Health care avoidance as vigilance: A model of maladaptive eating behaviors due to weight stigma in health care, avoidance, and internalization among women

Weight stigma—the devaluation of those with higher weight—is well-documented in health care settings. One common outcome of these experiences is avoidance of health care due to worry about being treated poorly for their weight gain. This avoidance of health care is a vigilance-based coping behavior, which is defined by anticipating a threat in a specific context and is marked by behavioral changes to avoid stigmatizing experiences. One supported predictor of health care avoidance is weight bias internalization or self-devaluation due to one’s body weight. This study explores a model in which weight stigma in health care is associated with maladaptive eating behaviors via health care avoidance, and the relationship between weight stigma in health care and health care avoidance is strongest for those high in weight bias internalization. Women were recruited to participate based on nationally (United States) representative quotas ( N = 1,115). Moderated mediation tested whether weight stigma was both directly associated with each maladaptive eating behavior and indirectly associated with each eating behavior via health care avoidance due to weight. Findings supported the proposed model for all three maladaptive eating outcomes (i.e., uncontrolled eating, emotional eating, and restrictive dieting). These results support a health care specific model that explains how weight stigma, weight bias internalization, and health care avoidance interact to contribute to maladaptive eating behaviors. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Source: journal abstract)