Self-esteem, body shame and eating disorder risk in obese and normal weight adolescents: A mediation model Mara Iannaccone a, ⁎, Francesca D'Olimpio b , Stefania Cella a , Paolo Cotrufo a a Observatory on eating disorders, Department of Psychology, Second University of Naples, Viale Ellittico, 31, 81100, Caserta, Italy b Department of Psychology, Second University of Naples, Viale Ellittico, 31, 81100 Caserta, Italy abstract article info Article history: Received 8 May 2014 Received in revised form 26 November 2015 Accepted 16 December 2015 Available online 2 January 2016 Objective: To investigate dysfunctional eating behaviors and psychological variables typically associated to eating disturbances such as low self-esteem, perfectionism, shame, perceived parental care and protectiveness in obese and normal weight adolescents and to examine how the main powerful eating disorder risk factors interact with each other which explains eating psychopathology vulnerability. Method: 111 high school students (68 males; age range 13–19 years) classified as obese and 111 age-, sex- and social status-homogeneous normal weight controls were included in the current study. All participants were asked to fill out self-report measures of parental behavior as perceived by the offspring, eating disturbance attitudes and behaviors, self-esteem, perfectionism and shame. Results: Significant differences between the two groups in relation to dysfunctional eating behaviors emerged. Body shame had the strongest relationship to eating problems vulnerability and acted as a mediator in the rela- tionship between low self-esteem and eating disorder risk among both obese and non-obese youngsters. Conclusions: These findings further our understanding of a potential underlying mechanism for eating pathology development in youngsters in general and in obese adolescents in particular, which is of great importance in terms of prevention and treatment. © 2016 Elsevier Ltd. All rights reserved. Keywords: Eating disorders Self-esteem Body shame Perfectionism Parental bonding Obesity 1. Introduction Obese individuals have been found to be at greater risk for develop- ing an eating disorder (ED) (Britz et al., 2000; Fairburn, Cooper, Doll, & Welch, 1999; Musaiger et al., 2013). Among the ED types, binge eating disorder has been recognized as a particularly common problem already in overweight children and teens (Isnard et al., 2003; Ranzenhofer et al., 2012; Tanofsky-Kraff, 2008). Empirical evidence has reported a preva- lence rates for binge or loss of control eating episodes among obese ad- olescents ranging from 36.5% to 45% (Decaluwé, Braet, & Fairburn, 2003; Glasofer et al., 2007). Some evidence has demonstrated that overweight precedes binge eating behavior (Tanofsky-Kraff, 2008; Reas & Grilo, 2007; Decaluwé & Braet, 2003) and that binge eating does not predict obesity onset (Stice, Presnell, Shaw, & Rohde, 2005). Little is known about which psychological constructs are associated with increased ED vulnerability among overweight people. In a research carried out by Cargill, Clark, Pera, Niaura, and Abrams (1999) using a sample of obese individuals, a stepwise regression analysis was con- ducted with EDE-Q Restraint, Obese Self-Image, Activity-Interference, Negative Body Image, Dissatisfaction factors, depression, self-efficacy, and baseline weight to determine which variables were significantly related to binge eating. Negative Body Image, particularly in relation to shame and concern with public appearance, was found to have the strongest relationship to binge eating status. In another study, increased negative affect, experience of teasing, thin-ideal internalization, and de- creased perfectionism resulted to be associated with increased eating disturbances in overweight treatment-seeking youth (Eddy et al., 2007). A more recent research showed that regular binge eating in mor- bidly obese individuals was strongly related to eating concerns and a lack of effortful control (Müller et al., 2012). However, other well-known risk factors for EDs such as low self- esteem, experiences of shame and perceived poorer family functioning are strongly associated with child and adolescent obesity and may rep- resent key variables in explaining an increased eating pathology risk. In a study carried out by Turner, Rose, and Cooper (2005), overweight fe- male adolescents perceived their fathers as being significantly more overprotective and significantly less caring than those in the normal weight group. Low self-esteem has been found to be related to a number of poten- tially modifiable risk factors, including obesity, among US adolescents Eating Behaviors 21 (2016) 80–83 ⁎ Corresponding author. E-mail addresses: mara.iannaccone@unina2.it (M. Iannaccone), francesca.dolimpio@unina2.it (F. D'Olimpio), stefania.cella@unina2.it (S. Cella), paolo.cotrufo@unina2.it (P. Cotrufo). http://dx.doi.org/10.1016/j.eatbeh.2015.12.010 1471-0153/© 2016 Elsevier Ltd. All rights reserved. Contents lists available at ScienceDirect Eating Behaviors