From one end of the scale to the other: overweight and obese individuals’ experiences with anorexic attitudes, cognitions, and behaviours

Abstract

AbstractThe weight-based definition of anorexia nervosa (AN) can result in heavier individuals being excluded from evidence-based interventions and erroneously included in practices with negative physical and psychological consequences. Our purpose was to address the AN weight criteria limitation by expanding upon the components of disordered eating underlying membership in weight categories that are considered unhealthy. In this cross-sectional study, 733 male and female participants completed online questionnaires assessing age, gender, BMI (height and weight), and disordered eating behaviours and attitudes. Participants were grouped according to their weight status (underweight, normal weight, overweight, and obese). Results indicated that BMI was positively associated with many aspects of disordered eating but was inversely associated with restricting eating, excessive exercise, and muscle building in women. Underweight men and women reported similar levels of body dissatisfaction, but compared to men, the effect was much more pronounced in women as weight increased. Taken together, lighter-weight individuals reported higher levels of AN-specific behaviour (restricting eating) compared to heavier-weight participants. In contrast, heavier-weight individuals had higher AN-related attitudes, cognitions, and behaviours, such as body dissatisfaction, cognitive restraint, and binge eating. These results support that AN attitudes, cognitions, and behaviours can be found in individuals regardless of whether they are underweight or obese. Future research is needed to develop interventions addressing anorexic symptoms in people considered overweight or obese to meet their specific needs.