Examination Date

Spring 4-6-2026

Degree

Dissertation

Degree Program

Community Health Science

Examination Committee

Dr. Tung Sung Tseng, Dr. Edward Trapido, Dr. Hui-Yi Lin, Dr. Jennifer Glick, Dr. Melinda Sothern

Abstract

ABSTRACT

Introduction: Disordered eating behaviors are increasingly recognized as significant contributors to obesity and related chronic disease risk. Body image shame, conceptualized as both external and internal shame, has emerged as a potential driver of disordered eating, particularly binge eating risk. However, the mechanisms linking body image shame to eating behaviors remain insufficiently understood. This mixed methods explanatory sequential study examined the association between body image shame and eating behaviors among U.S. adults and explored the mediating role of perceived behavioral control and the moderating role of social support. Methods: A cross-sectional online survey of U.S. adults assessed body image shame, eating behaviors, perceived behavioral control, social support, and demographics. Logistic regression examined associations between body image shame and binge eating risk, adjusting for sociodemographic factors. Stratified analyses were conducted by gender identity, race, age, and living area. Mediation analyses evaluated perceived behavioral control, and moderation analyses assessed whether social support influenced the relationship. Semi-structured interviews with a purposively selected subset of middle-aged cisgender women were conducted to explain and contextualize quantitative findings.

Results: Higher body image shame was associated with increased binge eating risk, while greater perceived behavioral control was associated with reduced risk. Perceived behavioral control partially mediated this relationship, whereas perceived social support did not significantly moderate it. Qualitative findings revealed that body image shame persists across the lifespan and is shaped by interpersonal, societal, and internalized processes. Integration of findings indicated that perceived behavioral control often reflects ongoing efforts to manage persistent body image shame rather than its resolution, highlighting a more complex relationship than suggested by quantitative findings alone.

Conclusion: Body image shame is a significant factor associated with binge eating risk among U.S. adults and operates through both internal psychological processes and broader sociocultural influences. Interventions should address both shame-related processes and individuals’ perceived ability to regulate eating behaviors. These findings demonstrate the value of integrating quantitative and qualitative approaches to better understand complex behavioral health phenomena.

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