] [CrossRef]
  16. Thomson, P.; Jaque, S.V. History of childhood adversity and coping strategies: Positive flow and creative experiences. Child Abus. Negl. 2019, 90, 185–192. [Google Scholar] [CrossRef] [PubMed]
  17. Wojcik, K.D.; Cox, D.W.; Kealy, D. Adverse childhood experiences and shame- and guilt-proneness: Examining the mediating roles of interpersonal problems in a community sample. Child Abus. Negl. 2019, 98, 104233. [Google Scholar] [CrossRef] [PubMed]
  18. Braun, T.D.; Quinn, D.M.; Stone, A.; Gorin, A.A.; Ferrand, J.; Puhl, R.M.; Sierra, J.; Tishler, D.; Papasavas, P. Weight Bias, Shame, and Self-Compassion: Risk/Protective Mechanisms of Depression and Anxiety in Prebariatic Surgery Patients. Obesity 2020, 28, 1974–1983. [Google Scholar] [CrossRef]
  19. Braun, T.D.; Gorin, A.A.; Puhl, R.M.; Stone, A.; Quinn, D.M.; Ferrand, J.; Abrantes, A.M.; Unick, J.; Tishler, D.; Papasavas, P. Shame and Self-compassion as Risk and Protective Mechanisms of the Internalized Weight Bias and Emotional Eating Link in Individuals Seeking Bariatric Surgery. Obes. Surg. 2021, 1–11. [Google Scholar] [CrossRef]
  20. Fekete, E.M.; Herndier, R.E.; Sander, A.C. Self-Compassion, Internalized Weight Stigma, Psychological Well-Being, and Eating Behaviors in Women. Mindfulness 2021, 12, 1–10. [Google Scholar] [CrossRef]
  21. Blum, A. Shame and guilt, misconceptions and controversies: A critical review of the literature. Traumatology 2008, 14, 91–102. [Google Scholar] [CrossRef]
  22. Udo, T.; Grilo, C.M. Perceived weight discrimination, childhood maltreatment, and weight gain in U.S. adults with overweight/obesity. Obesity 2016, 24, 1366–1372. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  23. Major, B.; Hunger, J.M.; Bunyan, D.P.; Miller, C.T. The ironic effects of weight stigma. J. Exp. Soc. Psychol. 2014, 51, 74–80. [Google Scholar] [CrossRef]
  24. Atzl, V.M.; Narayan, A.J.; Rivera, L.M.; Lieberman, A.F. Adverse childhood experiences and prenatal mental health: Type of ACEs and age of maltreatment onset. J. Fam. Psychol. 2019, 33, 304–314. [Google Scholar] [CrossRef] [PubMed]
  25. Feiring, C.; Taska, L.S. The Persistence of Shame Following Sexual Abuse: A Longitudinal Look at Risk and Recovery. Child Maltreatment 2005, 10, 337–349. [Google Scholar] [CrossRef] [PubMed]
  26. Dorahy, M.J.; Clearwater, K. Shame and Guilt in Men Exposed to Childhood Sexual Abuse: A Qualitative Investigation. J. Child Sex. Abus. 2012, 21, 155–175. [Google Scholar] [CrossRef] [PubMed]
  27. Davis, J.L.; Petretic-Jackson, P.A. The impact of child sexual abuse on adult interpersonal functioning: A review and synthesis of the empirical literature. Aggress. Violent Behav. 2000, 5, 291–328. [Google Scholar] [CrossRef]
  28. Thomson, P.; Jaque, S.V. Shame and Anxiety: The Mediating Role of Childhood Adversity in Dancers. J. Dance Med. Sci. 2018, 22, 100–108. [Google Scholar] [CrossRef] [PubMed]
  29. Reid, J. The imprint of childhood abuse on trauma-related shame in adulthood. Dign. J. Sex. Exploit. Violence 2018, 3. [Google Scholar] [CrossRef] [Green Version]
  30. McLennan, J.D.; MacMillan, H.L.; Afifi, T.O. Questioning the use of adverse childhood experiences (ACEs) questionnaires. Child Abus. Negl. 2020, 101, 104331. [Google Scholar] [CrossRef]
  31. Von Cheong, E.; Sinnott, C.; Dahly, D.; Kearney, P.M. Adverse childhood experiences (ACEs) and later-life depression: Perceived social support as a potential protective factor. BMJ Open 2017, 7, e013228. [Google Scholar] [CrossRef] [PubMed]
  32. Pearl, R.L.; Puhl, R.M. Measuring internalized weight attitudes across body weight categories: Validation of the Modified Weight Bias Internalization Scale. Body Image 2014, 11, 89–92. [Google Scholar] [CrossRef] [PubMed]
  33. Durso, L.E.; Latner, J.D. Understanding Self-directed Stigma: Development of the Weight Bias Internalization Scale. Obesity 2008, 16, S80–S86. [Google Scholar] [CrossRef]
  34. Puhl, R.M.; Luedicke, J.; Heuer, C. Weight-Based Victimization Toward Overweight Adolescents: Observations and Reactions of Peers. J. Sch. Health 2011, 81, 696–703. [Google Scholar] [CrossRef]
  35. Puhl, R.M.; Heuer, C.; Sarda, V. Framing messages about weight discrimination: Impact on public support for legislation. Int. J. Obes. 2010, 35, 863–872. [Google Scholar] [CrossRef] [PubMed]
  36. Pearl, R.L.; Dovidio, J.F. Experiencing Weight Bias in an Unjust World: Impact on Exercise and Internalization. Health Psychol. 2015, 34, 741–749. [Google Scholar] [CrossRef]
  37. Racine, N.M.; Madigan, S.L.; Plamondon, A.R.; McDonald, S.W.; Tough, S.C. Differential Associations of Adverse Childhood Experience on Maternal Health. Am. J. Prev. Med. 2018, 54, 368–375. [Google Scholar] [CrossRef]
  38. Pearl, R.L.; Wadden, T.A.; Hopkins, C.M.; Shaw, J.A.; Hayes, M.R.; Bakizada, Z.M.; Alfaris, N.; Chao, A.M.; Pinkasavage, E.; Berkowitz, R.I.; et al. Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity. Obesity 2017, 25, 317–322. [Google Scholar] [CrossRef]
Table 1. Participant characteristics for the full sample and by ACE status.
Table 1. Participant characteristics for the full sample and by ACE status.
ACE Status a
Total Sample
(N = 53)
Low/No
0 ACE
(n = 11)
Medium
1–2 ACE
(n = 17)
High
3+ ACE
(n = 23)
pb
M ± SD or n (%)
Demographic Factors & Covariates
Age (years)33.19 ± 10.033.18 ± 11.229.94 ± 8.333.74 ± 10.10.314
BMI (kg/m2)33.70 ± 7.232.35 ± 7.334.93 ± 7.932.89 ± 5.90.563
Race/Ethnicity 0.198
  Non-Hispanic white36 (67.9)10 (90.9)12 (70.6)14 (60.9)
  Historically marginalized/
  oppressed racial group
17 (32.1)1 (9.1)5 (29.4)9 (39.1)
Key Study Variables
WBIS—M (1–7)4.59 ± 0.94.11 ± 1.04.49 ± 0.94.83 ± 0.90.108
Experienced Weight Stigma (Y/N)34 (70.8)6 (60.0)10 (66.7)17 (81.0)0.417
ACE Questionnaire Total Score (0–17)2.90 ± 2.9--1.50 ± 0.75.26 ± 2.5-
ACE Subtype Frequency
  Abuse28 (52.8)--9 (52.9)19 (82.6)0.072
  Neglect18 (34.0)--2 (11.8)15 (65.2)0.001 *
  Household Dysfunction32 (60.4)--9 (52.9)22 (95.7)0.001 *
Note. Continuous variables are presented as M(SD). Categorical variables presented as n(%). a Based on collapsed 10-item ACE scores. b p represents differences between ACE status based on a one-way ANOVA for continuous variables and a Chi-square for categorical variables. Only those with Medium and High ACEs were included in Chi-squares for ACE subtypes. * Significant at p < 0.05. trending toward significance at p < 0.15. ACE = Adverse Childhood Experiences. WBIS—M = Weight Bias Internalized Scale—Modified.
Table 2. Associations of adverse childhood experiences with internalized weight stigma.
Table 2. Associations of adverse childhood experiences with internalized weight stigma.
Model 1a
Total ACEs Predicting
WBIS—M Scores
(n = 46)
Model 1b
ACE-Type Subscales Predicting WBIS—M Scores
(n = 46)
R2ΔR2R2ΔR2
Step 1 0.159--0.159--
Step 20.3050.146 *0.4240.265 *
βpβp
Age−0.373 *0.008−0.407 *0.003
Race/Ethnicity 0.1810.1900.2520.059
BMI0.2180.10600.1660.191
Total ACE Questionnaire Score0.399 *0.006--
ACEs—Abuse--0.477 *0.009
ACEs—Neglect--0.2030.173
ACEs—Household Dysfunction--−0.1610.273
Note: * p < 0.05; Only covariates (age, race/ethnicity, BMI) were entered on Step 1. For parsimony, specific beta coefficients of covariates are only presented for Step 2; 0 = oppressed/marginalized racial group, 1 = non-Hispanic white; ACE = adverse childhood experience; ACEs—Abuse = emotional, physical, or sexual abuse subscale score; ACEs—Neglect = emotional or physical neglect subscale score; ACEs—Household Dysfunction = mother treated violently, substance abuse, or mental illness in the household, parental separation or divorce, or incarcerated household member subscale score; BMI = body mass index; WBIS—M = Weight Bias Internalization Scale—modified.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Keirns, N.G.; Tsotsoros, C.E.; Addante, S.; Layman, H.M.; Krems, J.A.; Pearl, R.L.; Tomiyama, A.J.; Hawkins, M.A.W. Adverse Childhood Experiences Associated with Greater Internalization of Weight Stigma in Women with Excess Weight. Obesities 2021, 1, 49-57. https://doi.org/10.3390/Obesities1010005

AMA Style

Keirns NG, Tsotsoros CE, Addante S, Layman HM, Krems JA, Pearl RL, Tomiyama AJ, Hawkins MAW. Adverse Childhood Experiences Associated with Greater Internalization of Weight Stigma in Women with Excess Weight. Obesities. 2021; 1(1):49-57. https://doi.org/10.3390/Obesities1010005

Chicago/Turabian Style

Keirns, Natalie G., Cindy E. Tsotsoros, Samantha Addante, Harley M. Layman, Jaimie Arona Krems, Rebecca L. Pearl, A. Janet Tomiyama, and Misty A.W. Hawkins. 2021. "Adverse Childhood Experiences Associated with Greater Internalization of Weight Stigma in Women with Excess Weight" Obesities 1, no. 1: 49-57. https://doi.org/10.3390/Obesities1010005

Article Metrics

Back to TopTop