Cogn Ther Res (2013) 37:122–126
DOI 10.1007/s10608-012-9446-7
BRIEF REPORT
A Test of the Weight-Based Self-Evaluation Schema in Eating
Disorders: Understanding the Link between Self-Esteem,
Weight-Based Self-Evaluation, and Body Dissatisfaction
Kathryn Trottier • Traci McFarlane •
Marion P. Olmsted
Published online: 29 March 2012
Ó Springer Science+Business Media, LLC 2012
Abstract This study examined the relationships among
self-esteem, weight-based self-evaluation (WBSE), and
body dissatisfaction in eating disorders. According to the
cognitive conceptualization of weight-based self-evalua-
tion, global self-esteem is lowered based on negative
evaluations of weight/shape through the mechanism of the
WBSE schema. A series of linear regression analyses were
conducted with self-esteem, WBSE and body dissatisfac-
tion in order to test for mediation. Body dissatisfaction
significantly predicted WBSE, and WBSE significantly
predicted global self-esteem after controlling for body
dissatisfaction. The coefficient associated with the relation
between body dissatisfaction and self-esteem was signifi-
cant. It was significantly reduced but remained significant
after controlling for WBSE. These data are compatible
with the view that WBSE partially mediates the relation-
ship between body dissatisfaction and self-esteem across
eating disorders, and support the cognitive conceptualiza-
tion of WBSE in eating disorders.
Keywords Eating disorders
Self-esteem
Weight-based
self-evaluation
Body dissatisfaction
K. Trottier (&)
T. McFarlane
M. P. Olmsted
Department of Psychiatry, Eating Disorder Day Hospital,
Toronto General Hospital, University Health Network, 7-414,
South Eaton Building, 200 Elizabeth St., Toronto,
ON M5G 2C4, Canada
e-mail: Kathryn.Trottier@uhn.ca
K. Trottier
T. McFarlane
M. P. Olmsted
Department of Psychiatry, University of Toronto, Toronto,
ON, Canada
T. McFarlane
Department of Psychology, Ryerson University, Toronto,
ON, Canada
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Introduction
This study aimed to develop a better understanding of the
relationship between self-esteem, weight-based self-eval-
uation (WBSE) and body dissatisfaction. Specifically, we
tested the cognitive conceptualization of WBSE in eating
disorders, in which global self-esteem is believed to be
greatly influenced by perceptions of weight/shape. WBSE
(also called ‘undue influence’ and ‘overvalued ideas’) is
thought to be the result of a self-schema, which connects
weight and shape with self-esteem. According to Markus
(1977), ‘‘self-schemata are cognitive generalizations about
the self, derived from past experience, that organize and
guide the processing of self-related information contained
in the individual’s social experiences’’ (p. 64). WBSE is
hypothesized to be the fundamental maladaptive cognitive
feature of eating disorders (Fairburn et al. 2003). In the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV-TR), WBSE is listed as a key criterion for
diagnosis of both anorexia nervosa (AN) and bulimia
nervosa (BN; APA 2000). In addition, recent research
suggests that WBSE is also frequently present in binge
eating disorder (BED) and that when it is not, the presence
of a clinically significant eating disorder is questionable
(Mond et al. 2006).
Evidence that WBSE is resistant to our treatments and is
a predictor of relapse supports its importance as a main-
taining factor. Current treatments result in only small
changes in overvaluation of weight/shape (e.g., Wilson
1999) and residual levels have been shown to predict
relapse in AN, BN, and in a transdiagnostic eating disorder
sample. Fairburn et al. (1993a, b) examined predictors of
12-month outcome in a sample of BN patients who
received a course of behavior therapy, cognitive-behavior
therapy (CBT) or interpersonal therapy and found that
Cogn Ther Res (2013) 37:122–126
patients with the highest levels of overvaluation of weight/
shape at post-treatment were most likely to relapse. Carter
et al. (2004) examined predictors of relapse in a 15-month
follow-up study of weight-restored AN patients from an
inpatient program. Patients who showed greater reductions
in overconcern with weight/shape (which encompasses
WBSE) over the course of treatment were less likely to
relapse over the follow-up period. McFarlane et al. (2008)
found that the Weight-Influenced Self-Esteem Question-
naire (WISE-Q) was the only measure of psychopathology
that predicted relapse following day hospital treatment in a
transdiagnostic eating disorder sample.
One characteristic of schemas is that they can be acti-
vated or suppressed. Theoretically, the experience of body
dissatisfaction should activate the WBSE schema and
because the perception and evaluation of the body is neg-
ative, lead to a devaluation of the self in general (i.e.,
lowered self-esteem). Body shape/weight dissatisfaction
and overvalued ideas about weight and shape are related
but distinct constructs (Cooper and Fairburn 1993). Body
shape/weight dissatisfaction involves a perception and
evaluation of one’s body and is experienced as a collection
of negative thoughts about one’s body shape/weight and
may be accompanied by a corresponding feeling of dis-
tress. Although body dissatisfaction can be labile and
change with mood, the occurrence of eating disorder
symptoms (i.e., bingeing and purging), degree of control
over eating, and various other triggers (e.g., comments
from others on appearance; Cooper and Fairburn 1993), it
is typically present and severe in this population (Cooper
and Fairburn 1993). In contrast, the overvaluation of
weight/shape is a relatively stable cognitive construct.
Although body dissatisfaction is not a defining feature of
eating disorders (in contrast to overvaluation of weight/
shape), it likely does play a role in the maintenance of the
eating disorder because it tends to be accompanied by a
feeling of distress and because it has the potential to acti-
vate the WBSE schema. This study tested the hypothesis
that WBSE mediates the relationship between body dis-
satisfaction and global self-esteem in individuals with
eating disorders.
Method
Participants
Two hundred and fifty-one female eating disorder patients
were recruited from the Eating Disorders Program at the
Toronto General Hospital. Patients diagnosed with AN
(n = 88), BN (n = 114) and eating disorder not otherwise
specified (EDNOS) (n = 49) were combined to form one
eating disorder group because WBSE is thought to be a
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core cognitive feature across eating disorders. However,
the data were also analyzed separately for AN, BN, and
EDNOS because in the DSM-IV-TR, WBSE is a necessary
diagnostic criterion for BN but one of three alternative
criteria for the diagnosis of AN, and it is not required for
the diagnosis of EDNOS (APA 2000). Diagnoses were
assigned at the start of day hospital treatment by a psy-
chologist based on information collected during an abbre-
viated Eating Disorder Examination Interview (diagnostic
items only) and using DSM-IV-TR criteria (APA 2000).
Measures
The Eating Disorders Inventory (EDI)
The EDI is a 64-item, self-report instrument that assesses
eight dimensions. There are three subscales related to
disorder-specific psychopathology (Drive for Thinness,
Bulimia, Body Dissatisfaction) and five subscales related to
personality features and associated psychopathology
(Maturity Fears, Perfectionism, Interoceptive Awareness,
Interpersonal Distrust, Ineffectiveness). EDI scores have
been shown to be reliable (Garner and Olmsted 1984; Wear
and Pratz 1987) and valid (Gross et al. 1986). Although, the
entire inventory was administered, only the body dissatis-
faction subscale was utilized in this study.
The Rosenberg Self-Esteem Scale (RSES)
The RSES in a 10-item self-report questionnaire that
assesses global attitudes toward the self. RSES scores have
been shown to have strong convergent and discriminant
validity (Rosenberg 1979; Wylie 1989).
The Weight-Influenced Self-Esteem Questionnaire
(WISE-Q)
The WISE-Q is a 22-item self-report questionnaire that
measures the influence of negative perceptions of body
weight on multiple dimensions of self-esteem. Respondents
are instructed to imagine that they stepped on a scale and
saw that they had gained 5 lbs. They are then asked to
indicate how this 5 lb weight gain would negatively
influence how they feel about themselves in various
domains of self-esteem. Factor analysis suggests that the
WISE-Q measures two correlated aspects of WBSE—
namely, the extent that perceptions of weight/shape influ-
ence related aspects of self-esteem (i.e., ‘expected’
WBSE), as well as the extent that perceptions of weight/
shape influence seemingly unrelated domains of self-
esteem (i.e., ‘generalized’ WBSE). WISE-Q total and
subscale scores have been shown to have good reliability
and validity (Trottier et al. submitted). Although the entire
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scale was administered, only the generalized subscale score
was utilized in this study. The generalized subscale is the
best measure of the undue influence of weight/shape on
self-esteem as it contains items asking about the influence
of weight gain on unrelated domains of self-esteem (e.g.,
performance, personality, etc.).
Eating Disorder Examination (EDE)
The EDE is a semi-structured interview that allows the
detailed determination of the frequency of eating disorder
symptoms over the previous 3 months. In addition to pro-
viding information regarding the frequency of eating
symptoms, the EDE has five subscales (overeating,
restraint, eating concern, shape concern, weight concern).
Reliability and validity are well-established (Cooper and
Fairburn 1987; Cooper et al. 1989). An abbreviated EDE
containing only the diagnostic items was administered for
this study.
Procedure
All participants were administered the abbreviated EDE
interview, EDI, RSES and WISE-Q, and demographic
information was collected at the start of day hospital
treatment. Height and weight were measured during the
first week of treatment. Following the guidelines outlined
by Baron and Kenny (1986), a series of linear regression
analyses were conducted with self-esteem, generalized
WBSE, and body dissatisfaction (body dissatisfaction
subscale of the EDI) in order to establish mediation.
Results
Participant Demographics
Participants ranged from 17 to 58 years of age with an
average age of 26.13 years (SD = 8.01). Mean age of
onset of a clinical eating disorder was 17.44 years of age
(SD = 4.43). Body mass index ranged from 13.16 to 33.38
with the average BMI being 20.73 (SD = 3.61). Eighty-
five percent described themselves as being Caucasian, 2%
African American, 3% East Asian, 2% South Asian, 0.5%
West Indian, 0.5% Latina, 4% mixed ethnicity, and 3%
other.
Transdiagnostic Group
Figure 1 displays the paths that are estimated in mediation
models and Table 1 contains the statistics necessary to
examine the mediation hypothesis. Following the steps
outlined by Baron and Kenney (1986), we first established
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Cogn Ther Res (2013) 37:122–126
that body dissatisfaction (predictor variable) was related to
global self-esteem (outcome variable) by regressing self-
esteem on body dissatisfaction. The unstandardized
regression coefficient associated with the relation between
body dissatisfaction and global self-esteem was significant.
Thus, path c was significant, and the first requirement for
mediation was met. To establish that body dissatisfaction
was related to generalized WBSE (hypothesized mediator
variable), WBSE was regressed on body dissatisfaction.
The unstandardized regression coefficient associated with
this relation was also significant. Thus, path a was signif-
icant and the second condition for mediation was met. To
test whether generalized WBSE was related to global self-
esteem, self-esteem was regressed simultaneously on both
generalized WBSE and body dissatisfaction. The coeffi-
cient associated with the relation between generalized
WBSE and global self-esteem (controlling for body dis-
satisfaction) was also significant. Thus path b was signifi-
cant and all three conditions were met. This third
regression equation also provided an estimate of path c’,
the relation between body dissatisfaction and self-esteem,
controlling for WBSE. If this path is zero, then there is
complete mediation. This path was reduced1 (z = -4.50,
p \ .001) but remained significant after controlling for
generalized WBSE, indicating partial mediation.
DSM-IV-TR Diagnostic Groups
The three conditions for mediation were tested again, this
time separately on the data for BN, AN, and EDNOS
participants. Table 1 contains the statistics necessary to
examine the meditational hypotheses. When the groups
were examined separately, all three conditions continued to
be met for each diagnostic group. The coefficients associ-
ated with the relation between body dissatisfaction and
self-esteem were significant. Body dissatisfaction signifi-
cantly predicted generalized WBSE, and generalized
WBSE significantly predicted global self-esteem after
controlling for body dissatisfaction. The relations between
body dissatisfaction and global self-esteem were signifi-
cantly reduced (AN: z = -2.86, p \ .005; BN: z = -3.63,
p \ .001; EDNOS: z = -2.58, p \ .01) but remained
significant after controlling for generalized WBSE.
Discussion
The findings of the current study support a model in which
WBSE partially mediates the relationship between body
1
Sobel’s (1982) test was used to determine the significance of
mediation.
Cogn Ther Res (2013) 37:122–126 125

Path c’

Path a Path b

Predictor Variable Mediator Variable Outcome Variable

(Body Dissatisfaction) (WBSE) (Self-Esteem)

Path c
Predictor Variable Outcome Variable
(Body Dissatisfaction) (Self-Esteem)

Fig. 1 Mediation paths

Table 1 Regression coefficients by diagnostic group and/or shape is highly malleable and can be changed at will
is prevalent (Brownell and Wadden 1992). Owing to this
Testing steps in mediation model B SE B
belief, the alteration of weight and shape is viewed as an
Step 1: Path c AN -.30*** .07 avenue through which self-esteem can be increased.
BN -.30*** .05 According to the cognitive behavioral model, overvaluing
EDNOS -.43*** .08 weight and shape encourages the development of eating
All -.32*** .04 disordered behaviors, which in turn lead to lower levels of
Step 2: Path a AN .06*** .01 self-esteem and increased concerns about weight and
BN .06*** .01 shape. It is this on-going cycle that is thought to maintain
EDNOS .08*** .01 the eating disorder (Fairburn et al. 1993a, b).
All .07*** .01 The major limitation of this study is that the data are
Step 3: Path b AN -1.82** .56 correlational and were collected at a single point in time.
BN -2.23*** .49 As a result, the direction of the associations between the
EDNOS -1.88** .69 variables cannot be known (i.e., it is possible that the
All -1.88*** .32 associations are in the direction opposite to which we
Step 4: Path c’ AN -.19* .07 suggest). It will be important to address this in future
BN -.16** .06 research by using prospective and experimental designs.
EDNOS -.28** .09
For example, a future study could seek to replicate these
All -.19*** .04
findings by manipulating body dissatisfaction and subse-
quently measuring global self-esteem.
* p \ .05 The results of this study also suggest that WBSE plays a
** p \ .01 key role in the relationship between body dissatisfaction
*** p \ .001 and self-esteem across all categories of eating disorders.
Specifically, these data suggest that the cognitive concep-
dissatisfaction and self-esteem in eating disorders and tualization of WBSE applies to AN, BN and EDNOS.
provide support for the cognitive conceptualization of WBSE appears to be an important transdiagnostic variable
WBSE. Because individuals with eating disorders tend to in that it represents a core cognitive feature contributing to
evaluate themselves globally based on weight and shape, the maintenance of AN, BN and EDNOS.
the chronic and severe body dissatisfaction that they These data also provide further evidence of the validity
experience may contribute to low levels of self-esteem. of generalized WISE-Q scores. Specifically, the fact that
Body dissatisfaction, poor self-esteem, and WBSE are WISE-Q scores mediated the relationship between body
likely made worse the longer the eating disorder is main- dissatisfaction and global self-esteem suggest that the
tained. The results suggest that through the mechanism of scores are, indeed, a measure of the impact of perceptions
WBSE, body dissatisfaction may have a negative impact on of weight and/or shape on global self-esteem (i.e., WBSE).
self-esteem. In turn, low levels of self-esteem are thought Cognitive and behavioral strategies directly targeting the
to contribute to extreme concerns about weight and shape WBSE schema may be most effective at separating self-
(Fairburn et al. 1993a, b). In particular, individuals with esteem from weight and shape, and thereby improving
low self-esteem are thought to be particularly susceptible to treatment outcome and/or enhancing relapse prevention.
WBSE. In Western Culture, the belief that body weight Given that body dissatisfaction is normative among women

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in Western society (e.g., Klemchuck et al. 1990), it may be
unrealistic to expect individuals with eating disorders to
achieve body satisfaction. Instead, it is important that their
perceptions and feelings about their bodies become sepa-
rated from their global assessments of themselves as peo-
ple. Reducing the strength of the WBSE schema should
serve to protect and even rebuild self-esteem, thereby
reducing the likelihood of future eating disorder behaviors.
References
American Psychiatric Association. (2000). Diagnostic and Statistical
Manual of Mental Disorders, (4th ed., Text Revision). Wash-
ington, DC: American Psychiatric Association.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator
variable distinction in social psychological research: Conceptual,
strategic, and statistical considerations. Journal of Personality
and Social Psychology, 51, 1173–1182.
Brownell, K. D., & Wadden, T. A. (1992). Etiology and treatment of
obesity: Understanding a serious, prevalent, and refractory
disorder. Journal of Consulting and Clinical Psychology, 60,
505–517.
Carter, J. C., Blackmore, E., Sutandar-Pinnock, K., & Woodside, D.
B. (2004). Relapse in anorexia nervosa: A survival analysis.
Psychological Medicine, 34, 671–679.
Cooper, Z., & Fairburn, C. G. (1987). The eating disorder examina-
tion: A semi-structured interview for the assessment of the
specific psychopathology of eating disorders. International
Journal of Eating Disorders, 6, 1–8.
Cooper, P. J., & Fairburn, C. G. (1993). Confusion over the core
psychopathology of bulimia nervosa. International Journal of
Eating Disorders, 13, 385–389.
Cooper, Z., Cooper, P. J., & Fairburn, C. G. (1989). The validity of
the eating disorder examination and its subscales. British Journal
of Psychiatry, 154, 807–812.
Fairburn, C. G., Marcus, M. D., & Wilson, G. T. (1993a). Cognitive-
behavioral therapy for binge eating and bulimia nervosa: A
comprehensive treatment manual. In C. G. Fairburn & G.
T. Wilson (Eds.), Binge eating: Nature, assessment and treat-
ment (pp. 361–404). New York: Guilford Press.
Fairburn, C. G., Peveler, R. C., Jones, R., Hope, R. A., & Doll, H. A.
(1993b). Predictors of 12-month outcome in bulimia nervosa and
123
Cogn Ther Res (2013) 37:122–126
the influence of attitudes to shape and weight. Journal of
Consulting and Clinical Psychology, 6, 696–698.
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive
behaviour therapy for eating disorders: A ‘‘transdiagnostic’’
theory and treatment. Behaviour Research and Therapy, 4,
509–528.
Garner, D. M., & Olmsted, M. P. (1984). The eating disorder
inventory manual. Odessa, FL: Psychological Assessment
Resources.
Gross, J., Rosen, J. C., Leitenberg, H., & Willmuth, M. E. (1986).
Validity of the eating attitudes test and the eating disorders
inventory in bulimia nervosa. Journal of Consulting and Clinical
Psychology, 54, 875–876.
Klemchuck, H. P., Hutchinson, C. B., & Frank, R. I. (1990). Body
dissatisfaction and eating-related problems on the college
campus: Usefulness of the eating disorder inventory with a
nonclinical population. Journal of Counseling Psychology, 37,
297–305.
Markus, H. (1977). Self-schemata and processing information about
the self. Journal of Personality and Social Psychology, 35,
63–78.
McFarlane, T., Olmsted, M. P., & Trottier, K. (2008). Timing and
prediction of relapse in a transdiagnostic eating disorder sample.
International Journal of Eating Disorders, 41, 587–593.
Mond, J. M., Hay, P. J., Rodgers, B., & Owen, C. (2006). Recurrent
binge eating with and without the ‘‘undue influence of weight or
shape on self-evaluation’’: Implications for the diagnosis of
binge eating disorder. Behaviour Research and Therapy, 45,
929–938.
Rosenberg, M. (1979). Conceiving the self. New York, NY: Basic
Books.
Sobel, M. E. (1982). Asymptotic intervals for indirect effects in
structural equations models. In S. Leinhart (Ed.), Sociological
methodology 1982 (pp. 290–312). San Francisco: Jossey-Bass.
Trottier, K., McFarlane, T., Olmsted, M., & McCabe, R. (Submitted).
The weight influenced self-esteem questionnaire (WISE-Q):
Factor structure and psychometric properties.
Wear, R. W., & Pratz, O. (1987). Test-retest reliability for the eating
disorder inventory. International Journal of Eating Disorders, 6,
767–769.
Wilson, G. T. (1999). Cognitive behavior therapy for eating disorders:
Progress and problems. Behaviour Research and Therapy, 37,
S79–S95.
Wylie, Ruth. C. (1989). Measures of self-concept. Lincoln, NE:
University of Nebraska Press.
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