The Stress Process and Eating Pathology Among Racially Diverse Adolescents Seeking Treatment for Obesity

Recent years have seen a proliferation of treatments to address the epidemic of weight gain among young people. It is also essential to study unhealthy eating behaviors among obese adolescents, as dieting and unhealthy weight control behaviors lead to maintenance of overweight in this age group (Haines, Neumark-Sztainer, Wall, & Story, 2007b; Neumark-Sztainer et al., 2007). Stress may also influence eating behaviors and weight gain, such as through its association with dietary habits that support obesity (Cartwright et al., 2003; Jenkins, Rew, & Sternglanz, 2005). Stressors may also affect life-long health. The experience of negative life events during childhood (e.g., family violence) has been linked to obesity in adulthood, an association that is partially accounted for by the use of food in response to stress (Greenfield & Marks, 2009). The process of social stress consists of the sources of stress, the mediators of stress, and the manifestations of stress (Pearlin, 1999; Pearlin, Menaghan, Lieberman, and Mullan, 1981). The disability-stress-coping model proposes that certain risk factors (i.e., disease characteristics, functional independence, and stress) predict psychosocial functioning in children with illnesses, but that these associations are influenced by intrapersonal and environmental variables and stress processing variables (i.e., cognitive appraisal and coping; Wallander & Varni, 1992, 1995). An application of stress-and-coping models to disordered eating suggests that individuals who lack effective coping or problem-solving may turn to disordered eating behaviors, such as emotional eating or binging, as a means to cope (Greenfield & Marks, 2009; Shatford & Evans, 1986). The current study applies the process of stress to eating-related pathology among obese adolescents. We focus on sources of stress identified in research, including environmental stressors (e.g., Barker, Williams, & Galambos, 2006) and psychological status variables such as low self-esteem (e.g., Womble et al., 2001) and depressive symptoms (e.g., Eddy et al., 2007). Pearlin et al. (1981) identified lowered self-esteem as a secondary source of stress impacted by life events, such as job loss, and viewed depressive symptoms as one manifestation of these stressors. In a later study, Shatford and Evans (1986) discovered that depressive symptoms functioned similarly to low self-esteem as a source of stress contributing to bulimic behavior. In the current study, self-esteem and depressive symptoms are conceptualized as possible mediating variables in the relationship between stressors and eating pathology among obese adolescents. The outcome variable is a global measure of eating pathology comprised of weight concern, shape concern, eating concern, and restraint. Two types of environmental stressors were considered in the current investigation: Daily hassles and weight teasing. Daily hassles are associated with increased snacking, particularly in those who engage in emotional eating (O’Connor, Jones, Conner, McMillan, & Ferguson, 2008), and women who binge eat consume more calories on high stress days (Crowther, Sanftner, Bonifazi, & Shepherd, 2001). Teasing and rejection are pervasive among obese children and adolescents (van den Berg, Neumark-Sztainer, Eisenberg, & Haines, 2008), and teasing among obese adolescents is associated with behaviors that contribute to overweight (Hayden-Wade et al., 2005; Storch et al., 2007). In this study, we were interested in how daily hassles and teasing might be associated with eating pathology among obese adolescents. Previous research has shown that negative affect mediates the relations between teasing and eating pathology in treatment-seeking overweight youth (Eddy et al., 2007), young adults (Womble et al., 2001), and female adolescents (Hutchinson, Rapee, & Taylor, 2010; Suisman, Slane, Burt, & Klump, 2008; van den Berg, Wertheim, Thompson, & Paxton, 2002). Fewer studies have focused on daily hassles’ relation with eating pathology among adolescents, although some have studied stress more generally. Celio Doyle, le Grange, Goldschmidt, and Wilfley (2007) found that overweight adolescents at risk for eating disorders reported more stress than those at low-risk. Stress and negative affect were associated with same-day binge eating among undergraduates (Barker et al., 2006), and low self-esteem mediated the relations of stress and emotion-focused coping with disturbed eating attitudes in female adolescents (Fryer, Waller, & Kroese, 1997). At this time, the literature is bereft of research that applies models of the psychological and behavioral manifestations of stress (Pearlin, 1999; Pearlin et al., 1981; Wallander & Varni, 1992, 1995) to children who suffer from obesity. The current study fills this gap by investigating how stressors such as daily hassles and weight-teasing may be related to unhealthy eating. It also adds to our knowledge via its inclusion of a form of stress that is highly relevant to obese adolescents, weight-teasing, as well as that which may be commonly experienced by adolescents of all sizes, daily hassles. In addition to lower self-esteem and depressive symptoms, this study also included a measure of emotional upset specific to weight-teasing. Although obese adolescents are likely to show higher levels of depressive symptoms and decreased self-esteem in the face of environmental stress, it is possible that the experience of being teased may cause specific emotional distress (Quinlan, Hoy, & Costanzo, 2009). Additionally, the current study adds to the literature by investigating these relations in a primarily African American sample of adolescents. Weight-teasing has been shown to be equally problematic (Stern et al., 2007; van den Berg et al., 2008) and to have similar relations with emotional health across ethnic groups (Eisenberg, Neumark-Sztainer, & Story, 2003). However, there is evidence that White females experience more weight-related distress, which is associated with greater depressive symptoms (Young-Hyman et al., 2006), and White adolescents appear to experience greater eating pathology than their Black counterparts (Bisaga et al., 2005; Elliott, Tanofsky-Kraff, & Mirza, 2013). To our knowledge, ethnic differences have not been examined in models that seek to explain eating pathology.