Examining the Relationship between Individuals with Binge Eating or Binge Eating Disorder and Delaying Mental Healthcare Due to a Fear-Based Belief of Experiencing Weight-Discrimination

Background and Purpose: Despite being the most common eating disorder, binge eating disorder (BED) presents significant barriers to mental healthcare access. While affecting all body sizes, BE and BED (BE/BED) are often associated with higher body weights, leading to weight-based discrimination, especially in healthcare. These experiences can be internalized and impact individuals' cognitions, particularly beliefs about seeking and receiving care, and thus necessitate further study in BE/BED populations.

To date, no known research has explored individual cognitive-level barriers to receiving treatment for BED populations specifically. The purpose of this research was to investigate the relationship between having BE/BED and delaying mental healthcare due to a fear-based belief of experiencing weight discrimination, and the association with weight status.

Methods: This was a secondary data analysis of a cross-sectional survey as part of a larger research initiative on relationships with food and bodies. Participants were recruited through convenience sampling via online social media and professional social work and ED-related networking, oversampling for minoritized identities (i.e., race/ethnicity, gender identity, sexual orientation, body size, etc.). An online survey was administered, and data were collected in the Summer of 2021. A total of 337 participants were in this study that consisted of a subsample of respondents who indicated they had ever delayed or avoided mental healthcare. 44.8% of participants reported having BE/BED, the average BMI was 27.9 (SD=8.6), the average age was 33.53 (SD=10.5), and most of the participants were non-Hispanic White (54.9%), identified as Female/Woman (59.1%), and indicated their highest level of education as having at least an undergraduate degree (69.1%).

A binary logistic regression moderation analysis was conducted with those either having or not having BE/BED as the binary predictor variable, delaying or not delaying mental healthcare due to a fear-based belief of experiencing weight discrimination as the binary outcome variable, body mass index (BMI)- dichotomized into either lower weight BMI (14.0-29.9) or higher weight BMI (30.0 and greater)- as the moderator variable, and race/ethnicity and gender identity as categorical control variables.

Results: The moderation analysis revealed that those with BE/BED had 3.9 times greater odds of delaying mental healthcare due to a fear-based belief of experiencing weight discrimination compared to those without BE/BED, but only for those with higher BMIs. There was no relationship found between having BE/BED and delaying care due to a fear-based belief of experiencing weight discrimination for those with lower BMIs.

Conclusion and Implications: Findings highlight the significant role of individual-cognitive beliefs, specifically regarding weight-discrimination, as barriers to receiving mental healthcare for individuals with BE/BED. Given the pervasive nature of weight stigma, especially in healthcare settings and for larger-bodied individuals, fostering weight-inclusive provider-patient interactions can address internalized stigma and reduce beliefs about weight discrimination as a barrier to care.