Obesity and impairment in psychosocial functioning in women: The mediating role of eating disorder features

Objective: The objective was to test the hypothesis that, in women, the association between obesity and impairment in psychosocial functioning is mediated by levels of weight and shape concerns and/or binge-eating frequency. Research Methods and Procedures: Self-report measures of eating disorder psychopathology, mental health functioning, subjective quality of life in the psychological and social domains, and days "out-of-role" associated with any (physical or mental) health problem, were completed by a community sample of women classified as obese (BMI ≥30 kg/m², n = 639) or non-obese (BMI <30 kg/m², n = 4253). For each of the dependent measures, regression models were used to test the hypothesis of mediation by comparing the strength of the relationship between independent and dependent variables with and without inclusion of the putative mediator in the regression model. Results: On each measure, the conditions for perfect mediation were satisfied when weight or shape concerns acted as the putative mediator, indicating that there was no association between obesity and functional impairment after controlling for weight or shape concerns. In contrast, associations between obesity and impairment in psychosocial functioning remained highly significant when binge-eating frequency was the putative mediator. Discussion: The findings suggest that in women, weight and shape concerns are an important mediator of the relationship between obesity and impairment in psychosocial functioning, whereas binge eating may not be of primary importance. A greater focus on body acceptance in obesity treatment may be indicated.