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D'Adamo L, Shonrock AT, Monocello L, Goldberg J, Yaeger LH, Jebeile H, Pearl R, Wilfley DE. Psychological Interventions for Internalized Weight Stigma: A Systematic Review of Feasibility, Acceptability, and Preliminary Efficacy. RESEARCH SQUARE 2024:rs.3.rs-4844880. [PMID: 39257967 PMCID: PMC11384824 DOI: 10.21203/rs.3.rs-4844880/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
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 review of psychological interventions for IWS and examined their 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 internalized weight stigma as an outcome. Exclusion criteria included: (1) commentary or review; and (2) not a psychological intervention. A systematic 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 indicate 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. Additional research using rigorous study designs (e.g., randomized controlled trials) is needed to further evaluate the efficacy of interventions for IWS.
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Affiliation(s)
| | | | | | - Jake Goldberg
- Washington University in St Louis School of Medicine
| | | | | | - Rebecca Pearl
- University of Florida College of Public Health and Health Professions
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Kelly NR, Osa ML, Luther G, Guidinger C, Folger A, Williamson G, Esquivel J, Budd EL. Preliminary evaluation of a brief worksite intervention to reduce weight stigma and weight bias internalization. EVALUATION AND PROGRAM PLANNING 2024; 104:102434. [PMID: 38615372 DOI: 10.1016/j.evalprogplan.2024.102434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/20/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
Weight-based discrimination (WBD) is common and associated with reduced physical and emotional functioning. WBD is common in the workplace, yet no studies have evaluated a WBD intervention delivered in a worksite setting. This study evaluated the feasibility, acceptability, and preliminary effectiveness of a 3-hour, remote-delivered WBD intervention at a large public university. Six workshops including 94 participants (41.76 ± 9.37 y; 92.8% women) were delivered December 2020 through May 2021; 88.3% of participants enrolled in the study and 88.8% of enrolled participants completed pre- and post-intervention surveys. Participants strongly agreed the workshop contributed to a more inclusive work environment (M=4.98 ± 0.2; 1 =Strongly Disagree to 5 =Strongly Agree); and was highly needed (4.9 ± 0.3) and liked (4.8 ± 0.5). Qualitative feedback cited benefits of remote delivery in providing body size anonymity and wanting access to intervention materials and more time for discussion and action steps to reduce WBD. Participants experienced significant, medium reductions in explicit weight bias (ps < .001), significant, small reductions in weight bias internalization (p < .001), and statistically non-significant (p = .08), small-to-medium reductions in implicit bias. Targeting worksites as a delivery mechanism has the potential to reduce WBD, thereby improving the health and well-being of diverse employees and creating a more inclusive workspace.
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Affiliation(s)
- Nichole R Kelly
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA.
| | - Maggie L Osa
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Gabriella Luther
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Claire Guidinger
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Austin Folger
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Gina Williamson
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Juliana Esquivel
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
| | - Elizabeth L Budd
- Counseling Psychology and Human Services, University of Oregon, USA; The Prevention Science Institute, University of Oregon, USA
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3
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Pearl RL, Hernandez M, Bach C, Groshon L, Wadden TA. Prevalence of diagnosed psychiatric disorders among adults who have experienced and internalized weight stigma. Obes Sci Pract 2023; 9:681-687. [PMID: 38090681 PMCID: PMC10712401 DOI: 10.1002/osp4.700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 01/30/2024] Open
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 (<10%) reported current psychiatric diagnoses or use of psychiatric medications. In Study 2 (n = 129, 88.4% women, 65.1% white), one-third of participants reported a mood disorder history, and 21.7% reported an anxiety disorder history, with approximately 16%-18% reporting current diagnoses. In both studies, few participants reported a history of a diagnosed eating disorder despite high rates of current full- or subthreshold symptoms. Based on Beck Depression Inventory-II scores, approximately 54%-64% of participants reported mild or greater symptoms of depression. Conclusions Overall, lifetime history of diagnosed psychiatric disorders and current symptoms of depression and eating disorders were relatively high across two samples. More research is needed to determine the impact of weight stigma on the diagnosis and treatment of eating disorders and other psychiatric concerns.
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Affiliation(s)
- Rebecca L. Pearl
- Department of Clinical and Health PsychologyCollege of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
- Department of PsychiatryCenter for Weight and Eating DisordersPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Marian Hernandez
- Department of Clinical and Health PsychologyCollege of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
| | - Caroline Bach
- Department of PsychologyGeorgia Southern UniversityStatesboroGeorgiaUSA
| | - Laurie Groshon
- Department of Clinical and Health PsychologyCollege of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
| | - Thomas A. Wadden
- Department of PsychiatryCenter for Weight and Eating DisordersPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Shi XL, Li LY, Fan ZG. Psychiatrists’ occupational stigma conceptualization, measurement, and intervention: A literature review. World J Psychiatry 2023; 13:298-318. [PMID: 37383285 PMCID: PMC10294130 DOI: 10.5498/wjp.v13.i6.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/05/2023] [Accepted: 05/11/2023] [Indexed: 06/19/2023] Open
Abstract
Psychiatrists require frequent contact with and treatment of patients with mental illnesses. Due to the influence of associative stigma, psychiatrists may also be targets of stigma. Occupational stigma warrants special consideration because it significantly affects psychiatrists' career advancement, well-being, and their patients’ health. Given that there is no complete summary of this issue, this study reviewed the existing literature on psychiatrists' occupational stigma to clearly synthesize its concepts, measurement tools, and intervention strategies. Herein, we emphasize that psychiatrists’ occupational stigma is a multifaceted concept that simultaneously encompasses physically, socially, and morally tainted aspects. Currently, standardized methods to specifically measure psychiatrists’ occupational stigma are lacking. Interventions for psychiatrists’ occupational stigma may consider the use of protest, contact, education, comprehensive and systematic methods, as well as the use of psychotherapeutic approaches. This review provides a theoretical basis for the development of relevant measurement tools and intervention practices. Overall, this review seeks to raise public awareness of psychiatrists' occupational stigma, thereby promoting psychiatric professionalism and reducing its stigma.
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Affiliation(s)
- Xiao-Li Shi
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
| | - Lu-Yao Li
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
| | - Zhi-Guang Fan
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
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Donahue ML, Levin ME, Olson K, Panza E, Lillis J. Examining the role of experiential avoidance and valued action in the negative effects of weight self-stigma. J Behav Med 2023; 46:517-524. [PMID: 36370244 PMCID: PMC10175510 DOI: 10.1007/s10865-022-00378-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/03/2022] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Marissa L Donahue
- Department of Psychology, Utah State University, Logan, UT 84322, USA.
| | - Michael E Levin
- Department of Psychology, Utah State University, Logan, UT 84322, USA
| | - KayLoni Olson
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, USA
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA
| | - Emily Panza
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, USA
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA
| | - Jason Lillis
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, USA
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA
- Department of Psychology, California Northstate University, California, USA
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Vasiliou VS, Russell H, Cockayne S, Coelho GLDH, Thompson AR. A network analysis of psychological flexibility, coping, and stigma in dermatology patients. Front Med (Lausanne) 2023; 10:1075672. [PMID: 37261125 PMCID: PMC10227518 DOI: 10.3389/fmed.2023.1075672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction Despite the negative effects of stigma in individuals with skin conditions, interventions to address its effects are rare. This might be in part due to a continued lack of understanding as to how individuals respond to stigma. Methods In this study, we employed a step-case analytic method, using traditional regression, moderation, and network analyses, to examine the role of psychological flexibility (PF) with stigmatized experiences, and stigma-related outcomes. We run a cross-sectional study (n = 105 individuals with various skin conditions) and analyzed stigma-related variables. We included variables examining perceived stigmatization (PSQ), anxiety (GAD-7), depression (PHQ-9), well-being (EQ5D5L), and variables stemming from the PF model (CompACT), presented as three coping with stigma responses, namely "open," "aware," and "active.". Results Using network analysis, the most influential or central variables that contributed to stigma were generalized anxiety, perceived stigmatization, and valued actions. In relation to PF, being open to the experience of stigma (as opposed to avoidance), keeping a distance from stigmatized thoughts (as opposed to self-stigmatizing), and bringing attention to value-based committed actions (as opposed to passivity) were all found to contribute to less stigmatized experiences. Discussion The results indicate that two of the three skills of the PF model ("open" and "active") may be important targets for interventions targeting stigma in people living with skin conditions.
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Affiliation(s)
- Vasilis S. Vasiliou
- School of Psychology, South Wales Clinical Psychology Doctorate, Cardiff and Vale University Health Board, Cardiff University, Cardiff, United Kingdom
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Hellen Russell
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Sarah Cockayne
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Andrew R. Thompson
- School of Psychology, South Wales Clinical Psychology Doctorate, Cardiff and Vale University Health Board, Cardiff University, Cardiff, United Kingdom
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
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Tunç H, Morris PG, Kyranides MN, McArdle A, McConachie D, Williams J. The relationships between valued living and depression and anxiety: A systematic review, meta-analysis, and meta-regression. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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8
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Pearl RL, Wadden TA, Groshon LC, Fitterman-Harris HF, Bach C, LaFata EM. Refining the conceptualization and assessment of internalized weight stigma: A mixed methods approach. Body Image 2023; 44:93-102. [PMID: 36549092 DOI: 10.1016/j.bodyim.2022.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
Internalized weight stigma has gained increasing attention in empirical studies, though questions remain about the adequacy of existing measures. The current study utilized a mixed methods approach, including a novel semi-structured interview, to revisit the conceptualization of internalized weight stigma and explore in more depth the stereotypes and impacts of weight reported by individuals with high scores on the widely-used Weight Bias Internalization Scale. All participants were interviewed as part of the screening procedures for two clinical trials (Study 1 n = 84, mean age=47.8 years, 83.3% women, 67.9% Black, mean BMI=39.2 kg/m2; Study 2 n = 129, mean age=50.0 years, 88.4% women, 65.1% white, mean BMI=37.8 kg/m2). The most common weight stereotypes identified were being lazy, lacking willpower or self-control, and having poor eating habits. Up to 66% of participants reported that they did not endorse negative weight stereotypes or apply them to themselves. The most highly identified impacts of weight were on self-image (>70%) and emotions (68-83%), followed by social (37-62%) and health concerns (20-25%). Approximately 60% of participants indicated that weight affected their self-directed thoughts and feelings "very much" to "extremely." Findings have implications for understanding and assessing internalized weight stigma in research and in clinical settings where interventions are needed.
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Affiliation(s)
- Rebecca L Pearl
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL 32610-0165, USA; Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104, USA.
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104, USA
| | - Laurie C Groshon
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL 32610-0165, USA
| | - Hannah F Fitterman-Harris
- Department of Psychological & Brain Sciences, University of Louisville, 2301 S. 3rd St., Life Sciences, Room 317, Louisville, KY 40292, USA
| | - Caroline Bach
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104, USA
| | - Erica M LaFata
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104, USA
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9
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Effects of an acceptance and commitment-based psychoeducation program on prospective psychological counselors’ some personal and professional qualifications. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04274-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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10
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Mueller J, Richards R, Jones RA, Whittle F, Woolston J, Stubbings M, Sharp SJ, Griffin SJ, Bostock J, Hughes CA, Hill AJ, Boothby CE, Ahern AL. Supporting Weight Management during COVID-19 (SWiM-C): twelve-month follow-up of a randomised controlled trial of a web-based, ACT-based, guided self-help intervention. Int J Obes (Lond) 2023; 47:51-59. [PMID: 36369513 PMCID: PMC9651901 DOI: 10.1038/s41366-022-01232-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We developed a guided self-help intervention (Supporting Weight Management during COVID-19, "SWiM-C") to support adults with overweight or obesity in their weight management during the COVID-19 pandemic. This parallel, two-group trial (ISRCTN12107048) evaluated the effect of SWiM-C on weight and determinants of weight management over twelve months. METHODS Participants (≥18 years, body-mass-index ≥25 kg/m2) were randomised to the SWiM-C intervention or to a standard advice group (unblinded). Participants completed online questionnaires at baseline, four months, and twelve months. The primary outcome was change in self-reported weight from baseline to twelve months; secondary outcomes were eating behaviour (uncontrolled eating, emotional eating, cognitive restraint of food intake), experiential avoidance, depression, anxiety, stress, wellbeing and physical activity. INTERVENTIONS SWiM-C is based on acceptance and commitment therapy (ACT). Participants had access to an online web platform with 12 weekly modules and email and telephone contact with a trained, non-specialist coach. Standard advice was a leaflet on managing weight and mood during the COVID-19 pandemic. RESULTS 388 participants were randomised (SWiM-C: n = 192, standard advice: n = 196). The baseline-adjusted difference in weight change between SWiM-C (n = 119) and standard advice (n = 147) was -0.81 kg (95% CI: -2.24 to 0.61 kg). SWiM-C participants reported a reduction in experiential avoidance (-2.45 [scale:10-70], 95% CI: -4.75 to -0.15), uncontrolled eating (-3.36 [scale: 0-100], 95% CI: -5.66 to -1.06), and emotional eating (-4.14 [scale:0-100], 95% CI: -7.25 to -1.02) and an increase in physical activity (8.96 [MET-min/week], 95% CI: 0.29 to 17.62) compared to standard advice participants. We found no evidence of an effect on remaining outcomes. No adverse events/side effects were reported. CONCLUSIONS Whilst we were unable to conclude that the intervention had an effect on weight, SWiM-C improved eating behaviours, experiential avoidance and physical activity. Further refinement of the intervention is necessary to ensure meaningful effects on weight prior to implementation in practice. TRIAL REGISTRATION NUMBER ISRCTN 12107048.
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Affiliation(s)
- Julia Mueller
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
| | - Rebecca Richards
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Rebecca A. Jones
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Fiona Whittle
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jennifer Woolston
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Marie Stubbings
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stephen J. Sharp
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Simon J. Griffin
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK ,grid.5335.00000000121885934Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Carly A. Hughes
- Fakenham Medical Practice, Fakenham, UK ,grid.8273.e0000 0001 1092 7967Medical School, University of East Anglia, Norwich, UK
| | - Andrew J. Hill
- grid.9909.90000 0004 1936 8403Division of Psychological and Social Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Clare E. Boothby
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Amy L. Ahern
- grid.5335.00000000121885934MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Van Wasshenova E, Boardley D, Geers A, Tull M, Steiner V. A Brief Value-based Randomized Intervention to Promote Physical Activity in Patients Attending Cardiac Rehabilitation. AMERICAN JOURNAL OF HEALTH EDUCATION 2022. [DOI: 10.1080/19325037.2022.2142334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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12
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Schulz-Heik RJ, Lazzeroni LC, Hernandez B, Avery TJ, Mathersul DC, Tang JS, Hugo E, Bayley PJ. Valued living among veterans in breath-based meditation treatment or cognitive processing therapy for posttraumatic stress disorder: Exploratory outcome of a randomized controlled trial. Glob Adv Health Med 2022; 11:2164957X221108376. [PMID: 35770246 PMCID: PMC9234823 DOI: 10.1177/2164957x221108376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Valued living is the extent to which an individual's behavior is consistent with what they believe is important or good. It is unknown whether many complementary and integrative treatments and psychotherapies for posttraumatic stress disorder enhance valued living, and for whom. Objectives Measure within- and between-group changes in valued living in Veterans who completed cognitive processing therapy (CPT) and sudarshan kriya yoga (SKY) for posttraumatic stress disorder (PTSD); evaluate moderators of improvement. Methods Participants with clinically significant symptoms of PTSD were assigned to CPT, a first line, evidence-based psychotherapy for PTSD or SKY, an emerging breath-based meditation with strong preliminary empirical support in a parallel-groups randomized controlled trial at a single Veterans Affairs healthcare center. The Valuing Questionnaire subscales for progress in valued living (VQ-P) and obstruction in valued living (VQ-O) were exploratory outcome measures. Assessors were blind to treatment assignment. Results 59 participants completed treatment (29 CPT, 30 SKY). Participants in the CPT group improved from baseline to end of treatment in both VQ-Progress (d=0.55, p=0.02) and VQ-Obstruction (d=-0.51, p=0.03), while the SKY group did not improve on either subscale (d=0.08, p=0.69; d=0.00, p=1.00). However, differences between treatments were not statistically significant (p=0.16, 0.11, respectively). Participants reporting less valued living and more depression symptoms at baseline reported greater improvements in valued living following treatment. Conclusion CPT may have a positive effect on valued living. Individuals lower in valued living and with more depression may derive relatively more benefit.
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Affiliation(s)
- R Jay Schulz-Heik
- War Related Illness and Injury
Study Center, VA Palo Alto Healthcare
System, Palo Alto, CA, USA
| | - Laura C Lazzeroni
- War Related Illness and Injury
Study Center, VA Palo Alto Healthcare
System, Palo Alto, CA, USA
- Department of Psychiatry and
Behavioral Sciences, Stanford University School of
Medicine, Stanford, CA, USA
| | - Beatriz Hernandez
- Department of Psychiatry and
Behavioral Sciences, Stanford University School of
Medicine, Stanford, CA, USA
| | - Timothy J Avery
- War Related Illness and Injury
Study Center, VA Palo Alto Healthcare
System, Palo Alto, CA, USA
- Department of Psychiatry and
Behavioral Sciences, Stanford University School of
Medicine, Stanford, CA, USA
| | - Danielle C Mathersul
- War Related Illness and Injury
Study Center, VA Palo Alto Healthcare
System, Palo Alto, CA, USA
- Department of Psychiatry and
Behavioral Sciences, Stanford University School of
Medicine, Stanford, CA, USA
- Discipline of Psychology, Murdoch University, Murdoch, WA, UK
| | - Julia S Tang
- War Related Illness and Injury
Study Center, VA Palo Alto Healthcare
System, Palo Alto, CA, USA
- Department of Psychiatry and
Behavioral Sciences, Stanford University School of
Medicine, Stanford, CA, USA
| | - Emily Hugo
- War Related Illness and Injury
Study Center, VA Palo Alto Healthcare
System, Palo Alto, CA, USA
- Department of Psychiatry and
Behavioral Sciences, Stanford University School of
Medicine, Stanford, CA, USA
| | - Peter J Bayley
- War Related Illness and Injury
Study Center, VA Palo Alto Healthcare
System, Palo Alto, CA, USA
- Department of Psychiatry and
Behavioral Sciences, Stanford University School of
Medicine, Stanford, CA, USA
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13
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Rogers CB, Webb JB, Bauert L, Carelock J. Feasibility and Acceptability of a Guided Self-Help, Text-Messaging Intervention to Promote Positive Body Image of Emerging Adult Women. Front Glob Womens Health 2022; 3:849836. [PMID: 35572213 PMCID: PMC9099092 DOI: 10.3389/fgwh.2022.849836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
The predominant approach of existing eating disorder prevention programs targets risk factors for development; furthermore, burgeoning evidence suggests that promotion of protective factors against eating disorders (e.g., positive body image) is also a worthy avenue for prevention efforts. The present study considered existing literature gaps in the design of an 8-week guided self-help intervention meant to address the risk for disordered eating through the improvement of positive body image and enhancement of current adaptive functioning. The intervention incorporated elements of weight-inclusive health promotion (e.g., Health at Every Size; HAES) alongside positive psychology and third-wave behavioral interventions [e.g., self-compassion, mindful eating, Acceptance and Commitment Therapy (ACT)] to promote engagement in mindful-self-care. This mixed-methods study evaluated the feasibility and acceptability of the text-messaging based intervention in a diverse sample of cisgender college women (N = 30; 30% Black; 30% bisexual) at risk for disordered eating. Results indicated a high level of engagement and satisfaction with the intervention. Proof of concept was preliminarily supported by the observed significant changes in variables of interest (i.e., body appreciation, positive embodiment, mindful self-care, intuitive eating, self-compassion, disordered eating, and body image dissatisfaction) across the intervention. Overall, results of this study suggest that the use of a guided self-help program based in technology which seeks to reduce risk factors for disordered eating while also supporting adaptive functioning may be indicated for emerging adult women. This article will discuss how the present study provides the groundwork for continued development of innovative and remotely accessible interventions which promote positive body image.
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Affiliation(s)
- Courtney B. Rogers
- Cherokee Health Systems, Knoxville, TN, United States
- *Correspondence: Courtney B. Rogers
| | - Jennifer B. Webb
- Health Psychology PhD Program, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Lia Bauert
- Health Psychology PhD Program, University of North Carolina at Charlotte, Charlotte, NC, United States
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Brenton-Peters JM, Consedine NS, Cavadino A, Roy R, Serlachius AS. Investigating the effect of an online self-compassion for weight management (SC4WM) intervention on self-compassion, eating behaviour, physical activity and body weight in adults seeking to manage weight: protocol for a randomised controlled trial. BMJ Open 2022; 12:e056174. [PMID: 35105594 PMCID: PMC8808316 DOI: 10.1136/bmjopen-2021-056174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Individual weight management, defined as engaging in behaviours to maintain or lose weight, can improve health and well-being. However, numerous factors influence weight management outcomes, such as genetics, biology, stress, the social and physical environment. Consequently, weight management can be hard. Self-compassion, described as treating oneself kindly in times of failure or distress, has shown promise in improving weight management outcomes. The objectives of this study are twofold: (1) to examine the efficacy of an online self-compassion for weight management (SC4WM) intervention coupled with an online commercial weight management programme (WW Weight Watchers reimagined) with increasing self-compassion and improving weight management outcomes (eating behaviour, physical activity and body weight) in comparison with the WW programme only and (2) to explore whether improvements in weight management outcomes are moderated by eating restraint, weight self-stigma, perceived stress and psychological coping. METHODS AND ANALYSIS To achieve these objectives, 240 participants seeking to manage their weight were randomised to either an online behavioural commercial weight management programme (WW) or the online WW +SC4 WM intervention. Validated measures of self-compassion, stress, weight self-stigma, eating restraint, psychological coping and weight management outcomes were administered online at baseline, 4 weeks and at a 12-week follow-up. ETHICS AND DISSEMINATION Ethics has been granted by the University of Auckland Health Research Ethics committee. Results will be communicated in peer-review journals, conferences and a doctoral thesis. If effective in increasing self-compassion and improving weight management outcomes, the intervention could be made more widely available to supplement behavioural weight management programmes. TRIAL REGISTRATION NUMBER ACTRN12621000580875; Pre-results.
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Affiliation(s)
| | - Nathan S Consedine
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Alana Cavadino
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rajshri Roy
- Department of Nutrition and Dietetics, The University of Auckland, Auckland, New Zealand
| | - Anna Sofia Serlachius
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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15
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Di Sante J, Akeson B, Gossack A, Knäuper B. Efficacy of ACT-Based treatments for dysregulated eating behaviours: A systematic review and meta-analysis. Appetite 2022; 171:105929. [PMID: 35032613 DOI: 10.1016/j.appet.2022.105929] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND An increasing number of studies have investigated the efficacy of Acceptance and Commitment Therapy (ACT) for the reduction of dysregulated eating behaviours such as binge eating and emotional eating. However, little is known about their short- and long-term efficacy and underlying mechanisms of change. OBJECTIVES To conduct a systematic effect size analysis to estimate the efficacy of ACT-based treatments on measures of dysregulated eating and of psychological flexibility, a theorized ACT mechanism of change. METHODS Literature searches were conducted in PsycInfo, Medline, Web of Science, and ProQuest Dissertations. Within-group and between-group standardized mean differences were computed using Comprehensive Meta-Analysis Version 3. Additional subgroup and meta-regression analyses by study characteristics were conducted. RESULTS A total of 20 publications (22 samples, n = 1269) were included. Pre-post and pre-follow-up effects suggest that ACT-based treatments are moderately effective in reducing dysregulated eating behaviours and increasing psychological flexibility. These effects were comparable for binge-eating and emotional eating outcomes and for face-to-face interventions, Web-based interventions, and interventions that used a self-help book. Longer treatments were associated with larger outcome effect sizes, and changes in psychological flexibility were not associated with changes in dysregulated eating outcomes. Small significant effects were found in favour of ACT when compared to inactive control groups. The only three studies that included active control groups and did not show significant differences in outcomes between ACT and other treatments. CONCLUSION Future studies should aim to compare ACT-based treatments to active treatments and to provide empirical evidence for the theoretical mediating role of psychological flexibility in reported changes in eating behaviour.
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Affiliation(s)
| | - Bianca Akeson
- Department of Psychology, McGill University, Quebec, Canada
| | - Amanda Gossack
- Department of Psychology, McGill University, Quebec, Canada
| | - Bärbel Knäuper
- Department of Psychology, McGill University, Quebec, Canada
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16
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Pearl RL, Wadden TA, Jakicic JM. Is weight stigma associated with physical activity? A systematic review. Obesity (Silver Spring) 2021; 29:1994-2012. [PMID: 34747131 PMCID: PMC8612947 DOI: 10.1002/oby.23274] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/17/2021] [Accepted: 07/26/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Weight stigma is associated with impaired health, attributed in part to reductions in health-promoting behaviors. This review analyzed evidence of the association between weight stigma and physical activity (PA) in adults and youth. METHODS Three databases were searched for terms related to weight stigma and PA. Eligible studies reported the quantitative association between at least one measure of weight stigma and one behavioral measure of PA. RESULTS A total of 38 studies met eligibility criteria. Of the 29 studies of adults, 3 used objective PA measures, and 79% used an observational, cross-sectional design. Findings of the relationship between weight stigma and PA were mixed. Everyday weight discrimination and internalizing weight stigma were associated with reduced PA in most studies. Several studies found indirect, and not direct, effects of weight stigma on PA when analyses included other individual-level factors. In the nine studies of youth, two used objective PA measures, all were observational, and only one study was longitudinal. Most youth studies found a relationship between weight-based teasing and reduced PA. CONCLUSIONS Weight teasing, everyday discrimination, and internalization were associated with reduced PA. However, associations were inconsistent and often indirect. Future studies should include objective PA measures with larger samples and longitudinal assessments.
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Affiliation(s)
- Rebecca L. Pearl
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas A. Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John M. Jakicic
- Healthy Lifestyle Institute and Physical Activity and Weight Management Research Center, University of Pittsburgh, Pittsburgh, PA, USA
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17
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Iturbe I, Echeburúa E, Maiz E. The effectiveness of acceptance and commitment therapy upon weight management and psychological well-being of adults with overweight or obesity: A systematic review. Clin Psychol Psychother 2021; 29:837-856. [PMID: 34802174 DOI: 10.1002/cpp.2695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/29/2021] [Accepted: 11/14/2021] [Indexed: 01/22/2023]
Abstract
Several studies have examined acceptance and commitment therapy's (ACT) effectiveness for addressing physical and psychological distress people with obesity can face. Nevertheless, no review focusing specifically on ACT analysing randomized controlled trials (RCT) has been done up to date in this field. The present systematic review was developed following the PRISMA statement and aimed to examine ACT's effects on weight management and psychological well-being of adults with overweight or obesity. A conjunction of keywords related to ACT and excess weight was searched in four databases (Medline, PubMed, Psycinfo and Scopus) for articles meeting inclusion criteria. The literature search yielded 2,074 papers, and 16 were included in the review, finally. In 71.43% of the studies, ACT was effective to enhance psychological well-being; in 50% effectively targeted process variables and health behaviours related to weight management; in 31.82% of studies, physical variables were improved; and 21.38% of studies showed evidence in favour of ACT for eating behaviour modification. The present review supports ACT for promoting emotional aspects of individuals immersed in such weight-related battles and highlights the benefits of psychological well-being-oriented ACT in the context of obesity treatment. More studies targeting psychological well-being primarily and with longer follow-ups are required.
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Affiliation(s)
- Idoia Iturbe
- Department of Clinical and Health Psychology and Research Methodology, University of the Basque Country UPV/EHU, Donostia-San Sebastian, Spain
| | - Enrique Echeburúa
- Department of Clinical and Health Psychology and Research Methodology, University of the Basque Country UPV/EHU, Donostia-San Sebastian, Spain
| | - Edurne Maiz
- Department of Clinical and Health Psychology and Research Methodology, University of the Basque Country UPV/EHU, Donostia-San Sebastian, Spain
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18
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Pearl RL, Puhl RM, Himmelstein MS, Pinto AM, Foster GD. Weight Stigma and Weight-Related Health: Associations of Self-Report Measures Among Adults in Weight Management. Ann Behav Med 2021; 54:904-914. [PMID: 32333673 DOI: 10.1093/abm/kaaa026] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Weight stigma impairs health. Few studies have disentangled the associations of experienced versus internalized stigma with weight-related outcomes. PURPOSE To examine weight and health variables associated with weight stigma experiences and internalization in the largest-to-date sample of adults in weight management. METHODS WW (formerly Weight Watchers) members (N = 18,769, 94.6% female, 91.1% white) completed an online survey from 2017 to 2018. Participants reported whether they had experienced weight stigma and, if so, the onset, past-year frequency and distress, and interpersonal sources of stigma. Participants completed the Modified Weight Bias Internalization Scale (WBIS-M) and self-reported: past-year weight and lifetime weight cycles; current self-monitoring behaviors; eating self-efficacy; physical activity; perceived stress; eating to cope; body image; and mental and physical health-related quality-of-life (HRQOL). Participants reported their demographic characteristics, including height and weight to compute body mass index. RESULTS In logistic and linear regression analyses (controlling for participant characteristics), WBIS-M scores were negatively associated with weight loss, self-monitoring, eating self-efficacy, body image, and mental HRQOL and positively associated with weight gain, weight cycling, perceived stress, and eating to cope (p < .001). Experiencing weight stigma was associated with greater weight loss and less weight gain, although associations with other variables had small effect sizes (absolute β values < 0.10). WBIS-M scores remained significantly associated with all variables when including stigma onset, frequency/distress, and sources. CONCLUSIONS Internalized, but not experienced, weight stigma was consistently associated with adverse weight and health factors. Developing and testing interventions targeting internalized stigma in the context of weight management should be a research priority.
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Affiliation(s)
- Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA.,Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | - Mary S Himmelstein
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA.,Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Angela M Pinto
- Science Department, WW (formerly Weight Watchers) International, Inc., New York, NY, USA.,Department of Psychology, Baruch College, City University of New York, New York, NY, USA
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Science Department, WW (formerly Weight Watchers) International, Inc., New York, NY, USA
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19
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Henson A, Ruglis J, Sinacore A, Fitzpatrick M, Lanteigne D. Self‐compassion for youth in small city centres: A school‐based pilot project. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Alisha Henson
- Department of Educational & Counselling Psychology Faculty of Education McGill University Montreal QC Canada
- Pembroke Psychological Services Pembroke ON Canada
| | - Jessica Ruglis
- Department of Educational & Counselling Psychology Faculty of Education McGill University Montreal QC Canada
| | - Ada Sinacore
- Department of Educational & Counselling Psychology Faculty of Education McGill University Montreal QC Canada
| | - Marilyn Fitzpatrick
- Department of Educational & Counselling Psychology Faculty of Education McGill University Montreal QC Canada
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20
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The effect of acceptance and commitment training on improving physical activity during the COVID-19 pandemic. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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21
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Ameral V, Palm Reed KM. Envisioning a future: Values clarification in early recovery from opioid use disorder. J Subst Abuse Treat 2020; 121:108207. [PMID: 33357601 DOI: 10.1016/j.jsat.2020.108207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/04/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
High rates of relapse and overdose during early recovery from opioid use disorder (OUD) highlight the importance of providing effective treatment during this crucial phase. While early treatment often focuses on managing urges and withdrawal symptoms, eliciting personally salient motivators may help to target predictors of treatment outcomes such as motivation and self-efficacy. This experimental study examined the effect of a brief values clarification exercise on motivation and self-efficacy for abstinence in a sample of n = 93 individuals in brief residential treatment for OUD. Participants were randomly assigned to values clarification or a time management control condition exercise. Self-efficacy for abstinence as measured by a validated single-item measure was higher for participants in the values condition (M = 8.7) compared to control (M = 7.8, p = .013), while motivation for abstinence as measured by the commitment to sobriety scale was similarly high for both the values clarification (M = 28.0) and control (M = 27.8, p = .642) groups. There were no group differences in delay discounting, the theorized mediator of these relationships. Taken together, these results suggest that even a brief values clarification exercise may increase self-efficacy for abstinence when added to early residential treatment for OUD.
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Affiliation(s)
- Victoria Ameral
- Clark University, 950 Main Street, Worcester, MA 01610, USA; VA Bedford Healthcare System, 200 Springs Road, Bedford, MA 01730, USA.
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22
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Alleva JM, Atkinson MJ, Schwarten S, Theden A, Waldén MI, Martijn C. The potential benefits of death reflection for improving women's body image. Body Image 2020; 35:192-200. [PMID: 33045500 DOI: 10.1016/j.bodyim.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/07/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Abstract
This study investigated death reflection as a novel strategy to improve body image among women. Young adult women (N = 158; Mage = 21.35) completed a death reflection exercise, a death-related active control exercise (to ensure that effects were due to the manner in which women reflected on their death, rather than due to thoughts about death in general), or a non-death-related active control exercise. Participants completed measures of body image at posttest and 1-week follow-up. The women in the death reflection group, compared to the non-death-related control group, experienced higher body weight satisfaction at posttest. Among women higher in beauty orientation, those in the death reflection group experienced higher body shape satisfaction compared to women in the death-related control group. Effects were medium-to-large in magnitude. No group differences were observed for overall appearance satisfaction, appearance importance, broad conceptualisation of beauty, and endorsement of cultural appearance ideals. These findings provide preliminary support for death reflection as a technique to improve some facets of women's body image. Yet, future research is needed to test whether these effects are replicable and can be extended to other facets of body image.
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Affiliation(s)
- Jessica M Alleva
- Department of Clinical Psychological Science, Maastricht University, the Netherlands.
| | - Melissa J Atkinson
- Department of Psychology, University of Bath, United Kingdom; Centre for Appearance Research, University of the West of England, United Kingdom
| | - Sabine Schwarten
- Department of Clinical Psychological Science, Maastricht University, the Netherlands
| | - Anuschka Theden
- Department of Clinical Psychological Science, Maastricht University, the Netherlands
| | - Moon I Waldén
- Department of Clinical Psychological Science, Maastricht University, the Netherlands
| | - Carolien Martijn
- Department of Clinical Psychological Science, Maastricht University, the Netherlands
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23
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Potts S, Krafft J, Levin ME. A Pilot Randomized Controlled Trial of Acceptance and Commitment Therapy Guided Self-Help for Overweight and Obese Adults High in Weight Self-Stigma. Behav Modif 2020; 46:178-201. [PMID: 33251823 DOI: 10.1177/0145445520975112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Weight self-stigma, in which individuals internalize stigmatizing messages about weight, is a prevalent problem that contributes to poor quality of life and health. This pilot randomized controlled trial evaluated acceptance and commitment therapy (ACT) guided self-help using The Diet Trap for 55 overweight/obese adults high in weight self-stigma. Participants were randomized to the ACT self-help book plus phone coaching (GSH-P; n = 17), self-help book plus email prompts only (GSH-E; n = 20), or a waitlist condition (n = 18), with online self-report assessments at baseline and posttreatment (8 weeks later). Participants reported high satisfaction ratings and engagement with the ACT self-help book, with no differences between GSH-P and GSH-E. Both GSH-P and GSH-E improved weight self-stigma relative to waitlist with large effect sizes. There were mixed findings for health outcomes. The GSH-P condition improved more on healthy eating behaviors and general physical activity, but neither ACT condition improved more than waitlist on self-reported body mass index, emotional eating, and a second measure of physical activity. Results suggest an ACT self-help book with email prompts can reduce weight self-stigma and potentially improve some health behavior outcomes. Phone coaching may provide additional benefits for generalizing ACT to diet and physical activity.
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Affiliation(s)
- Sarah Potts
- Partnership Health Center, Missoula, MT, USA
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24
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Manchón J, Quiles M, León E, López-Roig S. Acceptance and Commitment Therapy on physical activity: A systematic review. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Geller S, Levy S, Hyman O, L. Jenkins P, Abu-Abeid S, Goldzweig G. Body Image, Emotional Eating and Psychological Distress among Bariatric Surgery Candidates in Israel and the United States. Nutrients 2020; 12:nu12020490. [PMID: 32075087 PMCID: PMC7071170 DOI: 10.3390/nu12020490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The present study aimed to examine the relations between body image dissatisfaction (BID) and psychological distress variables among bariatric surgery candidates from two distinct cultures in Israel and in the United States. METHODS A sample of consecutive pre-surgical bariatric candidates was recruited from a Bariatric Center in Israel (N = 114) and a Bariatric Center in the Unites States (N = 81). Body image dissatisfaction (BID-BSQ8), suicidal ideation (SBQ-R), depressive symptoms (PHQ-9), anxious symptoms (PHQ-7), and emotional eating behaviors (EES), were measured. Mediation models were assessed using path analysis. RESULTS BID was positively correlated with suicidality, depression, and anxiety in both samples. The relations between BID depression and anxiety were mediated by emotional eating in both cultures. However, the relation between BID and suicidality that was mediated by emotional eating in the Israeli sample, was reflected in a direct link between BID and suicidality in the US sample. CONCLUSION Our findings confirm the adverse effect of BID on psychological distress among surgery candidates in both cultures, emphasizing the intercultural similarities related to emotional eating behavior. Physicians and other health professionals are encouraged to be more attentive to this specific behavior.
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Affiliation(s)
- Shulamit Geller
- School of Behavioral Sciences, the Academic College of Tel Aviv-Yaffo, 14, Rabenu Yeruham St, Tel Aviv-Yaffo 6818543, Israel;
- Correspondence: ; Tel.: +97-236-802-533
| | - Sigal Levy
- Statistics Education Unit, the Academic College of Tel Aviv, Tel Aviv-Yaffo 6818543, Israel;
| | - Ofra Hyman
- Outpatient Psychiatry, Bassett Medical Center, Cooperstown, NY 13326-1394 USA;
| | - Paul L. Jenkins
- Bassett Healthcare Research Institute, Bassett Medical Center, Cooperstown, NY 13326-1394, USA;
| | - Subhi Abu-Abeid
- Bariatric Surgery Unit, General Surgery Division, the Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo 6423906, Israel;
| | - Gil Goldzweig
- School of Behavioral Sciences, the Academic College of Tel Aviv-Yaffo, 14, Rabenu Yeruham St, Tel Aviv-Yaffo 6818543, Israel;
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26
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Marshall RD, Latner JD, Masuda A. Internalized Weight Bias and Disordered Eating: The Mediating Role of Body Image Avoidance and Drive for Thinness. Front Psychol 2020; 10:2999. [PMID: 32038383 PMCID: PMC6987958 DOI: 10.3389/fpsyg.2019.02999] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/18/2019] [Indexed: 11/22/2022] Open
Abstract
Internalized weight bias has been linked with undesirable physical and psychological health outcomes, including disordered eating. Interventions have targeted internalized weight bias and associated outcomes, but little is known about underlying mechanisms of change. Existing treatment literature suggests that drive for thinness and body image avoidance may sustain the link between internalized weight bias and disordered eating. The present study aimed to determine if drive for thinness and body image avoidance mediated the relationship between internalized weight bias and disordered eating in an ethnically diverse sample. Participants included 225 female college students aged 18–49 years (mean age = 20.4 years, SD = 4.4), with a mean BMI of 23.3 kg/m2 who completed a computer-based survey for partial course credit. As expected, internalized weight bias was positively associated with disordered eating, and results supported the hypothesis of the mediating role of drive for thinness and body image avoidance. These results are important given the shortage of intervention efforts targeting internalized weight bias. Future intervention efforts aimed at reducing internalized weight bias and associated outcomes may benefit from simultaneously targeting drive for thinness and body image avoidance.
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Affiliation(s)
- Rachel D Marshall
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, United States
| | - Janet D Latner
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, United States
| | - Akihiko Masuda
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, United States
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27
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Lewis-Smith H, Diedrichs PC, Halliwell E. Cognitive-behavioral roots of body image therapy and prevention. Body Image 2019; 31:309-320. [PMID: 31519523 DOI: 10.1016/j.bodyim.2019.08.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 01/19/2023]
Abstract
The existing array of evidence-based body image prevention and intervention approaches has evolved over time. However, the majority originated directly or indirectly from a cognitive-behavioral conceptualisation of body image pioneered by Thomas F. Cash. In this way, it is difficult to overstate the impact Tom Cash has had on body image intervention research and practice. His ground-breaking work, building on the work of Schilder and Fisher, was the first to provide a comprehensive model of body image that reflected the broad range of influences and consequences of body image. His differentiation of the components of body image as a construct and between body image traits and states allowed us to identify and influence targets for intervention. Moreover, the intervention strategies that Tom Cash employed are still used today and laid the foundations for contemporary intervention programs. There is a gap of more than 15 years between the first and last of us receiving our PhDs, yet Cash's work has been an important influence on us all. We are extremely grateful for the theoretical and practical tools that he has given to our field. In this paper, we will outline how Cash's work has informed contemporary body image intervention and prevention. We will describe Cash's theory and intervention tools before discussing how this work paved the way for subsequent research and practice.
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Affiliation(s)
- Helena Lewis-Smith
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Phillippa C Diedrichs
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Emma Halliwell
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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28
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Ramos Salas X, Forhan M, Caulfield T, Sharma AM, Raine KD. Addressing Internalized Weight Bias and Changing Damaged Social Identities for People Living With Obesity. Front Psychol 2019; 10:1409. [PMID: 31293476 PMCID: PMC6606721 DOI: 10.3389/fpsyg.2019.01409] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/31/2019] [Indexed: 11/13/2022] Open
Abstract
Obesity is a stigmatized disease due to pervasive personal, professional, institutional, and cultural weight bias. Individuals with obesity experience weight bias across their lifespan and settings, which can affect their life chances and significantly impact health and social outcomes. The objectives of this study were to: (a) explore weight bias and stigma experiences of people living with obesity; (b) develop counterstories that can reduce weight bias and stigma; and (c) reflect on current obesity master narratives and identify opportunities for personal, professional, and social change. Methods: Using purposive sampling, we lived alongside and engaged persons with obesity (n = 10) in a narrative inquiry on weight bias and obesity stigma. We co-developed interim narrative accounts while applying the three-dimensional narrative inquiry space: (a) temporality; (b) sociality; and (c) place, to find meaning in participants' experiences. We also applied the narrative repair model to co-create counterstories to resist oppressive master narratives for participants and for people living with obesity in general. Results: We present 10 counterstories, which provide a window into the personal, familial, professional, and social contexts in which weight bias and obesity stigma take place. Discussion: A fundamental driver of participants' experiences with weight bias is a lack of understanding of obesity, which can lead to internalized weight bias and stigma. Weight bias internalization impacted participants' emotional responses and triggered feelings of shame, blame, vulnerability, stress, depression, and even suicidal thoughts and acts. Participants' stories revealed behavioral responses such as avoidance of health promoting behaviors and social isolation. Weight bias internalization also hindered participants' obesity management process as well as their rehabilitation and recovery strategies. Participants embraced recovery from internalized weight bias by developing self-compassion and self-acceptance and by actively engaging in efforts to resist damaged social identities and demanding respect, dignity, and fair treatment. Conclusion: Narrative inquiry combined with the narrative repair model can be a transformative way to address internalized weight bias and to resist damaged social identities for people living with obesity. By examining experiences, beliefs, values, practices, and relationships that contribute to dominant obesity narratives, we can begin to address some of the socially and institutionally generated negative views of individuals with obesity.
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Affiliation(s)
| | - Mary Forhan
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Timothy Caulfield
- Faculty of Law and School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Arya M. Sharma
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kim D. Raine
- Obesity Canada, University of Alberta, Edmonton, AB, Canada
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Abstract
PURPOSE OF REVIEW The purpose of this review was to examine different forms of disordered eating among individuals with excess weight, including their rates, correlates, and psychosocial treatments. RECENT FINDINGS Binge eating/binge eating disorder, loss of control eating, emotional eating, and food addiction are all fairly prevalent among individuals with excess weight. They appear to share many of the same correlates, including broader eating disorder psychopathology, body/shape/weight concerns, depression, anxiety, and low self-esteem. Behavioral, cognitive-behavioral, and third-wave (e.g., acceptance, mindfulness) therapies appear effective in improving binge eating, loss of control eating, emotional eating, associated features (e.g., weight and shape concerns), and psychological distress (e.g., depression). Certain forms of disordered eating are elevated among individuals with excess weight, and psychosocial interventions have been found effective in improving symptomatology. Empirical research examining the efficacy of treatments for food addiction is lacking, and greatly needed given both its rate and controversy.
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Affiliation(s)
- Bethany A Nightingale
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada.
| | - Stephanie E Cassin
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Centre for Mental Health, University Health Network, Toronto, ON, Canada.
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30
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Lillis J, Thomas JG, Olson K, Wing RR. Weight self-stigma and weight loss during behavioural weight loss intervention. Obes Sci Pract 2019; 5:21-27. [PMID: 30847224 PMCID: PMC6381303 DOI: 10.1002/osp4.314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/21/2018] [Accepted: 11/24/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Despite the myriad negative effects of weight self-stigma, its role in weight loss intervention has not been thoroughly examined. The aim of this study was to examine the association between weight self-stigma and weight loss. METHODS This longitudinal study examined the association between weight loss and changes in self-stigma, assessed by the Weight Self-Stigma Questionnaire, which distinguished between self-devaluation and fear of enacted stigma. Participants were adults with overweight or obesity enrolled in a 24-month weight loss intervention trial (groups were collapsed for this post hoc analysis) who were assessed at baseline, 6, 12, 18 and 24 months. RESULTS Baseline levels of self-stigma were not associated with weight loss outcomes. However, mixed models analysis showed that reductions in one aspect of weight self-stigma, self-devaluation, was associated with greater weight loss (p = 0.01). Cross products mediation analysis showed that increases in use of weight control strategies mediated the association between reductions in self-devaluation and greater weight loss (F = 14.86, p < 0.001; CI 0.09-0.37). CONCLUSIONS Results suggest that there may be potential for incorporating intervention methods targeting the reduction of self-stigma in order to improve weight loss outcomes.
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Affiliation(s)
- J. Lillis
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research CenterProvidenceRIUSA
| | - J. G. Thomas
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research CenterProvidenceRIUSA
| | - K. Olson
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research CenterProvidenceRIUSA
| | - R. R. Wing
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research CenterProvidenceRIUSA
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Olson KL, Lillis J, Thomas JG, Wing RR. Prospective Evaluation of Internalized Weight Bias and Weight Change Among Successful Weight-Loss Maintainers. Obesity (Silver Spring) 2018; 26:1888-1892. [PMID: 30421843 PMCID: PMC6249105 DOI: 10.1002/oby.22283] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Internalized weight bias (IWB) has been associated with weight regain after intentional weight loss, but reliance on cross-sectional data limits the understanding of this relationship. This study prospectively evaluated IWB as a predictor of weight change in a longitudinal observational study of successful weight-loss maintainers. METHODS National Weight Control Registry participants (maintained 13.6-kg weight loss for ≥ 1 y) were asked to complete an online questionnaire including current weight and Weight Bias Internalization Scale-Modified (WBIS-M) at baseline and 12 months. RESULTS At baseline, 1,250 of 1,643 eligible individuals completed the baseline assessment (71% female; 94% white; mean age ± SD: 52 y ± 13.1; BMI: 27 ± 5.5). The average WBIS-M score was 3.0 (± 1.3). Study completers (n = 862) reported 2.2% (± 7.8%) weight gain. Higher baseline IWB predicted weight gain among men (n = 254; t = -2.28; P = 0.02) but not women (n = 608; t = 1.22; P = 0.22). A one-point reduction in WBIS-M score at follow-up was associated with a 3.0% weight loss. CONCLUSIONS Among weight-loss maintainers, IWB may be a risk factor for weight gain among men. Weight loss at follow-up was associated with reduced IWB in both men and women. Reliance on female-only samples may limit our understanding of IWB and its implications for weight control.
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Affiliation(s)
- KayLoni L. Olson
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
| | - Jason Lillis
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
| | - J. Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
| | - Rena R. Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
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Puhl RM, Himmelstein MS. Weight Bias Internalization Among Adolescents Seeking Weight Loss: Implications for Eating Behaviors and Parental Communication. Front Psychol 2018; 9:2271. [PMID: 30519207 PMCID: PMC6258789 DOI: 10.3389/fpsyg.2018.02271] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/01/2018] [Indexed: 12/21/2022] Open
Abstract
Background: Emerging evidence has demonstrated a high prevalence of weight bias internalization (WBI) among adults, as well as consistent links between internalization and adverse psychological and physical health. However, research examining WBI in youth and its impact on their health is scarce, especially among youth seeking weight loss treatment who may be particularly vulnerable to weight stigma from peers and parents. To address this research gap, the present study assessed WBI in a weight loss treatment-seeking sample of adolescents, examining associations between internalization and adolescents' eating behaviors and parental weight-related communication. Methods: Adolescents (N = 148, M age = 15.97 years), completed online self-report measures to assess WBI (using the modified version of the WBI Scale), body weight, binge eating, eating as a coping strategy, and weight teasing from peers and family members. Adolescents also reported on the frequency of parental comments about body weight, parental dieting, and parental encouragement of adolescent dieting. Results: Adolescents expressed a high mean level of internalized weight bias (M = 5.45, SD = 0.88). Higher levels of internalization were observed across increasing body weight categories; no differences were observed for gender or history of weight teasing. WBI was significantly higher among adolescents who reported binge eating and eating to cope with distress. Regression analyses showed that weight-related comments from mothers (but not fathers) significantly predicted adolescents' WBI (including frequency of mothers' comments about adolescents' body weight, comments about their own body weight, and encouragement of their adolescent to diet), as did increased dieting frequency among mothers. Conclusion: The present study provides novel insights to the scant literature on WBI in youth. Findings indicate that WBI is high in both girls and boys engaged in weight loss, and is associated with maladaptive eating behaviors, higher frequency of maternal dieting, and mothers' comments about body weight. These findings have important clinical implications for youth and families engaged in weight loss treatment, and underscore the need for research to clarify adverse effects of internalization on weight-related health in youth and to better understand the role that parental weight communication may have on adolescents' internalization.
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Affiliation(s)
- Rebecca M Puhl
- Department of Human Development and Family Studies, Rudd Center for Food Policy and Obesity, Hartford, CT, United States
| | - Mary S Himmelstein
- Mary Himmelstein, Rudd Center for Food Policy and Obesity, Hartford, CT, United States
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33
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Linardon J, Gleeson J, Yap K, Murphy K, Brennan L. Meta-analysis of the effects of third-wave behavioural interventions on disordered eating and body image concerns: implications for eating disorder prevention. Cogn Behav Ther 2018; 48:15-38. [DOI: 10.1080/16506073.2018.1517389] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, Burwood, Australia
| | - John Gleeson
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Keong Yap
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Kylie Murphy
- Centre for Eating, Weight and Body Image, Melbourne, Australia
| | - Leah Brennan
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
- Centre for Eating, Weight and Body Image, Melbourne, Australia
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34
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Phelan SM. An update on research examining the implications of stigma for access to and utilization of bariatric surgery. Curr Opin Endocrinol Diabetes Obes 2018; 25:321-325. [PMID: 30048259 DOI: 10.1097/med.0000000000000431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW To summarize recent literature examining the relationship between stigma and utilization of surgical treatments for obesity. RECENT FINDINGS The stigma of obesity and stigma associated with surgical treatments for obesity can affect both healthcare providers' recommendations of these options and patients' likelihood of considering and choosing these treatments. Presurgical requirements of healthcare and insurance organizations and a lack of postsurgical support reflect the stigmatizing attitudes that bariatric/metabolic surgery is an 'easy fix' and 'last resort' for patients too undisciplined to lose weight in other ways. SUMMARY Here we review the literature published in the last year that addresses the implications of stigma for the utilization and outcomes of surgical treatments for obesity.
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Affiliation(s)
- Sean M Phelan
- Division of Healthcare Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
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35
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Acceptance and Commitment Therapy to Promote Value Attainment Among Individuals with overweight: A multiple baseline evaluation. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2018. [DOI: 10.1016/j.jcbs.2018.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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36
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Pearl RL, Puhl RM. Weight bias internalization and health: a systematic review. Obes Rev 2018; 19:1141-1163. [PMID: 29788533 PMCID: PMC6103811 DOI: 10.1111/obr.12701] [Citation(s) in RCA: 286] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 01/31/2023]
Abstract
A robust literature has documented the negative health effects of being the target of weight bias. Weight bias internalization (WBI) occurs when individuals apply negative weight stereotypes to themselves and self-derogate because of their body weight. Compared with experiences of weight bias, less is known about the relationship between WBI and mental and physical health, although more literature on this topic has emerged in recent years. The current systematic review identified 74 studies assessing the relationship between WBI and health and interventions designed to reduce WBI and improve health. Over half of identified studies were published from 2016 to 2017. Results showed strong, negative relationships between WBI and mental health outcomes. Fewer studies have examined the relationship between WBI and physical health, and results were less consistent. Key directions for future research are highlighted, including the need for prospective and experimental studies with greater sample diversity.
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Affiliation(s)
- R L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - R M Puhl
- Rudd Center for Food Policy and Obesity, Department of Human Development & Family Studies, University of Connecticut, Hartford, CT, USA
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37
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Affiliation(s)
- Rebecca L. Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Edwin & Fannie Gray Hall Center for Human Appearance, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Corresponding author: Rebecca L. Pearl, Center for Weight and Eating Disorders, 3535 Market Street, Suite 3026, Philadelphia, PA 19104,
| | - Thomas A. Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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38
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Hayward LE, Vartanian LR, Pinkus RT. Weight Stigma Predicts Poorer Psychological Well-Being Through Internalized Weight Bias and Maladaptive Coping Responses. Obesity (Silver Spring) 2018; 26:755-761. [PMID: 29427370 DOI: 10.1002/oby.22126] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Weight-based stigmatization is associated with negative psychological and behavioral consequences, but individuals respond to stigma in different ways. The present study aimed to understand some of the factors that predict how one will cope with weight stigma and how different coping responses predict psychological well-being. METHODS Across four samples, 1,391 individuals who identified as having overweight or obesity completed surveys assessing the frequency of weight stigma experiences, internalized weight bias, coping responses to weight stigma, and psychological distress. RESULTS Frequency of weight stigma predicted greater internalized weight bias, which predicted more frequent use of maladaptive coping responses ("disengagement coping") and less frequent use of adaptive coping responses ("reappraisal coping"), in turn predicting more depression, anxiety, and stress symptoms. CONCLUSIONS The more that individuals with overweight or obesity experience weight stigma and internalize weight bias, the more they report using maladaptive coping and the less they report using adaptive coping when dealing with weight stigma. Maladaptive coping is strongly associated with poorer psychological well-being. Thus, those who experience more frequent weight stigma may be more vulnerable to psychological distress because they appear to be at greater risk of employing maladaptive coping strategies.
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Affiliation(s)
- Lydia E Hayward
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Lenny R Vartanian
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca T Pinkus
- School of Psychology, The University of Sydney, New South Wales, Australia
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