Background
Following bariatric surgery, some patients experience adverse psychiatric outcomes, including substance use, suicidality, and self-harm. These factors are commonly associated with posttraumatic stress disorder (PTSD) and related symptoms (PTSD-S) that develop following adverse childhood experiences (ACE) and traumatic events. However, emerging evidence suggests chronic discrimination may also contribute to PTSD-S. Weight-based mistreatment is salient for people with obesity, but has received little attention in relation to PTSD-S.
Methods
Our study examined factors that may contribute to the link between experienced weight bias (WB), common in individuals seeking bariatric surgery, and PTSD-S. Setting: Teaching Hospital, Surgical Weight Loss Center, United States Methods: 221 participants completed self-report surveys of experienced, anticipated, and internalized WB, shame, mindfulness, self-compassion, ACE, and PTSD-S. Demographics and trauma history were obtained from patient medical records. Multiple regressions examined associations between Experienced-WB and mechanisms of PTSD-S, covarying demographics, ACE and trauma. Hayes' PROCESS macro tested two serial mediations (Experienced-WB->Anticipated-WB->Internalized-WB->shame->self-compassion or mindfulness->PTSD-S).
Results
All constructs accounted for substantial PTSD-S variance, R2=.673. Experienced-WB was associated with greater PTSD-S through two risk paths implicating Anticipated-WB-> shame, and Anticipated-WB->Internalized-WB->shame; two protective paths linked Experienced-WB to less PTSD-S through greater proximal mindfulness. Two findings replicated, with self-compassion similarly linked to less Experienced-WB-related PTSD-S via five protective paths.
Conclusions
Conclusions: Over and above ACE and trauma, Experienced-WB may contribute to PTSD symptoms through paths implicating Anticipated-WB, Internalized-WB, and shame. Longitudinal research is needed. Mindfulness and self-compassion may prove novel targets to disrupt these sequelae and reduce risk of adverse postoperative psychiatric outcomes.