**1. Introduction**

Especially in Western societies, a growing number of individuals with obesity (body mass index (BMI) ≥ 30 kg/m<sup>2</sup> [1]) are at risk of a range of medical and psychological health impairments [2,3]. Although obesity has a complex and multifactorial etiology, it is considered to be the main nutritional disorder, as it ultimately results from an imbalance between caloric intake and caloric expenditure [4]. Aspects that cause additional strain in many life domains (e.g., work settings) of individuals with obesity include weight-related stereotypes (i.e., negative beliefs about a stigmatized group), prejudices (i.e., negative emotions against a stigmatized person), and discrimination (i.e., negative behaviors towards

**Citation:** Puls, H.-C.; Schmidt, R.; Zenger, M.; Kampling, H.; Kruse, J.; Brähler, E.; Hilbert, A. Sex-Specific Mediation Effects of Workplace Bullying on Associations between Employees' Weight Status and Psychological Health Impairments. *Nutrients* **2021**, *13*, 3867. https:// doi.org/10.3390/nu13113867

Academic Editors: Fernando Fernandez-Aranda, Janet Treasure and Empar Lurbe

Received: 29 September 2021 Accepted: 27 October 2021 Published: 29 October 2021

**Publisher's Note:** MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

a stigmatized person [5]) such as workplace bullying [6]. The present study aimed to elucidate the intensity of experiences of workplace bullying across the weight range and its associations with psychological health impairments moderated by employees' sex.

In work settings, weight-related stereotypes describe individuals with obesity as, for example, being less effective, less ambitious, and showing more non-medical absenteeism compared with their co-workers with normal weight [7]. Meta-analytic evidence from experimental studies using simulated employment decisions showed that applicants with obesity, compared with those without obesity, were evaluated more negatively on a range of work-related characteristics, including lower hiring recommendations, lower estimated job success, and less job suitability. Most strikingly, the greatest difference in these simulated attributions to applicants with and without obesity was a lower rating of estimated coworker desirability for those having obesity [8]. In fact, workers with obesity reported frequent experiences of being bullied or socially isolated by their co-workers [7], which was termed workplace bullying [9]. Within a single observational study on two samples of *N* = 341 student employees and *N* = 528 full-time employees, self-reported experiences of workplace bullying were greater in employees with overweight and obesity than in those with normal weight [10]. Nonetheless, more population-based research considering additional moderators (e.g., age and socioeconomic status) would add to the yet limited evidence regarding experiences of workplace bullying across the weight range [11].

The only available study examining sex-specific effects in workplace bullying across the weight range revealed that women with overweight and obesity reported significantly more experiences of workplace bullying than women with normal weight, while this effect was not found in men, thus indicating a weight-by-sex interaction effect on experiences of workplace bullying [10]. In addition, evidence consistently showed women to be more affected by other forms of weight-related discrimination at the workplace than men, especially regarding recruitment and income [12,13]. For example, in a recent populationbased study following-up *N* = 6000 middle and high school seniors over four years after graduation, young women with overweight or obesity had less job chances and earned less than those with normal weight, while the opposite effect was found in men [14]. It may be concluded that women experience stronger weight-related discrimination at the workplace, including workplace bullying, than men.

General experiences of weight-related discrimination were associated with a range of medical and psychological health impairments, including eating disturbances (e.g., high-caloric food intake, binge-eating, or emotional eating; [15]). Specific psychological correlates of workplace bullying included elevated symptoms of emotional exhaustion and lower quality of life, both in workers across the weight range [16,17] and in workers with overweight or obesity compared with those with normal weight [18,19]. Further, in the study by Sliter et al. [10], experiences of workplace bullying partially mediated the association between weight status and job withdrawal, with the latter being associated with emotional exhaustion. Alongside depersonalization and reduced perceived accomplishment at work, emotional exhaustion represents a key symptom of the burnout syndrome [20], which itself is known to be an important health issue in work settings [21]. Notably, in sex-specific analyses, experiences of workplace bullying were more strongly associated with weight status in women than in men, and linked to job withdrawal in men, but not in women [10].

Research has only begun to elucidate the prevalence of experiences of workplace bullying and their sex-specific associations with psychological health impairments. Thus, the present study aimed to, firstly, describe the intensity of experiences of workplace bullying in a large population-based sample as a function of employees' weight status and sex. We expected more experiences of workplace bullying in individuals with overweight and obesity than with normal weight and, within participants with overweight or obesity, in women than in men. Secondly, weight status and workplace bullying were evaluated regarding their relative explanatory power for work-related psychological health impairments, hypothesizing a mediating effect of workplace bullying on the association

between higher weight status and elevated burnout symptoms as well as lower quality of life. Thirdly, we evaluated whether this mediating effect would be moderated by sex (i.e., evident in women, but not in men).
