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. Author manuscript; available in PMC: 2022 Nov 1.
Published in final edited form as: Stigma Health. 2021 Aug 5;6(4):494–501. doi: 10.1037/sah0000334

Factors linking perceived discrimination and weight bias internalization to body appreciation and eating pathology: A moderated mediation analysis of self-compassion and psychological distress.

Rachelle Pullmer a,b, Stephanie G Kerrigan a, Carlos M Grilo a, Janet A Lydecker a
PMCID: PMC8963128  NIHMSID: NIHMS1733701  PMID: 35360487

Abstract

Stigma and recurrent discriminatory experiences can lead to distress and internalization of biases. Self-compassion is a widely-recognized resilience factor that may decrease the impact of discrimination on psychological well-being. Research highlights the potential utility of self-compassion in counteracting the harmful effects of discrimination, reducing psychological distress, and preventing the development of eating disorders. The current study examined the roles of self-compassion and psychological distress in perceived discrimination, internalized weight bias, body image, and eating pathology. Participants (N=694) living in the United States completed an online battery of measures assessing perceived discrimination, weight bias internalization, self-compassion, psychological distress, body appreciation, and eating pathology. Self-compassion was associated negatively with perceived discrimination, weight-bias internalization, psychological distress, and eating pathology and was associated positively with body appreciation. Moderated mediation analyses examined whether psychological distress statistically mediated the relationship between perceived discrimination (Model 1) or weight bias internalization (Model 2) on body appreciation, as well as between perceived discrimination (Model 3) or weight bias internalization (Model 4) on eating psychopathology. For all models, self-compassion was explored as a moderator of indirect and direct effects. Results revealed how psychological distress mediated the link between perceived discrimination and body appreciation/eating psychopathology, as well as between weight bias internalization and body appreciation, but not eating psychopathology. For weight bias internalization models only, the statistical links between psychological distress in relation to body appreciation/eating psychopathology were stronger for those with lower self-compassion. Self-compassion may promote more effective coping and outcomes for individuals who are subject to societal stigma.

Keywords: self-compassion, discrimination, psychological distress, body image, eating disorders

Introduction

The pernicious effects of stigma are widely documented in scientific research. Stigma can exhaust emotion regulation strategies and erode mental and physical well-being through internalization of stigma messages and increased psychological distress (Hatzenbuehler, 2009; White Hughto, Reisner, & Pachankis, 2015). As underscored in the minority stress model (Meyer, 2003; Testa, Habarth, Peta, et al., 2015), mounting evidence highlights the deleterious sequelae that follow distal stressors (i.e., those caused by external sources) and proximal stressors (i.e., internal processes within a person).

Perceived discrimination and weight-bias internalization represent proximal and distal means through which individuals experience and interpret social stigma. Perceived discrimination is defined by the frequency with which people feel they are treated poorly on the basis of diverse characteristics, including race, ethnicity, sex, gender identity, sexual orientation, age, or other features (Williams, Jackson, & Anderson, 1997). Weight bias internalization occurs when people apply harmful weight stereotypes propagated by societal stigma and subsequently derogate themselves due to their body weight (Durso & Latner, 2008). Research demonstrates that those who perceive discrimination (including, but not limited to weight-based discrimination) or have internalized weight bias are more likely to report a host of adverse outcomes, including psychological distress, body dissatisfaction, disordered eating behaviours, social and academic impairment, and poorer physical health (Pearl & Puhl, 2018; Udo & Grilo, 2016; Udo, Purcell, & Grilo, 2017).

While the theoretical link between weight bias internalization and eating psychopathology is more apparent, a growing body of research underscores the pertinent role of overall perceived discrimination. Specifically, research has linked perceived discrimination with subclinical binge-eating (Durso, Latner, & Hayashi, 2012) as well as binge-eating disorder in African Americans (Assari, 2018). In addition, perceived discrimination has been linked with a higher prevalence of anorexia nervosa and eating disorder symptoms amongst ethnic and sexual minority groups (Kamody, Grilo, & Udo, 2019; Kwan, Gordon, & Minnich, 2018). Thus, it appears that perceived discrimination and eating disorder psychopathology are intricately related across varied cultural, ethnic, and minority groups. However, mechanistic and protective factors in the relationships among these variables remain unknown.

The integrative mediation framework identified by Hatzenbuehler (2009) highlights the importance of identifying pathways between stigma-related factors and health outcomes. Prior research references a strong link between various forms of discrimination and psychological distress (O’Brien et al., 2016; Pearl & Pugh, 2018; Sellers, Caldwell, Schmeelk-Cone, et al., 2003). Research in the field of eating disorders has identified psychological distress as a potential pathway through which psychosocial factors exert their effect on eating psychopathology (e.g., Pullmer, Coelho, & Zaitsoff, 2019; Stice, Gau, Rohde, et al., 2017). Psychological distress may therefore represent a key variable through which perceived discrimination and weight bias internalization are associated with health outcomes, specifically disordered eating and body image. Yet, limited research exists on the links between perceived discrimination, weight bias internalization, psychological distress, and eating psychopathology.

In conjunction with dismantling systemic stigma and discrimination, adaptive coping may buffer the impact of discriminatory experiences on psychological well-being (Hatzenbuehler, 2009). This notion is further supported by the minority stress model (Meyer, 2003; Testa et al., 2015), which posits that resilience factors attenuate the detrimental effects of distal and proximal stress factors on mental and physical health. One resilience factor that has become increasingly potent across a multitude of domains is self-compassion. Self-compassion involves responding to oneself with the same kindness and warmth one would provide for a close friend experiencing pain or suffering (Neff, 2003). Meta-analyses and systematic reviews underscore the causal link between self-compassion, psychopathology, and well-being in diverse populations (Ferrari, Hunt, Harrysunker, et al., 2019; Zessin, Dickhäuser, & Garbade, 2015). Recent research highlights how self-compassion may buffer the impact of discrimination on psychosocial outcomes across multiple stigmatized identities (Liu, Li, Wang, et al., 2020; Vigna, Poehlmann-Tynan, & Koenig, 2018, 2020).

With regard to eating pathology, those who are more self-compassionate appear less likely to experience psychological distress, and in turn less likely to endorse disordered eating and body dissatisfaction (Pullmer et al., 2019; Turk & Waller, 2020). Although self-compassion has been deemed a malleable resilience factor in the eating disorder field and throughout the mental health field more broadly, the role of self-compassion in discriminatory experiences is poorly understood. The current study therefore examined relations between perceived discrimination, weight bias internalization, psychological distress, self-compassion, body image, and eating pathology in a large group of adults. Based on emerging literature, we hypothesized that self-compassion would be positively associated with body appreciation and negatively associated with perceived discrimination, weight bias internalization, psychological distress, and eating pathology. We also hypothesized that psychological distress would statistically mediate the effect of perceived discrimination and weight bias internalization (conceptualized as distinct predictors in separate models) on body appreciation and eating pathology. Finally, we hypothesized that self-compassion would moderate the indirect and direct statistical effects of perceived discrimination, weight bias internalization, and psychological distress on body appreciation and eating pathology.

Method

Procedures

This study was approved by our university’s Institutional Review Board, and all participants provided informed consent online. Survey respondents (N=694) were recruited from Amazon’s Mechanical Turk website when they responded to an advertisement to “share your opinions about eating, weight, and health.” Individuals were eligible to participate if they were adults and currently resided in the United States. Participants were paid between $0.50 and $1.00 to complete the survey, consistent with similar studies during our data collection period. Data were collected in February 2020.

Mechanical Turk is an online recruitment platform that yields convenient, high-quality data. This recruitment platform has been used in psychological and psychiatric research (Zimmerman & Kerr, 2019), including research on eating and self-compassion (Siegel, Huellemann, Hillier, et al., 2020). Mechanical Turk respondents have greater demographic variability (e.g., age range) and are more geographically diverse than undergraduate samples (Behrend, Sharek, Meade, et al., 2011; Buhrmester, Kwang, & Gosling, 2011; Hauser & Schwarz, 2016). Psychometric properties of measures completed by Mechanical Turk respondents do not differ from participants recruited using traditional sources (Behrend et al., 2011). Importantly, Mechanical Turk allows for quality control from the platform as well as validity checks from within the survey to review response quality. In the current study, we required that each participant’s approval rating on Mechanical Turk exceeded 85%. We also required correct answers to four validity items throughout the survey that assessed effort and attention. In line with recommendations (Buhrmester et al., 2011), we used multiple response formats (multiple choice, true/false, and open-ended). Of the recruited sample, 28.7% were excluded for incomplete or suspected invalid responding.

Participants

With regard to gender, n = 373 participants self-identified as women, n = 317 as men, and n = 4 as transgender or non-binary. Participants (N = 694) were predominantly non-Hispanic (n = 630) and self-identified as follows: White (n = 573), Black/African-American (n = 68), Asian (n = 46), American Indian/Native Hawaiian/Alaskan Native (n = 13), and more than one race (n=12). The majority of participants were well-educated (n = 405 completed at least a bachelor’s degree). Of the sample, average age was 38.60 (SD=12.42) years and average BMI was 26.92 (SD=6.72) kg/m2. Additional demographic characteristics are summarized in TABLE 1.

Table 1.

Sample characteristics

Frequency
n 		Frequency
(%)
Gender identity
 Man 317 45.7%
 Woman 373 53.6%
 Transgender man 2 0.3%
 Transgender woman 1 0.1%
 Non-binary 1 0.1%
Sexuality
 Heterosexual 590 85.0%
 Homosexual 30 4.3%
 Bisexual 46 6.6%
 Asexual 19 2.7%
 Other 9 1.3%
Education
 Less than high school 7 1.0%
 High school diploma 95 13.7%
 Some university or Associates degree 187 26.9%
 Bachelors degree 288 41.5%
 Postgraduate education 117 16.8%
Ethnicity
 Hispanic/Latino 64 9.2%
Race
 White 553 79.7%
 Asian 44 6.3%
 Black/African-American 57 8.2%
 Native Hawaiian/Pacific Islander 0 0.0%
 American Indian, Native American, or Alaskan Native 3 0.4%
 More than one race 37 5.3%
Body Mass Index Category
 Underweight 31 4.5%
 Normal weight 292 42.1%
 Overweight 200 28.8%
 Obese 171 24.6%
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Note. N=694.

Measures

Body Mass Index (BMI).

Participants reported their height and weight, which were used to calculate BMI.

Self-compassion.

The Self-Compassion Scale (Neff, 2003) is a 26-item self-report measure used to assess the three main components of self-compassion: self-kindness, common humanity, and mindfulness. The SCS contains a total score which was used for this study. Higher scores indicate a greater propensity towards self-compassionate responses in the face of failure and suffering. Items yielded an internally consistent scale in the current study (α=.82).

Perceived Discrimination.

The Everyday Discrimination Scale (EDS; Williams et al., 1997) is a 9-item self-report measure that assesses perceived discrimination, with higher scores indicating higher frequency of perceived discrimination. The EDS contains one additional follow-up question for those who endorse items on the self-report measure inquiring about the perceived main reason for discrimination. Participants are provided with 10 response options for this follow-up question (e.g., gender, race, age) as well as an open-ended “other” response option. Analyses were re-conducted for participants who identified weight as their perceived main reason for discrimination (see Supplementary Materials for frequency data on this follow-up question).

Weight Bias Internalization.

Weight bias internalization was assessed with the 11-item Modified Weight Bias Internalization Scale (WBIS-M; Pearl & Puhl, 2014), which measures the degree to which individuals throughout the weight spectrum internalize weight bias and stigma. This measure was developed from the original WBIS, which focused on weight bias internalization in individuals with a BMI > 25 (Durso & Latner, 2008). Higher scores indicate elevated weight bias internalization. Cronbach’s alpha for this scale was .91 in the current study.

Psychological Distress.

The Hopkins Symptom Checklist (SCL-5; Aasheim, 2012) is a 5-item self-report measure that assesses psychological distress (defined as an aggregate of depressive and anxiety symptoms) over the past two weeks. The SCL-5 yields a mean score, with higher scores indicating increased psychological distress. Cronbach’s alpha for this scale was .90 in the current study.

Body Appreciation.

The Body Appreciation Scale (BAS-2; Tylka & Wood-Barcalow 2015) is a 13-item self-report measure that examines acceptance of and respect for one’s body. Higher scores demonstrate higher levels of body appreciation. Cronbach’s alpha for this scale was .95 in the current study.

Eating Psychopathology.

The brief version (Grilo, Reas, Hopwood, et al., 2015) of the Eating Disorder Examination Questionnaire (EDE-Q; Fairburn & Beglin, 1994) was used in the current study. The EDE-Q evaluates eating disorder psychopathology over the past 28 days. The brief version includes 7 items (dietary restraint [3 items], overvaluation [2 items], body dissatisfaction [2 items]) comprising a global severity scale and has consistently shown better psychometric properties than the full scale across clinical and non-clinical samples (Machado, Grilo, Rodrigues, et al., 2020; Machado, Grilo, & Crosby, 2018). Higher scores indicate greater severity of eating psychopathology. Cronbach’s alpha for this scale was .82 in the current study.

Data Analyses

Analyses were performed using SPSS version 24. Descriptive statistics (frequencies, means, and measures of central tendency) characterized the study sample on demographic and clinical variables. Bivariate correlations between all variables were examined. Conditional process analyses (Hayes, 2017) tested the relations among self-compassion, perceived discrimination, weight bias internalization, psychological distress, body appreciation, and eating pathology. The SPSS macro PROCESS was used for the mediation (Model 4) and moderated mediation (Model 59) analyses. This macro employs bootstrapping (a resampling technique) to obtain confidence intervals for indirect effects, which is advantageous compared to intervals that are obtained through tests that assume normality of distribution. All variables were mean-centered during analyses. All models utilized HC3 estimation and 10,000 bootstrap samples were generated, as recommended by Hayes (2017).

Four separate models were tested (see Figure 1 for a visual portrayal of these models; each model was tested for both simple statistical mediation and moderated mediation, thus two analyses were conducted for each theoretical model). Specifically, self-compassion was evaluated as a moderator of the indirect effect of weight bias internalization and perceived discrimination (predictors) on body appreciation and global eating psychopathology (outcomes) through psychological distress (mediator). These analyses were repeated for participants identifying weight as the perceived main reason for discrimination, according to the EDS.

Figure 1.

Figure 1.

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Moderated Mediation Models. Black text and graphics (pathways a, b, and c’; boxes X, M, and Y) show the simple mediation models initially run, while the blue graphics (middle box and lines) display the moderator addition. Abbreviations represent standard nomenclature for moderation and mediation models (X as predictor, Y as outcome, M as mediator, and W as moderator).

Results

Correlation analyses

As shown in TABLE 2, self-compassion was positively associated with body appreciation and negatively associated with perceived discrimination, weight bias internalization, psychological distress, and eating pathology.

Table 2.

Bivariate correlations between main study variables

M (SD) 1. 2. 3. 4. 5.
1.Body Appreciation 3.35 (0.96)
2.Eating psychopathology 2.89 (1.23) −.65**
3.Selfcompassion 3.16 (0.81) .59** −.45**
4.Psychological distress 1.85 (0.79) −.43** .37** −.54**
5.Perceived discrimination 10.79 (10.33) −.20** .13** −.20** .31**
6.Weight bias internalization 3.31 (1.51) −.69** .72** −.52** .50** .28**
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**

p < .01

Moderated Mediation results

TABLE 3 summarizes the simple mediation effects of psychological distress. Perceived discrimination (Model 1) and weight bias internalization (Model 2) had indirect effects on body appreciation through psychological distress. Perceived discrimination (Model 3), but not weight bias internalization (Model 4), had an indirect effect on global eating psychopathology through psychological distress.

Table 3.

Simple mediation effects of psychological distress

Independent Variable Dependent Variable Model R2 F Total Effect coefficient Indirect Effect CI Direct Effect coefficient
Discrimination Body Appreciation .19 76.75** −.02** (−0.02, −0.01) −.01
Weight Bias Body Appreciation .48 312.88** −0.44** (−0.09, −0.02) −0.40**
Discrimination Global eating psychopathology .14 58.44** 0.02** (0.001, 0.02) 0.003
Weight Bias Global eating psychopathology .52 491.00** 0.59** (−0.03, 0.04) 0.59**
Among the subset citing weight as the reason for perceived discrimination
Discrimination Body Appreciation .08 5.22** −.02* (−0.04, −0.001) −0.01
Discrimination Global eating psychopathology .06 4.02* 0.01 (0.001, 0.02) 0.004
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**

p < .01

*

p < .05

TABLE 4 summarizes the role of self-compassion in moderating the direct and indirect effects (i.e., any of the three pathways could be moderated by self-compassion) of discrimination and weight bias on body appreciation through psychological distress. Self-compassion did not moderate any of the three pathways for Model 1 (i.e., perceived discrimination). Self-compassion moderated the effect of psychological distress on body appreciation for Model 2 (i.e., weight bias internalization), such that at constant levels of psychological distress, greater self-compassion was associated with greater body appreciation. The remaining pathways were not moderated by self-compassion.

Table 4.

Self-compassion moderating the indirect effects of discrimination and weight bias on body appreciation and global eating pathology through psychological distress

Full sample
Psychological distress (mediator) Body appreciation (outcome)
B T B T
Model 1 Discrimination −0.02 −5.66*** 0.01 1.61
Self-compassion −0.50 −16.39*** 0.62 13.69***
Discrimination * Self-compassion .01 1.90 −0.002 −.51
Psychological Distress −.14 −2.56*
Psychological Distress * Self-compassion 0.10 1.98
Model 2 Weight bias .16 8.11*** −.35 −15.70***
Self-compassion −.37 −9.77*** .40 10.07***
Weight bias * Self-compassion .01 .41 −.04 −1.78
Psychological Distress .06 1.32
Psychological Distress * Self-compassion .17 3.70***
Psychological distress (mediator) Global eating psychopathology (outcome)
Model 3 Discrimination −0.02 −5.66*** 0.01 −0.41
Self-compassion −0.50 −16.39*** −1.60 −8.45***
Discrimination * Self-compassion 0.01 1.90 0.02 1.39
Psychological Distress 0.83 3.98***
Psychological Distress * Self-compassion −0.05 −0.25
Model 4 Weight bias .16 8.11*** 1.71 21.93***
Self-compassion −.37 −9.77*** −.50 −3.26**
Weight bias * Self-compassion .01 .41 .12 1.56
Psychological Distress −.24 −1.34
Psychological Distress * Self-compassion −.36 −2.22*
Among the subset citing weight as the reason for perceived discrimination
Psychological distress (mediator) Body appreciation (outcome)
B T B T
Model 5 Discrimination .02 2.48* −0.01 −1.40
Self-compassion −0.60 −9.33*** 0.82 6.69***
Discrimination * Self-compassion −.002 −0.32 0.003 1.51
Psychological Distress 0.22 1.59
Psychological Distress * Self-compassion 0.19 1.51
Psychological distress (mediator) Global eating psychopathology (outcome)
Model 6 Discrimination .02 2.48* .003 0.26
Self-compassion −0.60 −9.33*** −0.95 −6.79***
Discrimination * Self-compassion −.002 −0.32 −0.002 −0.18
Psychological Distress −0.24 −1.64
Psychological Distress * Self-compassion −0.26 −1.88
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***

p < .001

**

p < .01

*

p < .05

TABLE 4 summarizes the role of self-compassion in moderating the direct and indirect effects of discrimination and weight bias on global eating pathology through psychological distress. Self-compassion did not moderate any of the three pathways for Model 3 (i.e., perceived discrimination). Self-compassion moderated the effect of psychological distress on global eating psychopathology for Model 4 (i.e., weight bias internalization), such that at constant levels of psychological distress, greater self-compassion was associated with lower global eating pathology. Other pathways were not moderated by self-compassion.

A subset of individuals (n = 138) reported weight as the main reason for perceived discrimination. TABLE 3 AND TABLE 4 summarize the simple mediation effects of psychological distress and the role of self-compassion in moderating the indirect effects of weight-specific discrimination on body appreciation (Model 5) and global eating pathology (Model 6) through psychological distress. Within this subset, perceived discrimination had indirect effects on body appreciation and eating psychopathology through psychological distress. Self-compassion did not moderate these effects.

Discussion

While a host of research demonstrates proximal and distal factors related to societal stigma, little is known about the link between these factors in relation to eating psychopathology. This study demonstrated how psychological distress may represent a pathway through which discriminatory experiences exert their effects on body appreciation and eating psychopathology. Notably, for those with lower levels of self-compassion, psychological distress was more strongly associated with lower body appreciation and higher eating psychopathology. To our knowledge, this was the first study to examine the role of self-compassion in the relationships between psychological distress, discriminatory experiences, body image, and eating pathology.

The current study provides support that self-compassion may be most useful in disrupting the stress–wellness link as opposed to direct links between discrimination and mental health outcomes. This may be because self-compassion helps people confront objectively distressing emotions rather than manage them maladaptively. In other words, harnessing self-compassionate responses in the face of discriminatory experiences does not necessarily alleviate psychological distress, but may propagate more effective coping with psychological distress. By treating oneself with kindness as opposed to judgment and by disengaging from over-identification with negative body image thoughts and subsequent behaviours, individuals may experience increased body appreciation and decreased eating pathology. Altogether, results from this study indicate how promoting self-compassionate responses in the face of discriminatory experiences and associated distress might serve to generate healthier and more adaptive coping strategies.

Our findings are largely consistent with prior research indicating a robust association between discriminatory experiences, distress, and disordered eating (Pearl & Puhl, 2015). Only a handful of studies have examined the role of self-compassion in weight bias internalization, with research indicating a negative association in college women (Webb & Hardin, 2016), individuals classified as overweight/obese (Hilbert, Braehler, Schmidt, et al., 2015), and post-operative bariatric surgery patients (Braun et al., 2020).

Contrary to our hypotheses, self-compassion did not moderate the relations between variables in models including perceived discrimination as a predictor and psychological distress did not mediate the link between weight bias internalization and eating psychopathology. As indicated above, psychological distress statistically mediated the links between weight bias internalization and body appreciation, as well as between perceived discrimination and both outcome variables. Notably, self-compassion moderated the link between psychological distress and body appreciation/eating psychopathology for models including weight bias internalization as a predictor. In considering these statistical differences between models, it is possible that individuals who experience greater self-compassion may be less likely to express distress associated with weight bias internalization as body appreciation or eating disorder psychopathology, while external forces such as perceived discrimination may be less mitigated by self-compassion. It is also possible that other factors play a more pertinent role in the link between weight bias internalization and eating psychopathology (e.g., body image avoidance and drive for thinness; Marshall, Latner, & Masuda, 2019).

Prior research has demonstrated associations between perceived discrimination, self-compassion, and psychological distress in sexual minority groups (e.g., Liao, Kashubeck-West, Weng, et al., 2015). Alternatively, as explored in adolescents, it may be that self-compassion emerges as a protective factor for those experiencing pervasive discrimination at the intersection of multiple marginalized identities, as opposed to those experiencing specific forms of discrimination in the general population (Vigna et al., 2020). Experimental and longitudinal research could help elucidate directionality and specificity of effects (i.e., to clarify whether self-compassion has a greater influence on internalized biases as opposed to external factors, or whether self-compassion is more protective when considering the cumulative impact of numerous stigmatized identities). As indicated above, the sample of individuals reporting weight-based discrimination was notably smaller than the greater sample and did not reveal buffering effects of self-compassion. Collectively, targeted research in a larger sample of individuals facing weight-based discrimination and other forms of oppression is warranted in order to effectively investigate intersectionality in weight stigma and self-compassion, and to determine the potency of psychological distress as a mediator over time.

In terms of limitations, it is important to note that this study employed a cross-sectional design, which limits our ability to elucidate causal pathways and to determine whether models could be interpreted in reverse or alternate directions (Fairchild & Daniel, 2017; Hayes, 2017). This study also relied on self-report questionnaires. While self-report can be helpful for obtaining sensitive information pertaining to eating, weight, and discrimination, this form of data collection might be subject to various biases. Finally, the current study recruited a self-selected sample from Mechanical Turk. Although participants recruited via Mechanical Turk are typically more diverse than college student samples, they tend to be comprised of younger and more educated individuals than nationally-representative samples (Walters, Christakis, & Wright, 2018). In addition, our sample was predominantly comprised of White, Non-Hispanic, heterosexual, and college-educated individuals. Therefore, our findings should be interpreted with caution as they may not generalize to other groups which were not well-represented in our study.

Given the above limitations and gaps in the literature, future research should seek to provide a more nuanced understanding of the relationships between main study variables across cultural and ethnic groups, sexual and gender minority groups, and sociodemographic variables. As clearly delineated by Buchanan and colleagues (2020), it is imperative that we continue to challenge epistemic oppression and inequity in psychological science. The importance of these research priorities are further underscored by studies demonstrating intersectional differences in frequency of discriminatory experiences and utility of maladaptive and effective coping strategies across multiple social categories (e.g., race and gender; Fettich & Chen, 2012; Himmelstein, Puhl, & Quinn, 2017).

From a clinical standpoint, there is evidence to suggest that treatment-seeking individuals with binge-eating disorder and obesity report stronger internalized weight stigma, increased psychological distress, and poorer overall health when compared to nonclinical populations (Friedman & Brownell, 1995; Pearl, White, & Grilo, 2014). As such, it would be beneficial to examine self-compassion in clinical populations reporting recurrent discriminatory experiences and resultant distress to inform interventions and optimally enhance treatment outcomes.

Finally, there are numerous notable barriers to self-compassion, including feeling undeserving or unworthy of kindness, barriers which have been deemed prominent in individuals with eating disorders (Geller, Iyar, Kelly, et al., 2019; Kelly, Carter, Zuroff, et al., 2013). Given that this study did not explicitly assess barriers to self-compassion, future research would benefit from investigating whether such barriers are more prominent amongst marginalized groups, and relatedly, how barriers can be surmounted to promote wellbeing.

Conclusion

Our study provides support for the potential roles of self-compassion and psychological distress in the stress–wellness link in adults across the weight spectrum. It is widely acknowledged that stigma and discrimination serve as fundamental drivers of population-level health inequities by increasing stress and decreasing access to essential resources. While addressing institutional downfalls will remain vital, the current study in conjunction with a growing body of research highlights self-compassion as a key factor in building resilience among individuals facing recurrent discrimination.

Supplementary Material

Supplemental Material

References

  1. Aasheim V, Waldenstrom U, Hjelmstedt A, Rasmussen S, Pettersson H, & Schytt E (2012). Associations between advanced maternal age and psychological distress in primiparous women, from early pregnancy to 18 months postpartum. An International Journal of Obstetrics and Gynaecology, 119, 1108–1116. [DOI] [PubMed] [Google Scholar]
  2. Assari S (2018). Perceived discrimination and binge eating disorder; Gender difference in African Americans. Journal of Clinical Medicine, 7, 89. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Behrend TS, Sharek DJ, Meade AW, & Wiebe EN (2011). The viability of crowdsourcing for survey research. Behaviour Research Methods, 43, 800–813. [DOI] [PubMed] [Google Scholar]
  4. Braun TD, Quinn DM, Stone A, Gorin A, Ferrand J, Puhl RM, Sierra J, Tishler D, & Papasavas P (2020). Weight bias, shame, and self-compassion: Risk/protective mechanisms of depression and anxiety in prebariatric surgery patients. Obesity. 10.1002/oby.22920. [DOI] [PMC free article] [PubMed] [Google Scholar] [Retracted]
  5. Buchanan NT, Perez M, Prinstein M, & Thurston I (2020). Upending racism in psychological science: Strategies to change how our science is conducted, reported, reviewed, & disseminated. 10.31234/osf.io/6nk4x. [DOI] [PubMed] [Google Scholar]
  6. Buhrmester M, Kwang T, & Gosling SD (2011). Amazon’s Mechanical Turk: A new source of inexpensive, yet high-quality, data? Perspectives on Psychological Science, 6, 3–5. [DOI] [PubMed] [Google Scholar]
  7. Durso LE, & Latner JD (2008). Understanding self-directed stigma: Development of the Weight Bias Internalization Scale. Obesity, 16, S80–S86. [DOI] [PubMed] [Google Scholar]
  8. Durso LE, Latner JD, & Hayashi K (2012). Perceived discrimination is associated with binge eating in a community sample of non-overweight, overweight, and obese adults. Obesity Facts, 6, 869–880. [DOI] [PubMed] [Google Scholar]
  9. Fairburn CG, & Beglin SJ (1994) Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders. 16, 363–71. [PubMed] [Google Scholar]
  10. Ferrari M, Hunt C, Harrysunker A, Abbott MJ, Beath AP, & Einstein DA (2019). Self-compassion interventions and psychosocial outcomes: a meta-analysis of RCTs. Mindfulness, 10, 1455–1473. [Google Scholar]
  11. Fairchild AJ, & McDaniel HL (2017). Best (but oft-forgotten) practices: Mediation analysis. The American Journal of Clinical Nutrition, 105, 1259–1271. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Fettich KC, & Chen EY (2012). Coping with obesity stigma affects depressed mood in African-American and White candidates for bariatric surgery. Obesity, 20, 1118–1121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Friedman MA, & Brownell KD (1995). Psychological correlates of obesity: Moving to the next research generation. Psychological Bulletin, 117, 3–20. [DOI] [PubMed] [Google Scholar]
  14. Geller J, Iyar MM, Kelly AC, Srikameswaran S (2019). Barriers to self-compassion in the eating disorders: The factor structure of the fear of self-compassion scale. Eating Behaviors, 35, 101334. [DOI] [PubMed] [Google Scholar]
  15. Grilo CM, Reas DL, Hopwood CJ, & Crosby RD (2015). Factor structure and construct validity of the Eating Disorder Examination‐Questionnaire in college students: Further support for a modified brief version. International Journal of Eating Disorders, 48, 284–289. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Hatzenbuehler ML (2009). How does sexual minority stigma get under the skin? A psychological mediation framework. Psychological Bulletin, 135, 707–730. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Hauser DJ, & Schwarz N (2016). Attentive Turkers: MTurk participants perform better on online attention checks than do subject pool participants. Behaviour Research Methods, 48, 400–407. [DOI] [PubMed] [Google Scholar]
  18. Hayes AF (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: The Guilford Press. [Google Scholar]
  19. Hilbert A, Braehler E, Schmidt R, Lowe B, Hauser W, & Zenger M (2015). Self-compassion as a resource in the self-stigma process of overweight and obese individuals. Obesity Facts, 8, 293–301. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Himmelstein MS, Puhl RM, & Quinn DM (2017). Intersectionality: An understudied framework for addressing weight stigma. American Journal of Preventive Medicine, 53, 421–431. [DOI] [PubMed] [Google Scholar]
  21. Kamody RC, Grilo CM, & Udo T (2020). Disparities in DSM-5 defined eating disorders by sexual orientation among U.S. adults. International Journal of Eating Disorders, 53, 278–287. [DOI] [PubMed] [Google Scholar]
  22. Kelly AC, Carter JC, Zuroff DC, & Borairi S (2013). Self-compassion and fear of self-compassion interact to predict response to eating disorders treatment: A preliminary investigation. Psychotherapy Research, 23, 252–264. [DOI] [PubMed] [Google Scholar]
  23. Kwan MY, Gordon KH, & Minnich AM (2018). An examination of the relationships between acculturative stress, perceived discrimination, and eating disorder symptoms among ethnic minority college students. Eating Behaviors, 28, 25–31. [DOI] [PubMed] [Google Scholar]
  24. Liao KY-H, Kashubeck-West S, Weng C-Y, & Deitz C (2015). Testing a mediation framework for the link between perceived discrimination and psychological distress among sexual minority individuals. Journal of Counseling Psychology, 62, 226–241. [DOI] [PubMed] [Google Scholar]
  25. Linardon J, Susanto L, Tepper H, & Fuller-Tyskiewicz M (2020). Self-compassion as a moderator of the relationships between shape and weight overvaluation and eating disorder psychopathology, psychosocial impairment, and psychological distress. Body Image. Doi: 10.1016/j.bodyim.2020.03.001. [DOI] [PubMed] [Google Scholar]
  26. Liu S, Li C, Wang C, Wei M, & Ko S (2020). Self-compassion and social connectedness buffering racial discrimination on depression among Asian Americans. Mindfulness, 11, 672–680. [Google Scholar]
  27. Machado PP, Grilo CM, & Crosby RD (2018). Replication of a modified factor structure for the Eating Disorder Examination-Questionnaire: Extension to clinical eating disorder and non-clinical samples in Portugal. European Eating Disorders Review, 26, 75–80. [DOI] [PubMed] [Google Scholar]
  28. Machado PP, Grilo CM, Rodrigues TF, Vaz AR, & Crosby RD (2020). Eating Disorder Examination - Questionnaire short forms: A comparison. International Journal of Eating Disorders, 53, 937–944. [DOI] [PubMed] [Google Scholar]
  29. Marshall RD, Latner JD, & Masuda A (2019). Internalized weight bias and disordered eating: The mediating role of body image avoidance and drive for thinness. Frontiers in Psychology, 10, 2999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Meyer IH (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 647–697. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Neff KD (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2, 223–250. [Google Scholar]
  32. O’Brien KS, Latner JD, Puhl RM, Vartanian LR, Giles C, Griva K, & Carter A (2016). The relationship between weight stigma and eating behavior is explained by weight bias internalization and psychological distress. Appetite, 102, 70–76. [DOI] [PubMed] [Google Scholar]
  33. Pearl RL, White MA, & Grilo C (2014). Weight bias internalization, depression, and self-reported health among overweight binge eating disorder patients. Obesity, 22, 142–148. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Pearl RL, & Puhl RM (2014). Measuring internalized weight attitudes across body weight categories: Validation of the Modified Weight Bias Internalization Scale. Body Image, 11, 89–92. [DOI] [PubMed] [Google Scholar]
  35. Pearl RL, & Puhl RM (2018). Weight bias internalization and health: a systematic review. Obesity Reviews, 19, 1141–1163. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Sellers RM, Caldwell CH, Schmeelk-Cone KH, & Zimmerman MA (2003). Racial identity, racial discrimination, perceived stress, and psychological distress among African American young adults. Journal of Health and Social Behavior, 44, 302–317. [PubMed] [Google Scholar]
  37. Siegel JA, Huellemann KL, Hillier CC, & Campbell L (2020). The protective role of self-compassion for women’s positive body image: An open replication and extension. Body Image, 32, 136–144. [DOI] [PubMed] [Google Scholar]
  38. Testa RJ, Habarth J, Peta J, Balsam K, & Bockting W (2015). Development of the Gender Minority Stress and Resilience measure. Psychology of Sexual Orientation and Gender Diversity, 2, 65–77. [Google Scholar]
  39. Turk F, & Waller G (2020). Is self-compassion relevant to the pathology and treatment of eating and body image concerns? A systematic review and meta-analysis. Clinical Psychology Review, 79, doi: 10.1016/j.cpr.2020.101856. [DOI] [PubMed] [Google Scholar]
  40. Tylka TL, & Wood-Barcalow NL (2015). The Body Appreciation Scale-2: Item refinement and psychometric evaluation. Body Image, 12, 53–67. [DOI] [PubMed] [Google Scholar]
  41. Udo T, & Grilo CM (2017). Cardiovascular disease and perceived weight, racial, and gender discrimination in U.S. adults. Psychosomatic Research, 100, 83–88. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Udo T, Purcell K, & Grilo CM (2016). Perceived weight discrimination and chronic medical conditions in adults with overweight and obesity. International Journal of Clinical Practice, 70, 1003–1011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Vigna AJ, Poehlmann-Tynan J, & Koenig BW (2018). Does self-compassion covary with minority stress? Examining group differences at the intersection of marginalized identities. Self and Identity, 17, 687–709. [Google Scholar]
  44. Vigna AJ, Poehlmann-Tynan J, & Koenig BW (2020). Is self-compassion protective among sexual- and gender-minority adolescents across racial groups? Mindfulness, 11, 2020. [Google Scholar]
  45. Walters K, Christakis DA, & Wright DR (2018). Are Mechanical Turk worker samples representative of health status and health behaviors in the US? PLoS One, 13, e0198835. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Webb JB, & Hardin AS (2016). An integrative affect regulation process model of internalized weight bias and intuitive eating in college women. Appetite, 102, 60–69. [DOI] [PubMed] [Google Scholar]
  47. White Hughto JM, Reisner SL, & Pachankis JE (2015). Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions. Social Science & Medicine, 147, 222–231. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Williams DR, Yu Y, Jackson JS, & Anderson NB (1997). Racial differences in physical and mental health: Socio-economic status, stress and discrimination. Journal of Health Psychology, 2, 335–351. [DOI] [PubMed] [Google Scholar]
  49. Zessin U, Dickhauser O, & Garbade S (2015). The relationship between self-compassion and well-being: A meta-analysis. Applied Psychology: Health and Well Being, 7, 340–346. [DOI] [PubMed] [Google Scholar]
  50. Zimmerman M, & Kerr S (2019). How should the severity of depression be rated on self-report depression scales?. Psychiatry research, 280, 112512. [DOI] [PubMed] [Google Scholar]

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