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Abstract Background Internalized weight stigma (IWS) is highly prevalent and associated with deleterious mental and physical health outcomes. Initiatives are needed to address IWS and promote effective coping and resilience among individuals who are exposed to weight stigma. We conducted a systematic scoping review of the literature on psychological interventions for IWS and explored their intervention components, feasibility, acceptability, and preliminary efficacy at reducing IWS and related negative physiological and psychological health outcomes. Methods Eight databases were searched. Inclusion criteria included: (1) Psychological intervention; (2) Published in English; and (3) Included IWS as an outcome. Exclusion criteria included: (1) Commentary or review; and (2) Not a psychological intervention. A narrative review framework was used to synthesize results. Results Of 161 articles screened, 20 were included. Included interventions demonstrated high feasibility, acceptability, and engagement overall. Sixteen of 20 included studies observed significant reductions in IWS that were maintained over follow-up periods, yet data on whether interventions produced greater reductions than control conditions were mixed. Studies observed significant improvements in numerous physical and mental health outcomes. Conclusions Findings suggest that existing interventions are feasible, acceptable, and may provide meaningful improvements in IWS and associated health outcomes, highlighting the potential for psychological interventions to promote improved health and wellbeing in individuals with IWS. High-quality studies using rigorous study designs (e.g., randomized controlled trials) are needed to further evaluate the efficacy of interventions for IWS.

Abstract Background Health-related stigma and its internalization among individuals with chronic health conditions contribute to impaired mental and physical health and quality of life. Research on health-related stigma has been siloed, with disease-specific measures that may not capture the experiences of individuals with multiple health conditions and that prevent comparisons across health conditions. The current study aimed to develop and test a transdiagnostic measure of internalized health-related stigma for use among adults with different physical health conditions. Methods An existing measure of internalized mental health stigma was adapted to assess stigma due to chronic physical health conditions following COSMIN procedures, with input from advisory boards of community members living with a range of stigmatized health conditions (obesity, type 1 and type 2 diabetes, skin diseases, HIV, chronic pain, and cancers) and of health professionals who specialized in these conditions. The new Internalized Health-Related Stigma (I-HEARTS) Scale was tested in an online sample of 300 adults with these health conditions, recruited from ResearchMatch. Additional psychosocial measures of mental health and quality of life were administered, and participants provided information about their health conditions and demographic characteristics. Exploratory factor analysis and tests of reliability and validity were conducted to determine the psychometric properties of the I-HEARTS Scale, and k-means clustering and receiver of characteristic curve analysis were used to determine a clinically meaningful cutoff score indicating high levels of internalized stigma. Results Factor analysis results yielded a 25-item scale with a 3-factor solution, with subscales of Perceived and Anticipated Stigma, Stereotype Application and Self-Devaluation, and Stigma Resistance. Psychometric properties for internal consistency, inter-item and item-total correlations, and test-retest reliability were strong. Certain demographics (e.g., younger age) and characteristics related to health conditions (e.g., greater symptom severity) were associated with higher levels of internalized stigma. I-HEARTS Scale scores correlated moderately to strongly with related but distinct psychosocial measures, and a cutoff score of 3.40 or higher on the 1–7 rating scale was determined to indicate clinically meaningful levels of internalized stigma. Conclusions The I-HEARTS Scale is a reliable and valid measure for the assessment of internalized health-related stigma among adults with varied stigmatized chronic health conditions. Study pre-registration https://osf.io/84c5d/?view_only=87238512f6d6475c87f8f64280a8a15f .

Abstract Objective Cross‐sectional research has demonstrated that internalized weight stigma (IWS) is associated with less engagement in weight management behaviors, including physical activity. However, limited research has explored longitudinal relationships among IWS, physical activity, and weight loss. This study examined longitudinal associations of changes in IWS, physical activity, and weight and tested whether physical activity mediated the relationship between IWS and weight change. Methods Individuals with obesity and high IWS (N = 105) participated in a 72‐week behavioral weight loss intervention, with or without a weight stigma intervention. Measures of IWS (Weight Self‐Stigma Questionnaire), physical activity (accelerometry and self‐report), and weight were collected at baseline and weeks 20, 46 and 72. Correlations examined relationships among changes in variables from baseline to all timepoints, controlling for treatment condition. Mediation, controlling for treatment condition, tested whether IWS reductions during the first 20 weeks predicted greater weight loss at weeks 46 and 72 via increased physical activity between weeks 20 and 46 or 72. Results Decreases in IWS at week 20 were associated with greater week‐20 weight loss (r = 0.265, p = 0.012). Physical activity was not a significant mediator, but greater reductions in IWS at week 20 predicted greater week‐46 weight loss with or without controlling for physical activity (WSSQ: b = 0.30, confidence interval: 0.12, 0.54). Significant associations were not found at week 72. Conclusion Initial reductions in IWS were associated with greater week‐46 weight loss. Further research should investigate whether reducing IWS early in obesity treatment enhances long‐term outcomes. Clinical trial registration ClinicalTrials.gov (NCT03704064).

Abstract Objective Experiences and internalization of weight stigma are associated with greater self‐reported psychological distress and symptoms of psychiatric disorders such as depression and anxiety. However, little is known about the extent to which individuals who have experienced and internalized weight stigma are diagnosed with or provided treatment for psychiatric conditions. The current study aimed to characterize the prevalence of diagnosed psychiatric disorders among adults with obesity who had experienced and internalized weight stigma. Methods Weight‐loss treatment‐seeking adults with a history of experiencing weight stigma and high levels of internalized weight stigma were recruited for two clinical trials. Results In Study 1 (n = 84, 83.3% women, 67.9% Black), 25% of participants reported a lifetime history of a mood disorder. Few participants (

Weight bias internalization (WBI) is an understudied form of internalized stigma, particularly among treatment-seeking adults with overweight/obesity. The current study surveyed 13,996 adults currently engaged in weight management in the first multinational study of WBI. From May to July 2020, participants in six Western countries completed the Modified Weight Bias Internalization Scale (WBIS-M) and measures of weight change, health behaviors, psychosocial well-being, and health-related quality of life (HRQOL). Participants were majority white, female, middle-aged, and categorized as having overweight or obesity based on body mass index. Results showed higher mean WBIS-M scores among participants in the UK, Australia, and France than in Germany, the US, and Canada. Across all countries, and controlling for participant characteristics and experiences of weight stigma, WBIS-M scores were associated with greater weight gain in the past year. Participants with higher WBIS-M scores also reported poorer mental and physical HRQOL, less eating and physical activity self-efficacy, greater engagement in eating as a coping strategy, more avoidance of going to the gym, poorer body image, and greater perceived stress. Few interaction effects were found between experiences and internalization of weight stigma. Overall, the current findings support WBI as a robust correlate of adverse weight-related health indices across six Western countries. Prospective and experimental studies are needed to determine directionality and causality in the relationship between WBI and poor health outcomes.

Background/Aims: Sociocultural and familial factors associated with weight bias internalization (WBI) are currently unknown. The present study explored the relationship between interpersonal sources of weight stigma, family weight history, and WBI. Methods: Participants with obesity (N = 178, 87.6% female, 71.3% black) completed questionnaires that assessed the frequency with which they experienced weight stigma from various interpersonal sources. Participants also reported the weight status of their family members and completed measures of WBI, depression, and demographics. Participant height and weight were measured to calculate body mass index (BMI). Results: Linear regression results (controlling for demographics, BMI, and depression) showed that stigmatizing experiences from family and work predicted greater WBI. Experiencing weight stigma at work was associated with WBI above and beyond the effects of other sources of stigma. Participants who reported higher BMIs for their mothers had lower levels of WBI. Conclusion: Experiencing weight stigma from family and at work may heighten WBI, while having a mother with a higher BMI may be a protective factor against WBI. Prospective research is needed to understand WBI's developmental course and identify mechanisms that increase or mitigate its risk.

Background: The prevalence of overweight and obesity continues to rise and is associated with increased morbidity and mortality. Weight bias is common among physicians and medical students and limits the therapeutic alliance between providers and patients with overweight and obesity. Objective: The authors sought to explore the relationship between the gross anatomy course and medical student attitudes towards weight and obesity. Design: The authors employed a mixed-methods approach consisting of semi-structured interviews and anonymous web-based surveys of first-year medical students taking gross anatomy at one USA medical school. They analyzed transcripts of interviews and free-text survey responses using a grounded theory approach and performed tests of association to investigate the relationship between demographic information, responses to multiple-choice survey questions and weight bias. Results: A total of 319 (52%) first-year medical students (2015–2018) completed the survey and 33 participated in interviews. Of survey respondents, 71 (22%) responded that the course had changed how they felt about people with overweight/obesity. These respondents were also more likely to affirm that the course had affected their views toward their own bodies (p

Research has shown a negative relationship between weight bias internalization (WBI) and general measures of health-related quality of life (QOL), such as the Short Form–36. Less is known about the impact of WBI on weight-specific domains of QOL. This study examined the relationship between WBI and weight-related QOL, as measured by the Impact of Weight on Quality of Life (IWQOL-Lite) scale. Participants were 178 adults with obesity [71.3% black, 87.6% female, mean body mass index (BMI) = 40.9 ± 5.9 kg/m2] enrolled in a weight loss trial testing the effects of lorcaserin on weight loss maintenance. At baseline, participants completed the Weight Bias Internalization Scale (WBIS), the IWQOL-Lite and the Patient Health Questionnaire (PHQ-9, to assess symptoms of depression). Total scores for the IWQOL-Lite and its five subscales (Physical Function, Self-Esteem, Sexual Life, Public Distress and Work) were calculated. Linear regression analyses showed that WBIS scores were associated with the IWQOL-Lite total score and all subscales above and beyond the effects of demographic variables, BMI, and depressive symptoms (beta values = -0.18 to -0.70, p values < 0.019). The relationship between WBIS and the IWQOL-Lite scales did not differ by gender or race. WBI was associated with mental and physical aspects of weight-related QOL in a predominantly black and female treatment-seeking sample of patients with obesity. Prioritizing the development of interventions to reduce WBI may be important for improving weight-related QOL.

Background: Many participants experience clinically significant fluctuations in weight before beginning a behavioral weight loss program. Pre-treatment weight gain, often referred to as the “last supper” effect, may limit total weight loss from the time of the pre-treatment screening visit and could be an indicator that a participant will respond poorly to behavioral intervention.Methods: Data were from the weight loss phase of a two-phase weight loss maintenance trial, in which 178 participants with obesity (screening BMI = 40.5 ± 6.0 kg/m2, 87.6% female; 71.3% black) were provided with a 14 week lifestyle intervention that included a meal replacement diet. Participants were categorized as having gained >1.15%, remained weight stable, or lost >1.15% of initial weight between the pre-treatment screening visit and the first treatment session (48.7 ± 29.4 days). We first examined whether the weight change groups differed in baseline eating characteristics (e.g., emotional eating, self-regulation, craving frequency) using one-way ANCOVAs. Linear mixed models were then used to compare weight change groups on total weight loss from the screening visit to week 14 and in-treatment weight loss from weeks 1 to 14.Results: Nearly half of the sample (48.9%) gained >1.15% of initial weight during the pre-treatment period (+2.5 ± 1.2%); 41.0% remained weight stable (+0.2 ± 0.6%); and 10.1% lost >1.15% of initial weight (-2.2 ± 0.9%). There were no significant differences between the groups in baseline eating characteristics. As measured from the screening weight, the weight-gain group had a lower total loss of 6.8%, compared to 7.8% in the weight stable group (p = 0.02) and 9.0% in the weight-loss group (p = 0.003). The weight-gain group lost more weight in the first 4 weeks of treatment, but in-treatment losses did not differ among the groups at week 14.Conclusion: Pre-treatment weight gain was not an indicator of a poor response to a behavioral weight loss intervention and was associated with greater weight loss early in treatment. However, weight gain during the pre-treatment period may limit the total weight loss that participants achieve from the time that they first enroll in a weight loss program.