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Weight and shape concern (WSC) is a facet of negative body image that is common among individuals with overweight/obesity seeking behavioral weight loss treatment (BWL), but remains understudied. This secondary analysis evaluates associations between WSC, weight change, and weight-related behaviors among individuals in a 24-week BWL. Adults (n = 32) with body mass index 25-50 kg/m.sup.2 completed a baseline WSC questionnaire, measured weight at 12 and 24 weeks, measured physical activity via accelerometer, and completed 24-hour dietary recalls. Adherence to self-monitoring dietary intake and weight were assessed. A series of linear mixed models were used to evaluate associations between baseline WSC and weight change, as well as weight-related behaviors. Results revealed no significant effect of WSC on weight change. There were significant WSC x time interactions, such that those rating WSC "very important" decreased self-weighing and the "low importance" group decreased their caloric intake during treatment. The "pretty important" group had greater minutes of activity than the "low importance" group. Findings indicated that WSC may impact weight-related behaviors that contribute to BWL success. This trial was pre-registered on ClinicalTrials.gov (NCT03739151)., Author(s): Stephanie P. Goldstein [sup.1] , KayLoni L. Olson [sup.1] , J. Graham Thomas [sup.1] Author Affiliations: (1) grid.40263.33, 0000 0004 1936 9094, Department of Psychiatry and Human Behavior, The [...]

Harmful effects of weight self-stigma on quality of life and health behaviors have been well-established. However, the processes that lead to these negative outcomes are less understood. Psychological inflexibility is defined as a pattern of rigid psychological reactions dominating over values and meaningful actions. A lack in valued action is characterized by the absence of activities that are connected to what is personally meaningful. In this secondary analysis, we aim to extend research by examining two subprocesses of psychological inflexibility, experiential avoidance and lack of valued action, as statistical mediators of the relations between weight self-stigma and quality of life/health behavior outcomes. Baseline data from a clinical trial comparing weight loss maintenance interventions in a sample of 194 adults living with overweight or obesity and seeking treatment is analyzed. Results show that greater experiential avoidance and lower valued action were significantly related to lower quality of life and satisfaction with social roles, as well as greater depression, anxiety, and binge eating. Further, results from a parallel mediation analysis indicated that weight self-stigma is indirectly related to anxiety, disinhibited eating, and hunger through the relationship with experiential avoidance and lack of valued action., Author(s): Marissa L. Donahue [sup.1] , Michael E. Levin [sup.1] , KayLoni Olson [sup.2] [sup.3] , Emily Panza [sup.2] [sup.3] , Jason Lillis [sup.2] [sup.3] [sup.4] Author Affiliations: (1) grid.53857.3c, [...]

Background Little is known about weight stigma in sexual minority women, and even less is known about weight stigma in those who have attained substantial weight loss and maintenance. Purpose This study examined weight stigma experiences and internalization in sexual minority women from the National Weight Control Registry (NWCR) who had lost ≥30 pounds and maintained this weight loss for ≥1 year, and compared weight stigma levels between sexual minority women versus heterosexual women in the NWCR. Methods NWCR participants completed an electronic survey. Women who identified as a sexual minority (n = 64; 98% White; M BMI = 29 ± 8; M age = 47 ± 13) and heterosexual women matched on body mass index (BMI), age, and race (n = 64; 98% White; M BMI = 28 ± 7; M age = 51 ± 13) were included. Participants completed assessments of experienced and internalized weight stigma. Results Generalized linear models showed that a significantly larger proportion of sexual minority women in the NWCR reported experiencing weight stigma in the past year (24.2%) compared with heterosexual women (4.7%; p <.05). Furthermore, sexual minority (vs. heterosexual) women reported significantly higher levels of internalized weight stigma (p <.001), and a greater proportion of sexual minority women (35%) reported clinically significant internalized weight stigma relative to heterosexual women (2%; p <.001). Conclusions Sexual minority women are at greater risk for experienced and internalized weight stigma than their heterosexual counterparts among women who have attained significant long-term weight loss. It is critical to expand research on weight stigma in sexual minority women. [ABSTRACT FROM AUTHOR]

Objective: The goal of this follow‐up to a randomized proof‐of‐concept study was to determine if targeting body shape concern (BSC) has a clinically significant impact on long‐term weight change among adult women of higher body weight with BSC. A secondary aim was to observe the maintenance of body image improvements during follow‐up. Method: In the original 4‐week trial, women were randomized to behavioral weight loss recommendations alone (control; n = 15) or combined with the evidence‐based body project intervention (n = 17). All participants were directed to continue monitoring diet and exercise through Week 8. The current analysis focused on follow‐up data collected on weight, BSC, internalized weight bias, internalized thin ideal, and body appreciation at 8 weeks, 6 months, and 12 months. Percent weight change was calculated from baseline and compared against clinical milestones of −2.5% and −5%. An intent‐to‐treat approach was used for individuals lost to follow‐up (n = 11). Results: Body project participants achieved the clinically significant target of −2.5% weight loss by 12 months. Control participants did not reach the milestone and regained lost weight at 12 months. Neither condition reached the 5% clinical target. Both groups experienced improved body image, but body project participants maintained a greater magnitude of improvement in all measures except internalized thin ideal at 12 months. Conclusion: The current study provides preliminary evidence that targeting BSC among women with BSC who want to lose weight may improve long‐term weight loss. Further intervention development and testing are warranted. Public Significance: The results of this study suggest that targeting negative body image among adult women with high BSC might be a pathway to improve long‐term weight loss in behavioral weight management. This is aligned with precision medicine priorities to optimize weight‐related health care. [ABSTRACT FROM AUTHOR]

Background Individuals with obesity are disproportionately impacted by pain-related symptoms. Purpose This study evaluated experienced weight stigma and internalized weight bias (IWB) as predictors of pain symptoms in daily life among individuals with obesity. Methods Adults with obesity (n = 39; 51% female, 67% White, 43.8 ± 11.6 years old, BMI = 36.8 ± 6.7 kg/m2) completed a baseline assessment (demographics, experienced weight stigma, IWB) and a 14-day Ecological Momentary Assessment (EMA) period involving five daily prompts of pain/aches/joint pain, muscle soreness, experienced weight stigma, and IWB. Generalized linear models were used to assess experienced weight stigma and IWB at baseline as prospective predictors of EMA pain/soreness symptoms. Multi-level models were used to test the association of momentary weight stigma experiences and IWB with pain/soreness at the same and subsequent EMA prompts. Results IWB at baseline, but not experienced weight stigma, was associated with more frequent pain symptoms (p  < .05) and muscle soreness (p  < .01) during EMA. Momentary IWB (but not experienced stigma) was associated with more pain/aches/joint pain and muscle soreness at the same and subsequent prompt. Conclusions Internalized (but not experienced) weight bias was prospectively associated with pain symptoms in daily life among individuals with obesity. Results are consistent with growing evidence that weight-related stigmas represent psychosocial factors that contribute to weight-related morbidity typically attributed to body size. [ABSTRACT FROM AUTHOR]

Background: There is growing interest in identifying factors associated with healthy aging. This cross‐sectional study evaluated associations of psychological resilience with factors associated with aging in older adults with type 2 diabetes mellitus (T2DM). Methods: Participants were 3199 adults (72.2 ± 6.2 years of age, 61% female, 61% White, body mass index [BMI] = 34.2 ± 8.2 kg/m2) with T2DM enrolled in Look AHEAD (a multi‐site randomized clinical trial comparing an intensive lifestyle intervention for weight loss to diabetes education and support). Participants were followed observationally after the 10‐year intervention was discontinued. The following items were assessed approximately 14.4 years post‐randomization in a cross‐sectional analysis: Brief Resilience Scale; overnight hospitalizations in past year; physical functioning measured objectively (gait speed, grip strength) and via self‐report (Pepper Assessment Tool for Disability; physical quality of life [QOL; SF‐36]); a measure of phenotypic frailty based on having ≥3 of unintentional weight loss, low energy, slow gait, reduced grip strength, and physical inactivity. Depressive symptoms (PHQ‐9) and mental QOL (SF‐36) were also measured. Logistic/linear/multinomial regression was used to evaluate the association of variables with resilience adjusted for age, race/ethnicity, and gender. Results: Greater psychological resilience was associated with lower BMI, fewer hospitalizations, better physical functioning (i.e., lower self‐reported disability, better physical QOL, faster gait speed, greater grip strength, lower likelihood of frailty), fewer depressive symptoms, and greater mental QOL (all p < 0.05). Psychological resilience moderated the relationship of number of hospitalizations in the past year with self‐reported disability and grip strength. Conclusions: Psychological resilience is associated with better physical function and QOL among older adults. Results should be interpreted cautiously given cross‐sectional nature of analyses. Exploring the clinical benefits of resilience is consistent with efforts to shift the narrative on aging beyond "loss and decline" to highlight opportunities to facilitate healthy aging. [ABSTRACT FROM AUTHOR]

Background: Holidays are challenging for weight control and are consistently associated with weight gain. Managing holiday weight gain may be especially difficult for individuals with higher body weight or a history of overweight/obesity. The current study evaluated how individuals with a history of successful weight loss plan for the holiday season and how the use of weight control strategies was associated with weight change. Methods: A subgroup of participants in the National Weight Control Registry (NWCR) were asked to complete a survey before (November) and after the holidays (January). At pre‐holiday, participants reported height, weight, and weight goals for the holiday season (lose, maintain, minimize gains, or gain), and selected the top three weight control strategies they planned to use (from a list of 18). Post‐holiday, participants reported weight and how often (frequently, infrequently, or not at all) they used each of the 18 strategies throughout the holidays. Results: Individuals who completed both surveys were included in the analysis (n = 683; 69% female, 93% white, 54.6 years [SD: 13.2], 26.9 kg/m2 [SD: 5.5]). Pre‐holiday, 64% of participants were currently trying to lose weight. Only 35% of the sample wanted to continue losing weight during the holiday season. The most common strategies individuals planned to use during the holiday season were evidence based (maintaining exercise, monitoring portions, tracking foods, and self‐weighing). Participants gained 0.66 kg (SD: 1.85) from pre‐ to post‐holiday and reported using an average of 12/18 strategies. A greater number of strategies were associated with less weight gain (F[1, 670] = 4.28, p = 0.04). Daily self‐weighing (p = 0.03) and prioritizing food choices (p = 0.02) were individually associated with less weight gain. Discussion: Participants in the NWCR entered the holiday season with a variety of goals for their weight and used many different strategies to control their weight. Having a wider range of strategies may be helpful to navigate the challenges to weight control during the holidays. [ABSTRACT FROM AUTHOR]

In the article, the authors reflect on the weight-related stigmatization on the use of health-focused applications through images, language and functionality.

Objective: The Action for Health in Diabetes (Look AHEAD) trial was a randomized trial comparing effects of intensive lifestyle intervention (ILI) and diabetes support and education (DSE) on cardiovascular disease (CVD) among individuals with overweight/obesity and type 2 diabetes. A secondary analysis was conducted to evaluate the association between change in weight and waist circumference (WC) and CVD outcomes. Methods: Participants (N = 5,490) were classified into four categories based on change in weight and WC between baseline and year 1 (both increased, both decreased, etc.). Separate Cox proportional hazards regression models were fit for ILI and DSE (using group that reduced weight/WC as reference), and time to first occurrence of primary and secondary CVD outcomes from year 1 through a median of almost 10 years were compared. Second, time to first event among all four ILI groups relative to DSE was evaluated. Results: Within DSE, CVD outcomes did not differ. ILI participants with increased WC had increased risk of primary outcomes, regardless of weight loss (hazard ratio: 1.55 [95% CI: 1.11‐2.17]) or weight gain (hazard ratio: 1.76 [95% CI: 1.07‐2.89]), and had increased risk of secondary outcomes (overall P < 0.01) relative to ILI participants who reduced both weight and WC and relative to DSE participants. Conclusions: In this secondary analysis, increased WC during the first year of ILI, independent of weight change, was associated with higher risk for subsequent cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

The article focuses on the behavioral approaches for the treatment and prevention of obesity among children and adults. It discusses the components of behavioral weight loss program which include calorie restriction, increase in physical activity, and behavioral strategies. Also mentioned are the use of pharmaceutical treatments and bariatric surgery in obesity.

Look AHEAD found no difference between intensive lifestyle intervention (ILI) for weight loss and diabetes support and education (DSE; control) in cardiovascular (CVD) outcomes among individuals with overweight or obesity and type 2 diabetes (T2DM). This secondary analysis evaluated the association between change in weight and waist circumference (WC), a possible proxy for visceral adiposity, and risk for CVD outcomes. We classified Look AHEAD participants (n=4590) into one of four categories based on change in weight and WC from baseline to Year 1 (increase/increase, etc.) to examine the association between the categories and primary (myocardial infarction, stroke, hospitalized angina, CVD death) and secondary (primary outcomes and CABG/PTCA, hospitalized congestive heart failure, carotid endarterectomy, PVD, and total mortality) CVD outcomes from Year 1 to end of active treatment (median of 9 years). Cox proportional-hazards regression models were used to 1) compare ILI participants in the four categories to DSE and 2) evaluate the four categories within treatment groups using the group that decreased WC and weight as the reference. Compared to DSE, individuals in ILI who increased WC and weight and individuals who increased WC but decreased weight both had greater risk of secondary CVD outcomes (HR[95%CI]: 1.95 [1.33, 2.86] and 1.35 [1.02, 1.80] respectively). In analyses stratified by randomization group, DSE participants did not differ in cardiovascular events across categories. Individuals in ILI who gained WC (regardless of weight loss or gain), had increased risk of primary and secondary CVD outcomes compared to individuals in ILI who decreased weight and WC. Increased WC during weight loss treatment, regardless of weight loss or gain, is associated with greater risk for CVD outcomes in individuals with T2DM. This emphasizes the importance of measuring WC in clinical practice and testing interventions focused on decreasing WC. Disclosure: K.L. Olson: None. R.H. Neiberg: None. M. Espeland: Other Relationship; Self; Boehringer Ingelheim International GmbH, Ironwood Pharmaceuticals. K.C. Johnson: None. W.C. Knowler: None. A.E. Staiano: None. L.E. Wagenknecht: None. R.R. Wing: None. Funding: National Institutes of Health [ABSTRACT FROM AUTHOR]

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 ( M = -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., Competing Interests: Samantha J. Schram declares no conflicts of interest. KayLoni L. Olson serves as the Vice Chair of the Health Research Council for the Society of Health Psychology. Emily Panza was an invited speaker and received support for attending The Obesity Society's annual meeting in 2023. Jason Lillis received hourly consulting fees from Abacus Health Solutions for about 25 h of work to advise on integrating Acceptance and Commitment Therapy strategies into weight management products that they are developing., (© 2024 The Author(s). Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.)