Background

This study tested the effects of a novel, cognitive-behavioral intervention to reduce weight bias internalization (WBI; or self-stigma) in the context of weight management.

Methods

Adults with obesity and elevated WBI (score≥4 on the 7-point Weight Bias Internalization Scale; WBIS) were randomly assigned to behavioral weight loss (BWL) alone or combined with the Weight Bias Internalization and Stigma Program (BWL+BIAS). All participants attended weekly 90-minute group meetings for 12 weeks, followed by 2 bi-weekly meetings and 2 monthly meetings (26 weeks total). Changes in WBI from baseline to week 12 were assessed with the WBIS and Weight Self-Stigma Questionnaire (WSSQ). Secondary analyses examined changes in WBI at week 26 and changes in mood, body image, eating behaviors, physical activity, self-monitoring, and weight.

Results

Of 72 randomized participants (84.7% female, 66.7% black, age=47.1±11.5 years, BMI=39.2±6.1 kg/m2), 65 attended at least one group meeting and were included in modified intention-to-treat analyses (n=61 at weeks 12 and 26). Linear mixed models showed no differences between groups in WBIS score changes at weeks 12 (BWL+BIAS=-1.2±0.2, BWL=-1.0±0.2, p=0.30) or 26 (-1.5±0.2 vs -1.3±0.2, p=0.55). At week 12, participants in the BWL+BIAS group had greater odds of remission of elevated WBI (score<4 on the WBIS) than did BWL participants (OR=3.8, p=0.01). BWL+BIAS participants also had greater reductions in WSSQ total scores at week 12 (-6.0±1.4) than did BWL participants (-1.7±1.3, p=0.03), with greater changes on the Self-Devaluation subscale at weeks 12 (-3.7±0.8 vs. -1.0±0.8, p=0.02) and 26 (-4.1±0.8 vs. -1.6±0.8, p=0.03). BWL+BIAS participants reported some greater benefits for eating and self-monitoring. Percent weight loss did not differ between groups (BWL+BIAS=-4.5±1.0%, BWL=-5.9±1.0%, p=0.31).

Conclusions

A psychological intervention for weight stigma produced short-term reductions in some aspects of weight self-stigma among diverse patients with obesity.