1
|
Davidsen E, Pico ML, Sandøe P, Lund TB. "I am very critical of my body, but I am not a worthless person": A qualitative investigation of internalized weight stigma in Denmark. Front Psychol 2023; 13:1049568. [PMID: 36733862 PMCID: PMC9886864 DOI: 10.3389/fpsyg.2022.1049568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/12/2022] [Indexed: 01/19/2023] Open
Abstract
Aim The aim of this study was to explore how two of the main dimensions of internalized weight stigma (IWS), namely weight-related self-devaluation and distress, play out in the lives of people with excess weight (EW), and to study whether there are further dimensions of IWS. Method Ten informants with EW were included in this study. The sample size was determined prior to data collection based on available resources at the time of data collection. All informants both participated in in-depth interviews and responded to the questionnaire WBIS-2F consisting of the two subscales: weight-related self-devaluation and distress. The interview accounts were thematically coded and compared with the informants' scoring on WBIS-2F. Findings Seven themes were identified from the in-depth interviews: (1) devaluation of competencies, (2) self-blame, (3) bodily devaluation, (4) ambivalence, (5) anticipated stigma, (6) coping strategies, and (7) mental well-being. Overall, the informants scored low on the WBIS-2F subscale weight-related self-devaluation and high on the subscale weight-related distress. The qualitative findings echo the informants' scoring on WBIS-2F. However, novel aspects of IWS not covered by WBIS-2F were also identified. In particular, bodily devaluation presented itself as an integral part of IWS. Conclusion The two current dimensions of WBIS-2F were retrieved, but important additional aspects of IWS were also identified. Future research is needed to evaluate and test both qualitatively and quantitatively whether the additional aspects of IWS identified in this exploratory examination are separate constructs of IWS.
Collapse
Affiliation(s)
- Emma Davidsen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Peter Sandøe
- Department of Food and Resource Economics, University of Copenhagen, Copenhagen, Denmark,Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bøker Lund
- Department of Food and Resource Economics, University of Copenhagen, Copenhagen, Denmark,*Correspondence: Thomas Bøker Lund, ✉
| |
Collapse
|
2
|
Braun TD, Olson K, Panza E, Lillis J, Schumacher L, Abrantes AM, Kunicki Z, Unick JL. Internalized weight stigma in women with class III obesity: A randomized controlled trial of a virtual lifestyle modification intervention followed by a mindful self-compassion intervention. Obes Sci Pract 2022; 8:816-827. [PMID: 36483124 PMCID: PMC9722463 DOI: 10.1002/osp4.616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 11/11/2022] Open
Abstract
Background Internalized weight stigma (Internalized-WS) is prevalent among individuals with severe obesity, particularly women, and is associated with shame, disordered eating, and weight gain. Effective, accessible interventions that address both severe (Class-III) obesity and Internalized-WS are needed. This randomized pilot trial evaluated the feasibility, acceptability, and preliminary efficacy of a fully-remote lifestyle modification intervention (LM) followed by mindful self-compassion training (MSC) or control. Methods Twenty-eight women with Class-III obesity (46.6 ± 3.7 kg/m2) and elevated Internalized-WS were randomized to a virtually-delivered 4-month LM followed by a 2-month MSC or cooking/dietary education (CON). Psychosocial measures/weight were assessed at baseline, 4-(post-LM), 6-(post-MSC/CON), and 9-month (follow-up). Results Improvements in Internalized-WS, shame, and self-compassion were observed with LM. Mean 4-month weight loss was 6.3 ± 3.7%. MSC had lower attendance and usefulness ratings versus CON. Post-MSC/CON, MSC yielded significant and/or meaningful improvements in Internalized-WS, self-compassion, and intuitive eating relative to CON. Weight loss did not differ by group at 6-month, and at 9-month trended lower in MSC versus CON. Conclusion Virtual LM is feasible, acceptable, and leads to significant weight loss among women with severe obesity; MSC led to further improved Internalized-WS, self-compassion, and intuitive eating. Continued work is needed to elucidate effects of self-compassion training on Internalized-WS, its mechanisms, and linkages to cardiometabolic health and long-term weight loss.
Collapse
Affiliation(s)
- Tosca D. Braun
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Centers for Behavioral and Preventive MedicineThe Miriam HospitalProvidenceRIUSA
- Butler HospitalProvidenceRIUSA
| | - Kayloni Olson
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| | - Emily Panza
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| | - Jason Lillis
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| | - Leah Schumacher
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| | - Ana M. Abrantes
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Butler HospitalProvidenceRIUSA
| | - Zachary Kunicki
- Quantitative Sciences ProgramBrown UniversityProvidenceRIUSA
| | - Jessica L. Unick
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| |
Collapse
|
3
|
Sun M, Peng J, Lommel L. Prevalence and Correlates of Weight Stigma among Postpartum Women in China. Int J Environ Res Public Health 2022; 19:14692. [PMID: 36429415 PMCID: PMC9690326 DOI: 10.3390/ijerph192214692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
Weight stigma is linked to a variety of psychological and health problems. In the postpartum period, women may be more likely to experience weight-based discrimination because of their changing social roles, weight, and the new functions their bodies fulfill. However, few studies have explored the issue of postpartum women's weight stigma. Thus, to investigate the prevalence and correlates of weight stigma for postpartum women in China, we conducted a cross-sectional study of 507 postpartum women. Results showed that almost one quarter (21.1%) of postpartum women claimed to have experienced perceived weight stigma (PWS). Two thirds (66.1%) scored at the mean and 14.8% at the highest levels of weight bias internalization (WBI). During the postnatal period, the conditions of those most likely to report experiences of weight-based discrimination included low income [b = -0.203, p = 0.004], occupation as a worker [b = 0.921, p = 0.017] or farmer [b = 0.826, p = 0.033], stress [b = 0.044, p = 0.035], depression [b = 0.057, p = 0.021], and higher WBIS [b = 0.018, p = 0.002]. In addition, postpartum women who lived alone [b = 7.511, p = 0.048], were overweight or obese [b = 5.443, p = 0.000], and had higher PWS [b = 0.897, p = 0.004] and anxiety symptoms [b = 0.219, p = 0.011] had higher levels of internalized weight stigma. Findings from this study provide a foundation to better understand characteristics of postpartum women in China who are at risk for weight stigma.
Collapse
Affiliation(s)
- Mei Sun
- Xiangya School of Nursing, Central South University, Changsha 410017, China
- Xiangya Center for Evidence-Based Practice & Healthcare Innovation: A Joanna Briggs Institute Affiliated Group, Central South University, Changsha 410083, China
| | - Jiayuan Peng
- Xiangya School of Nursing, Central South University, Changsha 410017, China
| | - Lisa Lommel
- School of Nursing, University of California San Francisco, San Francisco, CA 94115, USA
| |
Collapse
|
4
|
Almutairi BF, Alsaygh KW, Altamimi MM, Alshammari AS, Alsomali AM, Alanazi SM, Alzahrani SM, Alsaad AS, Zacharakis G. Internalized Weight Stigma: Prevalence and Association With Psychiatric Disorder Among Overweight and Obese Individuals. Cureus 2021; 13:e18577. [PMID: 34760420 PMCID: PMC8572015 DOI: 10.7759/cureus.18577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 01/31/2023] Open
Abstract
Background and objective Unlike weight stigma, internalized weight stigma (IWS) may be a common but still underreported problem. With the recent emergence of studies investigating its various aspects in Arab-speaking countries, there is still scant data on its incidence and severity in the literature. In light of this, the aim of this study was to evaluate the prevalence of IWS and its association with psychiatric disorders and sociodemographic factors among overweight and obese individuals in a sample from a Saudi population. Methods A cross-sectional study was conducted among a Saudi population using a convenience sample technique and 868 individuals were enrolled to participate in this study. They were asked to fill out an electronic questionnaire about IWS, demographics, and other parameters such as Patient Health Questionnaire (PHQ)-9 and General Anxiety Disorder (GAD)-7. The association was tested using an independent t-test and chi-square test. Results The overall prevalence of internalized stigma in this study was 57%. Higher levels of internalization were more prevalent among younger respondents. We found that females were more prone to internalize weight stigma, at a slightly higher rate than males (59.26% vs. 53.66%), but this difference was not statistically significant. The other sociodemographic factors associated with higher internalization were as follows: being widowed, married, retired, or housewife. Those with higher IWS levels were individuals with higher BMI and with previous experiences of weight stigma. In addition, higher internalization was associated with the development of severe depression and anxiety (p<0.001). Conclusion The prevalence of IWS among overweight and obese individuals was found to be high, and it is highly associated with the development of severe depression and anxiety. There is a need to raise awareness about obesity stigma to help tackle IWS in overweight and obese individuals and to promote their quality of life.
Collapse
Affiliation(s)
| | - Khaled W Alsaygh
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
| | - Mazen M Altamimi
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
| | | | - Ahmed M Alsomali
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
| | - Sultan M Alanazi
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
| | - Saud M Alzahrani
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
| | - Ameer S Alsaad
- Psychiatry, Prince Sattam Bin Abdulaziz University, Al Kharj, SAU
| | | |
Collapse
|
5
|
Keirns NG, Tsotsoros CE, Addante S, Layman HM, Krems JA, Pearl RL, Janet Tomiyama A, Hawkins MA. Adverse Childhood Experiences Associated with Greater Internalization of Weight Stigma in Women with Excess Weight. Obesities 2021; 1:49-57. [PMID: 35463808 PMCID: PMC9033161 DOI: 10.3390/obesities1010005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Adverse childhood experiences (ACEs) may be an early life factor associated with adult weight stigma via biological (e.g., stress response), cognitive (e.g., self-criticism/deprecation), and/or emotional (e.g., shame) mechanisms. This pilot study investigated relationships between ACEs and internalized and experienced weight stigma in adult women with overweight/obesity and explored differential relationships between weight stigma and ACE subtypes (i.e., abuse, neglect, household dysfunction). Adult women (68% white, M age = 33 ± 10 years, M BMI = 33.7 ± 7.2 kg/m2) completed measures of ACEs (ACE Questionnaire), internalized weight stigma (IWS; Weight Bias Internalization Scale-Modified; WBIS-M), and lifetime experiences of weight stigma (yes/no). Data were analyzed with linear and logistic regression (n = 46), adjusting for age, race, and body mass index (BMI). Linear regressions revealed a positive association between ACE and WBIS-M scores (β = 0.40, p = 0.006), which was driven by Abuse-type ACEs (β = 0.48, p = 0.009). Relationships between WBIS-M scores and Neglect- and Household-Dysfunction-type ACEs did not reach significance (β = 0.20, p = 0.173; β = -0.16, p = 0.273). Though descriptive statistics revealed greater rates of experienced weight stigma endorsement by those with high-3+ ACEs (81%) vs. medium-1-2 ACEs (67%) or low/no-0 ACEs (60%), ACE scores were not significantly associated with experienced weight stigma in logistic regression (Wald = 1.36, p = 0.244, OR = 1.324, 95%, CI = 0.825-2.125). ACEs may be an early life factor that increase the risk for internalizing weight stigma in adulthood. Larger studies should confirm this relationship and follow-up on descriptive findings suggesting a potential association between ACEs and experienced weight stigma.
Collapse
Affiliation(s)
- Natalie G. Keirns
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA
| | - Cindy E. Tsotsoros
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA
| | - Samantha Addante
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA
| | - Harley M. Layman
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA
| | - Jaimie Arona Krems
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA
| | - Rebecca L. Pearl
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3108, Philadelphia, PA 19104, USA
| | - A. Janet Tomiyama
- Department of Psychology, University of California, A623 Franz Hall, 501 Portola Plaza, Los Angeles, CA 90095, USA
| | - Misty A.W. Hawkins
- Department of Psychology, Oklahoma State University, 116 Psychology Building, Stillwater, OK 74078, USA
| |
Collapse
|
6
|
Forbes YN, Moffitt RL, Van Bokkel M, Donovan CL. Unburdening the Weight of Stigma: Findings From a Compassion-Focused Group Program for Women With Overweight and Obesity. J Cogn Psychother 2020; 34:336-57. [PMID: 33372127 DOI: 10.1891/JCPSY-D-20-00015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to develop a 2-day intensive-format, Compassion-Focused Therapy (CFT) based group program targeting weight stigma in women with overweight and obesity, and to conduct a pilot study to determine the feasibility and acceptability of the intervention. METHOD Participants were 15 females aged 18-62 years (mean [M] = 43.60, standard deviation [SD] = 12.38), who participated in the program and completed measures of self-compassion, internalized weight stigma, psychological distress, life-satisfaction, loneliness, eating self-efficacy, body dissatisfaction, and body shame, at pre-treatment, post-treatment, and 3-month follow-up. RESULTS Significant improvements were found from pre-treatment to post-treatment for self-compassion and internalized weight stigma, with gains maintained at 3-month follow-up. Significant improvements were also found on measures of psychological distress, life satisfaction, loneliness, eating self-efficacy, and body dissatisfaction at the post-treatment assessment. Credibility ratings of the program were high. CONCLUSIONS This study has contributed to existing stigma research, being the first proof-of-concept study to demonstrate support for an intensive, CFT based group approach targeting the effects of weight stigma for women with overweight and obesity. The findings are discussed in terms of the potential of CFT to assist women develop resilience to the harmful effects of weight stigma, and possible future research directions to further develop and evaluate this approach.
Collapse
|
7
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
8
|
Meadows A, Higgs S. The Multifaceted Nature of Weight-Related Self-Stigma: Validation of the Two-Factor Weight Bias Internalization Scale (WBIS-2F). Front Psychol 2019; 10:808. [PMID: 31040808 PMCID: PMC6477068 DOI: 10.3389/fpsyg.2019.00808] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background Internalized weight stigma (IWS) is generally operationalized as self-devaluation due to weight in higher-weight individuals. The most commonly used measure of IWS, the Weight Bias Internalization Scale (WBIS), was developed from an original pool of 19 items. Item selection was guided by statistical techniques based upon an a priori hypothesized unidimensional factor structure. The resulting 11-item scale mostly assesses appearance-related attitudes, fear of stigma, affect, and desire for change, all of which may be a natural response to societal weight stigma, even in the absence of self-devaluation. Items pertaining to self-blame, stigma awareness, perceived legitimacy of weight stigma, and most items pertaining to self-worth, were excluded from the final scale. It is unclear whether an a priori assumption of multi-dimensionality would have produced different results. Methods Exploratory and confirmatory factor analysis of the original 19-item questionnaire was conducted in 931 higher-weight individuals. Results A 13-item two-factor structure was identified. Factor 1 comprised seven items that could be loosely conceived as weight-related distress. Factor 2 comprised six items, all of which pertained to weight-related self-worth. Tested individually, the six items making up the self-devaluation factor were an excellent fit for the data on all fit indices. Conclusion IWS is a multi-dimensional construct. The two-factor WBIS (WBIS-2F) provides options to explore the relationships between different aspects of IWS and upstream and downstream variables. The Self-Devaluation subscale is suitable for standalone use when weight-related self-devaluation per se is the construct of interest.
Collapse
Affiliation(s)
- Angela Meadows
- School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|