The Impact of Weight Self-stigma on Weight-loss Treatment Engagement and Outcome

Overview

Journal Obes Sci Pract

Date 2024 Nov 1

PMID 39483439

Authors

Samantha J Schram

KayLoni L Olson

Emily Panza

Jason Lillis

Affiliations

Soon will be listed here.

Abstract

Background: Individuals with overweight or obesity often endure significant weight-based prejudice and discrimination in various settings. Experiencing weight-related stigma is linked to many adverse psychosocial outcomes. Weight self-stigma is when an individual internalizes and identifies with negative attributes ascribed to people with larger bodies and has self-devaluing thoughts because of their weight and is associated with poorer health outcomes.

Aims: This study explored how weight self-stigma may impact weight management efforts and outcomes for adults participating in an onlight weight-loss intervention.

Materials And Methods: 508 adults (86.2% female, 84.6% White) with overweight or obesity participated in an asynchronous 12-week online weight-loss intervention with computer-generated feedback. Weight and weight self-stigma were measured at baseline and 3 months later.

Results: Thirty-one point five percent of the sample reported high levels of stigma, which was associated with greater program dropout than those who did not report high stigma (32.5% vs. 21.6%). Program completers reporting high self-stigma showed better treatment engagement (77.0% vs. 69.7% lessons viewed) and weight loss ( = -6.31% vs. -5.08%); these differences were not observed when using intent-to-treat assumptions. When analyzed as a continuous variable, weight self-stigma showed no association with treatment engagement and outcome.

Discussion: These findings highlight the complexity of understanding how self-stigma affects treatment engagement and outcome in behavioral weight loss and the need for more targeted research in this understudied area.

Conclusion: Results suggest that weight self-stigma plays a role in weight management during an online weight-loss intervention, affecting engagement and outcomes.

References

Wott C, Carels R . Overt weight stigma, psychological distress and weight loss treatment outcomes. J Health Psychol. 2010; 15(4):608-14. DOI: 10.1177/1359105309355339. View

Crane N, Hagerman C, Horgan O, Butryn M . Patterns and Predictors of Engagement With Digital Self-Monitoring During the Maintenance Phase of a Behavioral Weight Loss Program: Quantitative Study. JMIR Mhealth Uhealth. 2023; 11:e45057. PMC: 10394603. DOI: 10.2196/45057. View

Sobal J . Obesity and socioeconomic status: a framework for examining relationships between physical and social variables. Med Anthropol. 1991; 13(3):231-47. DOI: 10.1080/01459740.1991.9966050. View

Friedman K, Reichmann S, Costanzo P, Zelli A, Ashmore J, Musante G . Weight stigmatization and ideological beliefs: relation to psychological functioning in obese adults. Obes Res. 2005; 13(5):907-16. DOI: 10.1038/oby.2005.105. View

Cardel M, Newsome F, Pearl R, Ross K, Dillard J, Miller D . Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk. J Acad Nutr Diet. 2022; 122(6):1089-1098. PMC: 10056599. DOI: 10.1016/j.jand.2022.01.004. View

Brechan I, Kvalem I . Relationship between body dissatisfaction and disordered eating: mediating role of self-esteem and depression. Eat Behav. 2015; 17:49-58. DOI: 10.1016/j.eatbeh.2014.12.008. View

Lillis J, Luoma J, Levin M, Hayes S . Measuring weight self-stigma: the weight self-stigma questionnaire. Obesity (Silver Spring). 2009; 18(5):971-6. DOI: 10.1038/oby.2009.353. View

Flegal K . Use and Misuse of BMI Categories. AMA J Ethics. 2023; 25(7):E550-558. DOI: 10.1001/amajethics.2023.550. View

Puhl R, Himmelstein M, Pearl R . Weight stigma as a psychosocial contributor to obesity. Am Psychol. 2020; 75(2):274-289. DOI: 10.1037/amp0000538. View

10.

Heuer C, McClure K, Puhl R . Obesity stigma in online news: a visual content analysis. J Health Commun. 2011; 16(9):976-87. DOI: 10.1080/10810730.2011.561915. View

11.

OBrien K, Latner J, Puhl R, Vartanian L, Giles C, Griva K . The relationship between weight stigma and eating behavior is explained by weight bias internalization and psychological distress. Appetite. 2016; 102:70-6. DOI: 10.1016/j.appet.2016.02.032. View

12.

Puhl R, Moss-Racusin C, Schwartz M . Internalization of weight bias: Implications for binge eating and emotional well-being. Obesity (Silver Spring). 2007; 15(1):19-23. DOI: 10.1038/oby.2007.521. View

13.

Pearl R, Wadden T, Chao A, Walsh O, Alamuddin N, Berkowitz R . Weight Bias Internalization and Long-Term Weight Loss in Patients With Obesity. Ann Behav Med. 2018; 53(8):782-787. PMC: 6636884. DOI: 10.1093/abm/kay084. View

14.

Molarius A, Linden-Bostrom M, Karlsson J . Desire to lose weight and need of weight loss support in the adult population-Results from a cross-sectional study in Sweden. Obes Sci Pract. 2020; 6(4):373-381. PMC: 7448151. DOI: 10.1002/osp4.412. View

15.

Lee K, Hunger J, Tomiyama A . Weight stigma and health behaviors: evidence from the Eating in America Study. Int J Obes (Lond). 2021; 45(7):1499-1509. PMC: 8236399. DOI: 10.1038/s41366-021-00814-5. View

16.

Sattler K, Deane F, Tapsell L, Kelly P . Gender differences in the relationship of weight-based stigmatisation with motivation to exercise and physical activity in overweight individuals. Health Psychol Open. 2018; 5(1):2055102918759691. PMC: 5846936. DOI: 10.1177/2055102918759691. View

17.

Puhl R, Lessard L, Himmelstein M, Foster G . The roles of experienced and internalized weight stigma in healthcare experiences: Perspectives of adults engaged in weight management across six countries. PLoS One. 2021; 16(6):e0251566. PMC: 8168902. DOI: 10.1371/journal.pone.0251566. View

18.

Martin C, Herrick K, Sarafrazi N, Ogden C . Attempts to Lose Weight Among Adults in the United States, 2013-2016. NCHS Data Brief. 2018; (313):1-8. View

19.

Saunders J, Nutter S, Russell-Mayhew S . Examining the Conceptual and Measurement Overlap of Body Dissatisfaction and Internalized Weight Stigma in Predominantly Female Samples: A Meta-Analysis and Measurement Refinement Study. Front Glob Womens Health. 2022; 3:877554. PMC: 9070483. DOI: 10.3389/fgwh.2022.877554. View

20.

Puhl R, Brownell K . Bias, discrimination, and obesity. Obes Res. 2001; 9(12):788-805. DOI: 10.1038/oby.2001.108. View