Characterizing fear of weight gain and sensitivity to weight gain in individuals seeking weight loss treatment



Weight concern, including fear of weight gain and sensitivity to weight gain, is indicative of disordered eating in individuals with underweight or healthy weight. It is unknown, however, whether or how these constructs present in individuals with excess weight, particularly among those with binge-eating disorder (BED). This study sought to characterize fear of weight gain and sensitivity to weight gain and examine their relationship with disordered eating and depression symptoms, in individuals seeking weight loss treatment, both with and without BED.


Adults seeking weight loss treatment in an urban primary care clinic (N = 131) completed the Eating Disorder Examination interview and Beck Depression Inventory. Height and weight were collected.


Clinical levels of fear of weight gain and sensitivity to weight gain were present in this sample. Individuals with BED reported experiencing fear of weight gain (48.6%), significantly more than those without BED (20.9%); both groups reported similar and clinically elevated sensitivity to weight gain. Both constructs were related to greater levels of disordered eating and depression symptoms, at times based on BED status. Fear of weight gain was associated with overvaluation of weight and shape for those without BED only. Objective and subjective bulimic episodes were unrelated to fear of weight gain or sensitivity to weight gain, regardless of BED status.


Fear of weight gain and sensitivity to weight gain were common in this sample and may be maladaptive, as evidenced by associations with elevated eating psychopathology. Future studies should examine these variables within larger samples and should employ longitudinal designs.

Level of evidence

Level III: case–control analytic study.

This is a preview of subscription content, access via your institution.

Fig. 1

Data availability

The datasets generated during and/or analyzed during the current study are available from the senior author on reasonable request.


  1. 1.

    American Psychological Association (ed) (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  2. 2.

    Attia E (2010) Anorexia nervosa: current status and future directions. Annu Rev Med 61:425–435.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Fairburn CG, Cooper Z, Shafran R (2003) Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther 41(5):509–528.

    Article  PubMed  Google Scholar 

  4. 4.

    Fairburn CG, Cooper Z (1993) The eating disorder examination. In: Fairburn CG, Wilson GT (eds) Binge eating: nature, assessment, and treatment, 12th edn. Guilford Press, New York, pp 317–360

    Google Scholar 

  5. 5.

    Berg KC, Peterson CB, Frazier P, Crow SJ (2012) Psychometric evaluation of the eating disorder examination and eating disorder examination-questionnaire: a systematic review of the literature. Int J Eat Disord 45(3):428–438.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Grilo CM, Masheb RM, Lozano-Blanco C, Barry DT (2004) Reliability of the eating disorder examination in patients with binge eating disorder. Int J Eat Disord 35(1):80–85.

    Article  PubMed  Google Scholar 

  7. 7.

    Grilo CM, Masheb RM, Wilson GT (2001) Different methods for assessing the features of eating disorders in patients with binge eating disorder: a replication. Obes Res 9(7):418–422.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Rodgers RF, DuBois R, Frumkin MR, Robinaugh DJ (2018) A network approach to eating disorder symptomatology: do desire for thinness and fear of gaining weight play unique roles in the network? Body Image 27:1–9.

    Article  PubMed  Google Scholar 

  9. 9.

    Linardon J, Phillipou A, Castle D, Newton R, Harrison P, Cistullo LL, Griffiths S, Hindle A, Brennan L (2018) The relative associations of shape and weight over-evaluation, preoccupation, dissatisfaction, and fear of weight gain with measures of psychopathology: an extension study in individuals with anorexia nervosa. Eat Behav 29:54–58.

    Article  PubMed  Google Scholar 

  10. 10.

    Levinson CA, Zerwas S, Calebs B, Forbush K, Kordy H, Watson H, Hofmeier S, Levine M, Crosby RD, Peat C, Runfola CD, Bulik CM (2017) The core symptoms of bulimia nervosa, anxiety, and depression: a network analysis. J Abnorm Psychol 126(3):340–354.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Goldschmidt AB, Aspen VP, Sinton MM, Tanofsky-Kraff M, Wilfley DE (2008) Disordered eating attitudes and behaviors in overweight youth. Obesity (Silver Spring) 16(2):257–264.

    Article  Google Scholar 

  12. 12.

    Killen JD, Taylor CB, Hayward C, Haydel KF, Wilson DM, Hammer L, Kraemer H, Blair-Greiner A, Strachowski D (1996) Weight concerns influence the development of eating disorders: a 4-year prospective study. J Consult Clin Psychol 64(5):936–940.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Taylor CB, Altman T (1997) Priorities in prevention research for eating disorders. Psychopharmacol Bull 33(3):413–417

    CAS  PubMed  Google Scholar 

  14. 14.

    Hudson JI, Hiripi E, Pope HG Jr, Kessler RC (2007) The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 61(3):348–358.

    Article  PubMed  Google Scholar 

  15. 15.

    Grilo CM (2013) Why no cognitive body image feature such as overvaluation of shape/weight in the binge eating disorder diagnosis? Int J Eat Disord 46(3):208–211.

    Article  PubMed  Google Scholar 

  16. 16.

    Grilo CM, Hrabosky JI, White MA, Allison KC, Stunkard AJ, Masheb RM (2008) Overvaluation of shape and weight in binge eating disorder and overweight controls: refinement of a diagnostic construct. J Abnorm Psychol 117(2):414–419.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Grilo CM, White MA, Gueorguieva R, Wilson GT, Masheb RM (2013) Predictive significance of the overvaluation of shape/weight in obese patients with binge eating disorder: findings from a randomized controlled trial with 12-month follow-up. Psychol Med 43(6):1335–1344.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Linardon J (2017) Correlates of the over-evaluation of weight and shape in binge eating disorder and mixed eating disorder samples: a meta-analytic review. Eat Disord 25(3):183–198.

    Article  PubMed  Google Scholar 

  19. 19.

    Thomas JJ, Vartanian LR, Brownell KD (2009) The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: meta-analysis and implications for DSM. Psychol Bull 135(3):407–433.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Heinberg L, Haythornthwaite J, Rosofsky W, McCarron P, Clarke A (2000) Body image and weight loss maintenance in elderly African American hypertensives. Am J Health Behav 24(3):163–173.

    Article  Google Scholar 

  21. 21.

    Wilkinson L, Pacanowski CR, Levitsky D (2017) Three-year follow-up of participants from a self-weighing randomized controlled trial. J Obes 2017:4956326.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Butryn ML, Phelan S, Hill JO, Wing RR (2007) Consistent self-monitoring of weight: a key component of successful weight loss maintenance. Obesity (Silver Spring) 15(12):3091–3096.

    Article  Google Scholar 

  23. 23.

    Zheng Y, Klem ML, Sereika SM, Danford CA, Ewing LJ, Burke LE (2015) Self-weighing in weight management: a systematic literature review. Obesity (Silver Spring) 23(2):256–265.

    Article  Google Scholar 

  24. 24.

    Goldschmidt AB, Hilbert A, Manwaring JL, Wilfley DE, Pike KM, Fairburn CG, Striegel-Moore RH (2010) The significance of overvaluation of shape and weight in binge eating disorder. Behav Res Ther 48(3):187–193.

    Article  PubMed  Google Scholar 

  25. 25.

    Beck AT, Steer RA, Brown GK (1987) Manual for revised beck depression inventory. Psychological Corporation, New York

    Google Scholar 

  26. 26.

    Beck AT, Steer R, Garbin MG (1988) Psychometric properties of the Beck Depression Inventory 25 years of evaluation. Clin Psychol Rev 8:77–100.

    Article  Google Scholar 

  27. 27.

    Barnes RD, Ivezaj V, Martino S, Pittman BP, Paris M, Grilo CM (2018) Examining motivational interviewing plus nutrition psychoeducation for weight loss in primary care. J Psychosom Res 104:101–107.

    Article  PubMed  Google Scholar 

  28. 28.

    Barnes RD, White MA, Martino S, Grilo CM (2014) A randomized controlled trial comparing scalable weight loss treatments in primary care. Obesity (Silver Spring) 22(12):2508–2516.

    Article  Google Scholar 

  29. 29.

    Field AP (ed) (2013) Discovering statistics using IBM SPSS statistics: and sex and drugs and rock ‘n’ roll, 4th edn. Sage, Los Angeles

    Google Scholar 

  30. 30.

    Sauer B, Brookhart MA, Roy JA et al (2013) Covariate Selection, in Developing a Protocol for Observational Comparative Effectiveness Research: A User’s Guide, Velentgas P et al (ed), Rockville (MD)

  31. 31.

    Grilo CM, Masheb RM, Crosby RD (2012) Predictors and moderators of response to cognitive behavioral therapy and medication for the treatment of binge eating disorder. J Consult Clin Psychol 80(5):897–906.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Gallagher KM, Updegraff JA (2012) Health message framing effects on attitudes, intentions, and behavior: a meta-analytic review. Ann Behav Med 43(1):101–116.

    Article  PubMed  Google Scholar 

  33. 33.

    Ort A, Fahr A (2018) Using efficacy cues in persuasive health communication is more effective than employing threats—an experimental study of a vaccination intervention against Ebola. Br J Health Psychol 23(3):665–684.

    Article  PubMed  Google Scholar 

  34. 34.

    Puhl R, Luedicke J, Lee Peterson J (2013) Public reactions to obesity-related health campaigns: a randomized controlled trial. Am J Prev Med 45(1):36–48.

    Article  PubMed  Google Scholar 

  35. 35.

    Murray SB, Strober M, Craske MG, Griffiths S, Levinson CA, Strigo IA (2018) Fear as a translational mechanism in the psychopathology of anorexia nervosa. Neurosci Biobehav Rev 95:383–395.

    Article  PubMed  Google Scholar 

Download references


This study was supported by the National Institutes of Health (NIH). Dr. Barnes has received research Grants: R03-DK10400801A1 and K23-DK092279. NIH had no role in the study design, collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.

Author information




All authors contributed to the methodology, statistical plan and analyses. Dr. Bullock conducted literature searches and wrote the original draft of the manuscript, as well as reviewed and edited all drafts. Dr. Barber wrote the discussion and identified conclusions. Dr. Barnes conceptualized and designed the study, as well as collected the data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Anastasia J. Bullock.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Yale Human Investigation Committee (i.e., Institutional Research Board) (#1106008713) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bullock, A.J., Barber, J. & Barnes, R.D. Characterizing fear of weight gain and sensitivity to weight gain in individuals seeking weight loss treatment. Eat Weight Disord 26, 385–393 (2021).

Download citation


  • Fear of weight gain
  • Sensitivity to weight gain
  • Overweight
  • Obesity
  • Binge-eating disorder