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Running head: OBESITY AND PSYCHOLOGICAL DISTRESS 1

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The Impact of Obesity and Gender on Disordered Eating Attitudes, Exercise, and Psychological

Distress among College Students

Jeanne L. Edman

Cosumnes River College

Wesley C. Lynch

Montana State University

David J. Patron

University of California, Davis OBESITY AND PSYCHOLOGICAL DISTRESS 2

Abstract

Obesity has been linked to number of psychological problems including depression and disordered eating. The present study examined whether obese students would indicate higher risk of psychological distress than students of other weight categories. We also examined if there were gender differences on measures of psychological distress and whether disordered eating attitudes and body dissatisfaction were associated with depressed mood. A total of 872 students completed a questionnaire that assessed depressed mood, disordered eating attitudes, body dissatisfaction and measures of exercise. The results support our prediction that female students and obese students would report higher levels of psychological distress than other students.

Obese students and female students reported higher rates of weight concerns, media influences, weight control behaviors and lower self-confidence, but there were no gender differences in depression. As predicted, disordered eating and body dissatisfaction correlated with depressed mood, and weight-based teasing correlated with psychological distress among obese students of both genders. The findings suggest that obese students are at high risk for eating disorders, depression, and body dissatisfaction, and these are linked to weight-based teasing and media influences.

Keywords: Obesity, Obesity victimization, depression, body dissatisfaction, exercise, gender

differences, disordered eating attitudesThe Impact of Obesity, Gender and Ethnicity on

Disordered Eating Attitudes, and Psychological Distress among College Students in Hawaii

Obesity is considered one of America’s biggest health challenges and has been associated with a number of health problems including diabetes, heart disease and cancer (Centers for

Disease Control and Prevention, 2011). Although the majority of obese individuals report few psychological problems, obesity has also been linked to disordered eating, body dissatisfaction, OBESITY AND PSYCHOLOGICAL DISTRESS 3 and depression (de Wit et al., 2010; Desai, Miller, Staples & Bravender, 2008; Grilo, White, &

Masheb, 2009; Fassino, Leombruni, Piero, Abbate-Daga, & Giacomo Rovera, 2003; Pasco,

Williams, Jacka, Brennan, & Berk, 2013; McCabe & Ricciardelli, 2003; Chen, Jiang, & Mao,

2009).

Literature Overview

Numerous studies link obesity with depression (Marmorstein, Iacono, & Legrand, 2014;

Yu, Parker, & Dummer, 2013). For example, obese adolescents of both genders report higher levels of depression than normal weight youth (Goldfield et al., 2010) and adolescent obesity predicted later life depression (Marmorstein et al., 2014). One explanation for the high risk of depression is our culture’s stigmatization of obesity since obese individuals are often perceived as lazy and blamed for their weight condition (Martin, Rhea, Greenleaf, Judd, & Chambliss,

2011; Puhl & Brownell, 2003). It is not uncommon for obese individuals to experience weight victimization including teasing, social exclusion or avoidance (Puhl, Luedicke, & Heuer, 2011) and these experiences often result in increased psychological distress (Almeida, Savoy, & Boxer,

2011; Puhl & Heuer, 2010; Vartanian & Shaprow, 2008; Vartanian & Novak, 2011). For example, weight-based teasing had a negative impact on adolescents’ mood, self-esteem and activity efficacy (Greenleaf, Petrie, & Martin, 2014) and has been linked to obesity (Sutin &

Terracciano, 2013). Experiences of weight stigmatization, bullying, and obesity discrimination are associated with body dissatisfaction, depression, anger, binge and emotional eating, and exercise avoidance (Puhl & Luedicke, 2012; Sutin & Terracciano, 2013; Vartanian & Novak,

2011) and body dissatisfaction is linked to depression (Rosenstrom et al., 2013). These studies suggest that obese victims of weight-based discrimination are at increased risk of depression and body dissatisfaction which may trigger unhealthy behaviors including emotional eating, binge OBESITY AND PSYCHOLOGICAL DISTRESS 4 eating, and declines in physical exercise. Thus, obese individuals are at great risk to gain even more weight.

As described above, weight victimization is associated with disordered eating and some studies have indicated that e binge eating may be a coping mechanism for those who have difficulty expressing negative emotions (; Pinaquy, Chabrol, Simon, Louvet, & Barbe, 2003;

Zeeck, Stelzer, Linster, Joos, & Hartmann, 2011). Puhl and Luedicke (2012) found that overweight adolescents who experienced weight-based teasing had higher depression and anger, as well as increased food consumption. Obese patients with binge eating disorder reported difficulty with regulation of emotion (Gianini, White, & Masheb, 2013). Obese individuals reported high levels of emotional eating (; Pauli-Pott, Becker, Albayrak, Hebebrand & Pott,

2013) and anger was associated with disordered eating among obese individuals of both genders

(Edman, Yates, Aruguete, & DeBord, 2005; Fassino et al., 2003).

Gender, Eating Disorders, and Body Dissatisfaction

A number of studies have found that American females have higher rates of weight problems, depression, and negative eating attitudes than males (Baillie & Copeland, 2013;

Lynch, Eldridge, Edman, & Yates, 2011). Women are more likely to misperceive themselves as overweight which was associated with increased risk of depression among adolescent females

(Vaughan & Halpern, 2010). The psychological impact of weight stigmatization appears especially prevalent among women and this may be because of the importance of a woman’s weight in her self-definition (Grover, Keel, & Mitchell, 2003). For example, low self-esteem was observed among obese women (Smith et al., 2014).. One reason that women may bemay be highly sensitive to their weight is because of the media’s suggestion that female thinness results in beauty and success (Harrison & Cantor, 1997; Tiggemann & Slater, 2004). Studies indicate OBESITY AND PSYCHOLOGICAL DISTRESS 5 thatindicate that media exposure is associated with body dissatisfaction and disordered eating among females (Slevec & Tiggemann, 2011; Swami, Taylor, & Carvalho, 2011).. The media portrayal of the thin woman as attractive and successful may impact males’ biases since obese women were less likely to have a romantic partner (Ali, Rizzo, Amialchuk, & Heiland, 2014) and obese males preferred normal weight romantic partners (Aruguete, Yates, Edman, &

Sanders, 2007). Thus, it is not surprising that obese women often experience psychological problems such as depression, body dissatisfaction and low self-esteem.

Exercise and Psychological Distress

As described above, weight stigmatization is associated with exercise avoidance (Puhl &

Luedicke, 2012) which is of concern since exercise has been found to have a number of positive health benefits and is one of the most effective ways to manage weight problems. For example, exercise is associated with higher self-esteem, lower body dissatisfaction, and positive mood among normal weight and obese individuals (Adams, Moore, & Dye, 2007; Strohle et al., 2007) and obese women who participated in aerobic exercise reported lower depression than a control group (Sarsan, Ardic, Ozgen, Topuz, & Sermez, 2006). However, overweight and obese adults and children tend to exercise less than other weight groups (Shriver et al., 2011; Wright, 2011;

Yates, Edman, Crago, Cromwell, 2001). Gender differences in exercise have been observed with males reporting higher levels of exercise participation, commitment and intensity than females across a number of ethnic and weight groups (; Edman et al., 2005; Hoelscher, Barroso, Springer,

Castrucci, & Kelder, 2009; Yates, Edman, & Aruguete, 2004).

The present study examined whether there are gender and weight category differences in depressed mood, disordered eating, body dissatisfaction, self-reported health, selection of healthy figures, and amount of exercise among college students in Hawaii. We also examined whether OBESITY AND PSYCHOLOGICAL DISTRESS 6 disordered eating attitudes, body dissatisfaction and exercise were associated with depressed mood among obese individuals. We predicted that:

H1: Obese students and female students would report higher disordered eating scores on

the McKnight Risk Factor Survey-IV (MRFS-IV) disordered eating subscales: peer

weight-based teasing, emotional eating, media modeling, weight control behavior; and

the EAT-26 than non-obese and male students. Non-obese students and men would

report higher scores on the MRFS-IV subscales of self-confidence and appearance

concerns than obese students and women.

H2: Obese students and female students would report higher depressed mood, body

dissatisfaction, and lower levels of exercise than non-obese students and males.

H3: Disordered eating attitudes and behaviors, assessed by the EAT-26 and subscales of

the MRFS-IV, would be positively associated with depression and body dissatisfaction

for both genders. Also, the MRFS-IV social subscales of peer weight-based teasing and

media modeling would be associated with binge eating, emotional eating, weight

concerns, weight control, and low self-confidence. Exercise measures would be

negatively associated with depression for both genders.

H4: A higher percentage of obese women would score above the CES-D cutoff (greater

than or equal to a score of 16) and the EAT-26 cutoff (greater than or equal to a score of

20) indicating high risk for depression and disordered eating than obese men.

Method

Participants

A convenience sample of 872 students, representing six University of Hawaii campuses, volunteered to participate in the study including 339 males and 553 females (N = 533). The mean OBESITY AND PSYCHOLOGICAL DISTRESS 7 age for males was 23.02 (SD=7.25) and females 23.87 (7.92). A total of 136 of these students were categorized as obese, since they reported body mass indexes (BMIs) at 30 or higher, which is the established cutoff for obesity. BMI was calculated from self-reported height (m) and weight (kg) as kg/m2, and the average BMI was 34.76 (SD = 4.89) for obese males and 34.59

(SD = 3.89) for obese females. The average age for obese males was 25.67 (SD = 8.76) and

25.83 (SD = 10.25) for females. A total of 45% of the obese sample were Asian/Pacific Islander,

27% White, 23% multiple ethnicity, and 5% other.

Materials and Procedures

Participants signed a written consent form prior to data collection that was approved by the Institutional Review Board of the University of Hawai’i. The survey packet consisted of several sections including four previously validated screening instruments. Research instruments included the Center for Epidemiologic Depression Scales (CES-D), McKnight Risk Factor

Survey-IV (MRFS-IV), Eating Attitudes Test-26, (EAT-26), the Figure Rating Scale (FRS), exercise measures and measures of physical exercise. Students were also requested to provide weight, height, gender and ethnicity. Surveys were administered in a variety of social science, nursing, and philosophy classes. Teachers were contacted in advance and agreed to make time available either during or after classes on a voluntary basis. Students completed the surveys using paper and pencil.

Center for Epidemiologic Studies-Depression (CES-D). The CES-D was developed to measure depressive symptoms in the general population, and consists of 20 four point Likert- type items (Radloff, 1977). The CES-D has been found to have adequate test-retest reliability, internal consistency, and convergent and divergent validity (Morin et al., 2011; Opoliner,

Blacker, Fitzmaurice, & Becker, 2013; Van Dam & Earleywine, 2011) and is a reliable and valid OBESITY AND PSYCHOLOGICAL DISTRESS 8 measure of depression among a variety of age and ethnic groups including Asian and Pacific

Islanders (Aruguete, Yates, Edman, & Sanders, 2007; Boutin-Foster, 2008; Cheng & Chan,

2008; Kanazawa, White, & Hampson, 2007). There are four sub-scales including depressed affect (DA), positive affect (PA), somatic (SOM) and interpersonal (IP). The total CES-D score can range from 0 - 60. Traditionally, individuals with scores of 16 or greater are viewed as being at risk for depression (Radloff, 1977), and will be referred to as “high scorers”. The Cronbach’s alpha for the present sample was .76.

McKnight Risk Factor Survey-IV (MRFS-IV). The MRFS-IV is a self-report instrument originally designed to assess risk factors for the development of eating disorders among pre- and post-adolescent girls (Shisslak et al., 1999). The MRFS-IV assesses the individual’s eating behaviors and attitudes, as well as social influences on eating such as weight- based teasing and media influences. Because our main interest was in the relationship between gender, body size, body image and risky eating attitudes and behaviors, 36 items were selected from the original MRFS-IV survey that assesses the following 10 risk domains: appearance appraisal (3 items), binge eating (2 items), confidence (3 items), emotional eating (3 items), media modeling (2 items), over-concern with weight and shape (5 items), purge behavior (3 items), support/sharing (3 items), weight control behaviors (7 items), and weight teasing by peers

(5 items). An advantage of the MRFS-IV is that it includes psychosocial domains such as media influences and teasing by peers. Items such as “In the past year, how often have you worried about having fat on your body?” are rated on 5-point Likert-type scales ranging from 1 = never to 5 = always. Convergent validity, internal reliability and test-retest reliability have been reported for the over-concern with weight domain (Shisslak, et al., 1999). More information concerning the scoring of the MRFS-IV is available by contacting the Laboratory for the Study OBESITY AND PSYCHOLOGICAL DISTRESS 9 of Behavioral Medicine (http://bml.stanford.edu). Cronbach’s alpha for the MRFS-IV for the present data was .85.

Eating Attitudes Test (EAT-26). The EAT-26 is a short form of the original Eating

Attitudes Scale (EAT) (Garner & Garfinkel, 1979), and has been found to have very good reliability and validity as a measure of eating disorder symptoms among the general population

(Garner, Olmsted, Bohr, & Garfinkel, 1982). An EAT-26 score greater than 20 has been found to be predictive of eating disorder pathology (Mann et al., 1983). The EAT-26 has been successfully used among a number of ethnic groups in Hawaii (Lynch et al., 2011) and demonstrated good internal consistency and discriminant validity (Clausen, Rosenvinge,

Friborg, & Rokkedal, 2011; Siervo, Boschi, Papa, Bellini, Falconi, 2005). EAT-26 total scores of

20 or higher indicated risk for disordered eating (Garner, 1997). Cronbach’s alpha for the EAT-

26 was .85.

Figure Rating Scale (FRS). The FRS, originally developed by Stunkard, Sorenson, and

Schulsinger (1983) is designed to assess body size or shape satisfaction. Participants choose one of nine gender-specific body shape figures that appear most similar to their current body shape and then choose the figure that most closely matches their preferred body shape. The absolute value of the discrepancy scores is computed to indicate the level of body dissatisfaction (BD). In psychometric studies, this method of assessing BD has shown high test-retest reliability and moderate construct validity when compared to other methods of BD assessment among females, and is an appropriate measure of body size dimension of body dissatisfaction among males

(Thompson & Altabe, 1991; Williams, Gleaves, Cepeda-Benito, Erath, & Cororve, 2001).

Physical Exercise Levels. Participants were asked to report the total number of hours of exercise per week, rate their exercise intensity (1 = mild and 3 = strenuous), commitment to OBESITY AND PSYCHOLOGICAL DISTRESS 10 exercise (1 = couldn’t care less and 7 = totally committed), and exercise frequency (1 = rarely and 3 = regularly). Participants were also asked to report the approximate number of hours of exercise per week and rate how healthy they felt (1 = not healthy and 7 = very healthy).

Results

H1 Tests

MRFS analyses. Using the total sample (N = 872), a 2 (obese vs. non-obese) by 2

(gender) MANOVA analysis indicated significant multivariate main effects for both weight category, Wilks’ lambda = .861, F(13, 856) = 10.67, p < .0001, and gender, Wilks’ lambda = .

895, F(13, 856) = 7.75; p < .0001, on MRFS domain scores with no significant interaction, supporting H1. Since the multivariate test was significant, individual univariate tests were conducted for main effects on individual MRFS domain scores.

Obesity effects. As predicted, obese students reported higher scores on the following

MRFS subscales (see Table 1): weight-based teasing, F(1, 868) = 35.16, p < .0001; weight concern, F(1, 868) = 80.80, p < .0001; emotional eating, F(1, 868) = 14.67, p < .0001; media influence, F(1, 868) = 11.04, p < .001; weight control, F(1, 868) = 41.76, p < .0001; and binging, F(1, 868) = 5.24, p < .05. Obese students also reported lower self-confidence, F(1, 868)

= 5.49, p < .05, and less appearance concerns, F(1, 868) = 38.79, p < .0001. There were no obesity category differences in the purging or social support sub scale scores of the MRFS; and contrary to our prediction, there were no obesity category differences in EAT-26 scores.

Gender effects. Univariate analyses also revealed that females reported higher scores on weight-based teasing, F(1, 868) = 11.88, p < .001; weight concern, F(1, 868) = 60.42, p < .0001; emotional eating, F(1, 868) = 35.21, p < .0001; media influence, F(1, 868) = 19.40, p < .001; weight control, F(1, 868) = 32.14, p < .0001; purging, F(1, 868) = 7.65, p < .05; social support, OBESITY AND PSYCHOLOGICAL DISTRESS 11

F(1, 686) = 13.02, p < .001; and the EAT-26 total score, F(1, 868) = 18.70, p < .001, supporting

H1. Males reported higher levels of self-confidence, F(1, 868) = 113.86, p < .0001, and appearance concerns, F(1, 868) = 20.01, p < .0001. Contrary to our prediction, there were no gender differences in binge eating scores.

H2 Tests

Emotion-related analyses. A second 2 (obesity category) x 2 (gender) MANOVA analysis revealed significant gender, Wilks’ lambda = .971, F(5, 831) = 5.03, p < .0001, and weight category differences, Wilks’ lambda = .793, F(95, 831) = 43.50, p < .0001, on measures of body dissatisfaction, depression, exercise frequency, exercise intensity, and exercise regularity, with no significant interaction, supporting H2.

Obesity effects. As predicted, subsequent ANOVA analyses revealed that obese students reported higher depression, F(1, 865) = 6.28, p < .05, and body dissatisfaction scores, F(1, 868)

= 221.27, p < .0001. Also, as predicted, obese students reported lower levels of exercise frequency, F(1, 852) = 11.83, p < .001, exercise regularity, F(1, 851) = 16.33, p < .0001, and exercise intensity, F(1, 846) = 9.29, p < .01, than students of normal weight, supporting H2.

Gender effects. Females indicated higher body dissatisfaction scores, F(1, 861) = 8.68, p

< .01, than males, but there were no gender differences in depression. Also, females reported lower exercise scores than males as follows: exercise frequency, F(1, 852) = 7.39, p < .01; exercise regularity, F(1, 851) = 8.20, p < .01; and exercise intensity, F(1, 846) = 19.43; p < .

0001.

H3 Tests

In order to examine H3, Pearson correlation analyses were conducted among the subsample of only obese students (N = 136) for each males (N = 58) and females (N = 78) OBESITY AND PSYCHOLOGICAL DISTRESS 12 separately to determine whether there were relationships among measures of disordered eating attitudes and behaviors, body dissatisfaction, exercise performance dissatisfaction and measures of physical exercise. As shown in Table 2, all 10 sub-scales of the MRFS and the EAT-26 significantly correlated with depression among obese females, supporting H3. Both the EAT-26 score and body dissatisfaction score correlated with depression for males.. Eight of the 10

MRFS sub-scales correlated with depression among obese males, with only weight control behaviors and social support demonstrating no association. Also, in support of H3, weight-based teasing and media modeling were positively associated with body dissatisfaction, binge eating, emotional eating, and weight control behaviors, and negatively associated with self-confidence among obese students of both genders. Contrary to our prediction, none of the exercise measures correlated with depression for either gender.

H4 Tests

Chi-square analyses were conducted on the subsample of obese students to o examine whether a higher percentage of obese females were at high risk for depression and disordered eating than obese men (H4). As predicted, there were significant gender differences in the percent of individuals with high scores on the EAT-26 with 12% of the females but 0% of males scoring above the cutoff of 20, x2(1) = 7.12, p < .01. Contrary to our prediction, however, there were no gender differences in the percent of individuals with high CES-D scores with 43% of obese females and 41% of obese males reporting scores above the cutoff.

Discussion

As predicted, obese students reported higher levels of teasing, media influence, emotional eating, weight concerns, binge eating, weight control behaviors, and lower self-confidence and appearance concerns than normal weight students. The higher levels of weight-based teasing OBESITY AND PSYCHOLOGICAL DISTRESS 13 suggest a pattern of weight victimization, with similar associated consequences of low self- confidence and high levels of emotional eating found in previous research (Greenleaf et al.,

2014; Puhl & Luedicke, 2012). Also, the influence of media was higher among obese students.

Sensitivity to the media's linking of thinness to attractiveness and success likely contributes to the lower self-confidence, high body dissatisfaction, and higher weight control behaviors among obese individuals (Slevec & Tiggemann, 2011; Swami et al., 2011).

Our prediction that females would report higher levels of negative eating attitudes than males was also supported: women indicated more weight concerns, were more influenced by the media, had higher levels of binge and emotional eating, and were more dissatisfied with their bodies than men. The finding supports previous research (Baillie & Copeland, 2013; Lynch et al., 2011). Women also reported less self-confidence and appearance concerns. Although obese females were at higher risk than males for disordered eating, the EAT-26 scores were low with only 12% of females scoring above the EAT-26 cutoff, which is lower than previous studies of women which ranged between 15-23% (Calderon, 2006; Garner, 1997). More surprising is the finding that no obese males scored above the EAT-26 cutoff. Further research should examine why obese students in Hawaii report such low risk of disordered eating as measured by the EAT-

26. Our prediction that obese females would report higher risk of depression was not supported since obese students of both genders were at risk for depression with more than 40% scoring above the CES-D cutoff and support previous research suggesting high risk of depression among obese youth (Goldfield et al., 2010). As predicted, obese students and female students indicated lower exercise than other students. Additionally, obese students, especially females, report high levels of binge and emotional eating, low self-confidence and low exercise levels which suggest a greater likelihood of gaining even more weight. OBESITY AND PSYCHOLOGICAL DISTRESS 14

The present data support previous findings of an association between disordered eating attitudes, and depression among obese students of both genders (Wildes, Simons, Marcus, 2005;

Yu et al., 2013). The findings also indicated that social factors such as weight-based teasing and media modeling are linked with body dissatisfaction, depressed mood, binge and emotional eating, and low self-confidence among the obese of both genders (Puhl & Luedicke, 2012; Sutin

& Terracciano, 2013). Thus, it appears that obese students of both genders experience weight victimization and the resulting consequences including depressed mood, binge eating, body dissatisfaction and low self-confidence which support previous findings (Puhl & Luedicke, 2012;

Sutin & Terracciano, 2013). Obese women appear to be particularly vulnerable and report the highest scores on nearly every measures of psychological distress including body dissatisfaction, binge and emotional eating and weight control behaviors. They also report the highest scores on the social items of media influence and weight-based teasing which both correlated with measures of psychological distress, low self-confidence and low levels of physical exercise.

These findings suggest that weight victimization may be a factor in exercise avoidance, supporting previous research by Puhl and Luedicke (2012) and suggest that obesity prevention programs and weight intervention programs targeted to obese females and incorporate weight- based stigma reduction are needed. It is important that these programs address the psychological, social and physical issues faced by obese women such as low confidence, weight- based teasing, and body dissatisfaction in order to encourage weight loss program participation and completion. The lack of association between exercise and depression among the obese sample was unexpected, but may be due to the overall low involvement in exercise activities.

A major strength of the study was the use of two measures to assess disordered eating: the

MRFS and the EAT-26. An advantage of using the MRFS is that it assesses psycho-social OBESITY AND PSYCHOLOGICAL DISTRESS 15 domains such as the influence of media, self-confidence and weight-based teasing, as well as eating behaviors such as purging, binging and emotional eating. The use of the EAT-26 allowed us to obtain cutoff scores to determine the percentage of students at risk for disordered eating.

However, there are also several limitations to the present study. The data are self-report and students may not be accurate in their reporting of variables such as weight or height. The sample sizes for the obese group ethnic comparisons were small, which resulted in lower statistical power for these analyses. Also, our measure of body dissatisfaction assesses the thinness dimension but not muscle or tone dissatisfaction, which is more common among males (Yean et al., 2013). Thus, future studies with males should include a measure of muscle satisfaction.

Conclusion

The present data indicate that obese students and female students experience more weight-based teasing and media influences than other students. These social influences are associated with higher risk of disordered eating, body dissatisfaction and depression among obese men and women. Obese students reported lower health quality and less exercise than students of normal weight; however, no association was found between exercise and depressed mood. These findings suggest that obese college students, especially females, are at high risk for even greater weight gain since they report higher levels of binge and emotional eating, greater body dissatisfaction, experience greater weight prejudice, and have high risk of depression than students of normal weight. Accordingly, it is important to develop appropriate weight intervention and treatment programs that address both the physical, social and psychological issues experienced by obese students.

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Table 1.

Gender and BMI Differences in Eating Disorder Risk Factors

High BMI (n = 58) (SD) M M

1. Depression (CES-D) (9.29) 16.59 15.31 2. Body Dissatisfaction (FRS) (0.84) 2.02 1.04 3. Eating Disorders (EAT-26) (4.39) 6.38 8.08 4. Appearance Concerns (0.77) 3.02 3.15 5. Binge Eating (0.92) 2.19 2.16 6. Confidence (0.74) 3.40 3.30 7. Emotional Eating (0.66) 1.98 2.14 8. Media Modeling (0.94) 2.59 2.70 9. Weight Concerns (0.98) 3.19 3.07 10. Purging Behavior (0.29) 1.19 1.23 11. Social/Support (1.16) 3.28 3.80 12. Weight Control Behaviors (0.79) 2.43 2.37 13. Weight Teasing by Peers (0.65) 1.79 1.62 Note: CES-D = Center for Epidemiological Studies – Depression Scale. FRS = Figure Rating Scale. EAT-26 = Eating Attitudes Test-26. Variables 4 – 13 are subscales of the McKnight Risk Factor Survey-IV. Depression: n(male normal) = 281, n(male high) = 58, n(female normal) = 454, n(female high) = 76 Body Dissatisfaction: n(male normal) = 274, n(male high) = 58, n(female normal) = 455, n(female high) = 78 OBESITY AND PSYCHOLOGICAL DISTRESS 26 OBESITY AND PSYCHOLOGICAL DISTRESS 27

Table 2.

Pearson Correlations Among Study Variables for Females, BMI ≥ 30 1 2 3 4 5 6 7 8 1. Depression (CES-D) —— 2. Body Dissatisfaction (FRS) -.007 —— 3. Eating Disorders (EAT-26) .494** .177 —— 4. Appearance Appraisal -.455** -.395** -.454** —— 5. Binge Eating .449** .056 .407** -.255* —— 6. Confidence -.536** -.310** -.458** .780** -.296** —— 7. Emotional Eating .378** .114 .417** -.312** .760** -.369** —— 8. Media Modeling .455** .214 .556** -.420** .408** -.413** .460** —— 9. Weight Concerns .454** .332** .547** -.536** .405** -.489** .403** .707** 10. Purging Behavior .295** -.062 .249* -.257* .179 -.340** .314** .151 11. Support/Sharing -.295** -.082 -.075 .309** -.230* .417** -.332** -.029 12. Weight Control Behaviors .478** .075 .597** -.222 .411** -.344** .460** .559** 13. Weight Teasing by Peers .490** .109 .520** -.439** .393** -.348** .432** .483** Note: CES-D = Center for Epidemiological Studies – Depression Scale. FRS = Figure Rating Scale. EAT-26 = Eating Attitudes Test-26. Variables 4 – 13 are subscales of the McKnight Risk Factor Survey-IV. N = 76 **p < 0.01 level. *p < 0.05 level. OBESITY AND PSYCHOLOGICAL DISTRESS 28

Table 3.

Pearson Correlations Among Study Variables for Males, BMI ≥ 30 1 2 3 4 6 7 9 1. Depression (CES-D) —— 2. Body Dissatisfaction (FRS) .384** —— 3. Eating Disorders (EAT-26) .273* .244 —— 4. Appearance Appraisal -.535** -.395** -.189 —— 5. Binge Eating .303* .181 .390** -.313* — 6. Confidence -.633** -.233 -.216 .643** — - . 2 7. Emotional Eating .445** .434** .327* -.390** —— 9 8 * - . 2 8. Media Modeling .386** .308* .291* -.420** .436** 9 0 * - . 5 9. Weight Concerns .545** .466** .512** -.614** 5 .485** —— 3 * * - . 10. Purging Behavior .267* .127 .246 -.177 1 .221 .397** 7 9 . 1 11. Support/Sharing -.254 .015 .102 .072 .094 .042 4 2 - . 12. Weight Control Behaviors .199 .006 .594** .007 0 .246 .496** 4 3 13. Weight Teasing by Peers .554** .289* .403** -.420** - .365** .563** . OBESITY AND PSYCHOLOGICAL DISTRESS 29

3 3 2 * Note: CES-D = Center for Epidemiological Studies – Depression Scale. FRS = Figure Rating Scale. EAT-26 = Eating Attitudes Test-26. Variables 4 – 13 are subscales of the McKnight Risk Factor Survey-IV. N = 58 **p < 0.01 level. *p < 0.05 level.

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