Internalized Weight Stigma and Binge-Eating Disorder

INTERNALIZED WEIGHT STIGMA AND BINGE-EATING DISORDER

Internalized weight stigma occurs when a person, applying social negative weight stereotypes to themselves, has negative beliefs about themselves for perceiving having a high weight and other reactions. Patients with internalized weight stigma believe that "they are lazy," "they don't have willpower in controlling eating and weight," "they lack in self-discipline," "they do not have self-control," "they feel like a failure," or "others think they are fat because they lack in self-discipline and willpower."

People with internalized weight stigma have frequent negative emotions that are often managed with binge-eating episodes, overeating, and dysregulated eating (Fig .1), common eating patterns in those who suffer from binge-eating disorders. Indeed, high levels of internalized weight stigma seem to influence the variance of eating disorder psychopathology beyond the contributions of fatphobia, depression, and self-esteem in patients with binge-eating disorder. At the same time, the associated low self-efficacy can lead to avoiding the treatment for fear of failing to control eating and weight.

IDENTIFYING THE PRESENCE OF INTERNALIZED

WEIGHT STIGMA

Some psychological processes of internalized weight stigma are similar to those operating on low self-esteem. However, they are determined and reinforced by the pervasive weight stigma present in our society that disparages individuals with higher weight.

Internalized weight stigma is characterized by a stable unconditional negative view of self and selfworth for perceiving to have a higher weight and by negative comparisons with others who are without higher weight. Other features are the presence of pronounced cognitive processing biases, extreme rules related to the control of eating and weight goals, and the belief that it is impossible to control eating, which undermines the treatment of binge-eating disorder.

How to address weight stigma

Addressing internalized weight stigma and binge eating is not easy and it is advisable to seek help from a therapist. Below are described some strategies that can be used. internalized

LEARNING ABOUT WEIGHT REGULATION

AND BINGE EATING

It is fundamental to know that people with higher weight are often the target of denigration and prejudice and have become part of a socially devalued group (weight stigma). This happens because, in our society, individuals with a higher weight tend to be (falsely) considered lazy, unattractive, lacking willpower and self-discipline, and being responsible for their condition. These stereotypes and/or prejudices are based on ignorance, as research has demonstrated that body weight and eating are regulated by a complex combination of genetic and environmental factors and that weight is only in part under the control of the individual.

CREATING THE PERSONAL FORMULATION

The personal formulation is a visual representation (a diagram) of the processes that maintain the internalized stigma and its relationship to binge eating episodes. It should be done collaboratively with a therapist and include the factors that need to be addressed during the treatment (it is considered the road map of the treatment).

ARRIVING AT A BALANCED VIEW OF SELFWORTH

The final step in addressing internalized weight stigma is to accept a more balanced (i.e., less negative) view of themselves. The goal is to arrive at a more realistic appraisal of one's qualities. For example, the judgment "I am weak because I don't lose weight" may be questioned by reviewing times when one has been strong, especially when it would be acceptable or understandable not to be strong (e.g., in following a strict diet). While such a re-appraisal might lead to identifying areas where one would still like to make changes, this does not warrant the conclusion that one is "weak."

This type of re-appraisal should include the notion of "acceptance" and the idea that a balance needs to be struck between "acceptance" and "change." One can change aspects of life (e.g., how one eats within certain limits) However, there are other aspects of life that one cannot change (e.g., one's shape and height; one's early experiences) or that can only change to a limited extent or with great difficulty (e.g., one's weight in the long-term; one's family; other people).

The goal is to behave consistently with this new balanced appraisal of themselves and observe the results. Examples might include asking for help when previously this was viewed as a sign of weakness; challenging criticism on weight and eating as ignoring them and responding to criticism assertively, or being more active, for example, joining a group that fights prejudice against people with higher weight; experimenting with making new friends who don't have biases about weight.