PHILADELPHIA --People with obesity are often treated with less respect than other people, discriminated against, and socially devalued because of their weight. This societal stigma can sometimes be internalized, leading individuals with obesity to blame and devalue themselves because of their weight. While it's known that weight "self-stigma" is associated with poor mental and physical health, little is known about how to help people combat it. Now, in a first-of-its-kind study, researchers at Penn Medicine showed that people who received a new stigma-reduction intervention, along with standard behavioral weight loss treatment, devalued themselves less due to their weight compared to participants who only received the weight loss treatment.
Their findings were published today in the Journal of Consulting and Clinical Psychology.
"Our findings suggest that incorporating an intervention that targets internalized weight stigma into weight management programs may be beneficial for individuals who struggle with poor self-image due to their weight," said the study's principal investigator and lead author Rebecca Pearl, PhD, an assistant professor of Psychology in Psychiatry in the Perelman School of Medicine at the University of Pennsylvania.
Research has found that, beyond the effects of body mass index (BMI) and depression, self-directed weight stigma is associated with heightened risk for cardiovascular and metabolic disease. Although there is increased awareness of the health effects of weight stigma, questions exist about effective strategies to mitigate it. For this study, the team conducted the first randomized controlled trial of an intervention designed to reduce internalized weight stigma as part of a weight management program.
Seventy-two adults with obesity who reported experiencing and internalizing weight stigma participated in the six-month weight loss study. In one group, participants received behavioral weight loss treatment and access to the Weight Bias Internalization and Stigma (BIAS) program, which provided skills to help them combat negative weight-related thoughts, cope with weight-stigmatizing experiences, and increase their self- and body-acceptance. The other group of participants only received behavioral weight loss treatment, which also included more information on cooking tips and recipes.
Using two validated measures, the team assessed self-reported weight stigma at baseline, week 12, and week 26. Researchers also examined other self-report measures of psychological and behavioral factors, along with weight, blood pressure, and waist circumference. The team found that participants who received the Weight BIAS program showed significantly greater decreases on one measure of internalized weight stigma--self-devaluation-- than participants who received weight loss treatment alone. However, researchers noted there were no differences between groups for the other measures of internalized weight stigma. Groups also did not differ in changes in other measures of psychological well-being, behavior change, or changes in weight and other health metrics, with participants in both groups showing improvements. For example, participants in the Weight BIAS program lost an average of 4.5 percent of their starting body weight at 6 months, compared with 5.9% for those in the standard weight loss group. Participants rated the Weight BIAS program highly in their assessment of how much they liked it and benefited from it. The weight loss intervention was also rated highly in both groups.
"Weight loss and stigma reduction can seem like contradictory goals to some people," said Pearl. "Our results, however, suggest that they can be complementary. We can promote both at the same time."
Researchers note that the study was limited by its relatively small sample size and short duration of treatment and assessment. Future studies may explore whether this type of intervention may also be beneficial for people with lower levels of internalized stigma. Pearl's team is currently conducting a larger and longer-term study of a similar psychological intervention for weight self-stigma that can be incorporated into weight management. For more information about Pearl's study, visit the study's website.
This study was supported by a grant from WW International (formerly Weight Watchers). Other authors include: Thomas A. Wadden, PhD, Jena S. Tronieri, PhD, and Robert I. Berkowitz, MD, of the Penn Center for Weight and Eating Disorders and the Children's Hospital of Philadelphia.
Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $7.8 billion enterprise.
The Perelman School of Medicine has been ranked among the top medical schools in the United States for more than 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $425 million awarded in the 2018 fiscal year.
The University of Pennsylvania Health System's patient care facilities include: the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center--which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report--Chester County Hospital; Lancaster General Health; Penn Medicine Princeton Health; and Pennsylvania Hospital, the nation's first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Home Care and Hospice Services, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.
Penn Medicine is powered by a talented and dedicated workforce of more than 40,000 people. The organization also has alliances with top community health systems across both Southeastern Pennsylvania and Southern New Jersey, creating more options for patients no matter where they live.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2018, Penn Medicine provided more than $525 million to benefit our community.