Written by Jacqueline Patmore, BA.
When we think about eating disorders, one of the first things that comes to mind is body dissatisfaction. It is a key component in the way we understand, diagnose and treat disorders like anorexia nervosa and bulimia nervosa, and its absence is part of how we define avoidant restrictive food intake disorder (ARFID). While a lot of research has been done on body dissatisfaction, the concept is still relatively elusive to researchers – we simply do not have a full picture of what is going on. Recently, investigators at the University of Louisville tried to get a better sense of what specific aspects of body dissatisfaction were most significant as well as explore the feelings associated with them. The researchers took a closer look at two specific aspects of body dissatisfaction– feelings of fatness and fear of weight gain.
Important Terms Defined
Feelings of fatness are described by 60-100% of individuals with eating disorders. It has been well documented that these feelings are associated with anxiety, depression, low self-esteem and other negative symptoms. The presence of these feelings also predicts restrictive eating and eating concerns better than both body dissatisfaction and depression (two ideas that have been highly researched).
You might assume that feelings of fatness track with body weight or size…but this is actually not the case! Feelings of fatness are not correlated with BMI or weight, and this finding sends a strong signal that something else is likely going. What is it that could produce these “feelings of fatness” without the actual objective physical reality of “fatness?” What Levinson and her colleagues suggest is that it is actually the emotional experience of “fatness” that matters the most. They refer to this as the cognitive affectual experience of fatness, and hypothesize that the way that people with some types of eating disorders interpretfatness and feel about perceived fatness acts as a primary driver of this experience.
Fear of weight gain, the second aspect of body dissatisfaction that is focused on in this study, is a hallmark feature of anorexia nervosa and atypical anorexia nervosa. Fear of weight gain has been previously shown to make a unique contribution to eating disorder severity, above and beyond body shape and weight concerns.
Along with body dissatisfaction, eating disorders also tend to track with other cognitive-affective factors, like anxiety and depression. Researchers and practitioners have long held that all of these factors – body dissatisfaction, affect, and mood – are related. This is a central principle in cognitive behavioral therapy, a well-studied and well-established eating disorder treatment. For that reason, researchers in this study felt that it was important to identify the cognitive-affective variables that were related specifically to feelings of fatness and fears of weight gain.
In a group of 168 individuals with eating disorders, a variety of cognitive-affective variables (including negative affect, guilt, shame, fear of negative evaluation, anxiety sensitivity, and depression) were considered as potentially associated with feelings of fatness and fears of weight gain. Researchers also hoped to learn if any of these variables were predictive of feelings of fatness and fears of weight gain.
What did the study find?
- Depression was associated with feelings of fatness, and predicted feelings of fatness more than any other emotional experience.
- Fears of negative evaluation and depression were uniquely associated with fears of weight gain.
- Feelings of shame predicted fear of weight gain.
Why does this matter?
As often happens in scientific studies, some (but not all) of the results surprised the investigators:
- Depression and negative evaluation fears did contribute to feelings of fatness and predicted them over time (expected)
- Shame did predict fear of weight gain (expected)
- Depression also contributed to fear of weight (unexpected)
- Anxiety did not contribute to fear of weight gain(unexpected)
Findings, whether expected or not, often can have clinical implications and always help point us scientists towards their next questions. In this case, the study authors suggest that (1) targeting depression may be a good strategy in eating disorder treatment, especially if patients report feeling fat, and (2) to decrease fears of weight gain in patients with eating disorders, it may be important to address fear of negative evaluation, depression, and shame.
Ultimately, determining the affective states and conditions surrounding feelings of fatness and fear of weight gain is really important, as it will help inform treatment development efforts, and improve our understanding of the drivers and maintaining factors of certain eating disorders.
To read the study referenced above, please see:
Levinson, C. A., Williams, B. M., & Christian, C. (2020). What are the emotions underlying feeling fat and fear of weight gain? Journal of affective disorders, 277, 146–152. https://doi.org/10.1016/j.jad.2020.08.012
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