A Third-Wave Intervention for Internalized Weight Bias Combined with a Weight Loss Program Using Video Conference Software

Abstract

Background. Obesity is highly prevalent and associated with a plethora of adverse outcomes on health (e.g., heart disease, type II diabetes, certain forms of cancer), suggesting a clear need for effective weight loss strategies. Behavioral weight loss programs (BWLP) can produce weight loss for mild to moderate obesity, with a 5-10% weight loss on average by modifying lifestyle factors. However, complex biological, psychological, social, and environmental factors also contribute to an individual’s weight. Specifically, individuals who are overweight or obese are often frequently subjected to discrimination, prejudice, or stigmatization in a variety of settings. It is possible for individuals to internalize stereotypes about weight, such as the belief that individuals who are obese or overweight are lazy. This internalization, known as internalized weight bias (IWB), has been shown to impact mental (e.g., depression and anxiety) and physical health (e.g., cardiometabolic functioning), as well as weight loss and weight loss associated behaviors (e.g., interference with exercise and healthy eating). These associated behaviors especially pose a risk for weight regain and disruption of healthy weight loss. Therefore, given the association between IWB and weight loss associated behaviors, as well as the psychological and health risks associated with IWB, IWB interventions are also needed independently and in conjunction with BWLPs. Interventions using third-wave strategies (such as acceptance commitment therapy; ACT) have begun to show promise in reducing IWB, but have not yet been conducted in conjunction with a BWLP. Finally, there has also been a growing need for telehealth-based programs and interventions. The COVID19 pandemic demonstrated a clear need for efficacious telehealth programs, and a further benefit is that these programs may reach populations with limited access to resources (i.e., rural populations). Thus, the current study aims to pilot a novel ACT-based IWB intervention paired with a standard BWLP delivered through video conferencing software.

Methods. The baseline sample included 54 men, women, and individual identifying as nonbinary, with 28 participants completing some form of post data. The mean age was 45.4 years (SD = 12.2) and the average weight was the average weight was 227.4 lbs (SD = 42.8) and 38.5 for BMI (SD = 6.6), Racial and ethnic breakdown was as follows: Black (N = 13, 24.1%), Hispanic or Latino/a (N = 3, 5.6%), Native American/Native Alaskan (N = 2, 3.7%) or White (N = 34, 63%). Ten 90-minute weekly sessions were offered over video conferencing software, with 60 minutes of weight loss programming and 30 minutes of IWB intervention. The BWLP used was adapted from the Diabetes Prevention Program, while the IWB intervention used ACT-based principles, self-compassion, and the dialectical behavioral therapy skill DEAR MAN.

Results. Participants demonstrated a significant reduction in IWB (p = .002), as well as externalized weight bias (p <.001). In addition, participant weight loss was significant, as participants lost an average of 2.16% of their body weight (SD = 2.34%; p = < .001). Participants also demonstrated a decrease in emotional eating (p =.001) and saturated fat intake (p =.016), and an increase in moderate physical activity (p =.005). Participants reported several other benefits including a reduction in depressive symptoms (p =.026), self-judgement (p =.023), and psychological inflexibility (p =.004), and an increase in self-esteem (p =.007), mindfulness (p =.013), and self-compassion (p <.001). Participants reported high treatment acceptability and that the program was helpful.

Discussion. While the current study does note limitations (e.g., small sample size, no control group), this is the first intervention combing treatment for IWB using third-wave skills (including ACT, self-compassion, and DEARMAN skill of DBT) in conjunction with a BWLP. In addition, this is the first IWB intervention that has utilized a virtual format. The intervention was successful in reducing IWB (and weight) among a sample of weight loss seeking participants.