Internalized Weight Bias Is Associated With Dysregulated Affect and Binge Eating in Daily Life Among Adults of High Body Weight With and Without HIV.

BACKGROUND

High weight status (ie, body mass index ≥30 kg) is prevalent among people living with HIV, yet few studies have examined internalized weight bias (IWB) and its links to health outcomes in this population.

OBJECTIVE

This study examined whether momentary IWB was associated with contemporaneous and prospective risk for dysregulated affect and binge eating in the daily lives of adults of high weight status with HIV, and a reference group of adults of high weight status without HIV.

DESIGN

This study is a secondary analysis of data from a 2-week ecological momentary assessment study conducted from 2018 to 2019 in Rhode Island. Five signal-contingent prompts were delivered daily at semirandom intervals to assess outcomes.

PARTICIPANTS/

SETTING

Participants were aged 18 years and older with a body mass index ≥30 with an HIV diagnosis (n = 28) and without an HIV diagnosis (n = 39).

MAIN OUTCOME MEASURES: Momentary negative affect, positive affect, stress, and binge eating were assessed.

STATISTICAL ANALYSES PERFORMED: Momentary IWB was within-person centered. Multilevel generalized linear models with a random intercept were used to test associations between IWB and outcomes. Models were run separately for adults with vs without HIV. Covariates were sexual orientation, race/ethnicity, gender, age, education level, body mass index, ecological momentary assessment adherence, and time.

RESULTS

Among people living with HIV, momentary elevations in IWB were associated with lower likelihood of positive affect (P < .01) and greater likelihood of binge eating (P < .05) at the same ecological momentary assessment prompt, and with lower likelihood of positive affect (P < .05) and greater likelihood of negative affect (P < .05) at the subsequent prompt. Among adults without HIV, momentary elevations in IWB were associated with a greater likelihood of concurrent negative affect (P < .001), stress (P < .001), and binge eating (P < .05), and with a greater likelihood of prospective stress (P < .01).

CONCLUSIONS

Findings link momentary elevations in IWB to dysregulated affect and binge eating in the daily lives of adults of higher weight, both with and without HIV. Future research investigating IWB in people living with HIV is warranted, given the limited work in this population.