Elisabeth Rauh

Who copes well? Obesity-related coping and its associations with shame, guilt, and weight loss†

The relationship among weight-related coping, guilt, and shame was investigated in a sample of 98 obese German individuals over a 6-month period. In terms of the objectives, the study explored the kind and frequency of typical coping situations in which obese individuals become aware of being obese. Furthermore, the study sought to determine the predictive utility of weight-related shame and guilt concerning coping responses, and to establish whether there is an association between coping responses and weight change. A longitudinal examination over a 6-month period was chosen with two measurement points. As typical distressing coping situations, individuals reported mostly negative evaluations through others/self, physical exercise situations, or environmental hazards (mainly shopping for clothes). Weight-related shame at baseline was a significant negative predictor for problem-focused engagement coping, whereas weight-related guilt was a significant positive predictor for problem-focused engagement strategies and dietary restraint at follow-up. Although Body Mass Index showed no substantial association with the coping measures, weight loss was accompanied by a substantial drop in problem-focused disengagement coping (wishful thinking, problem avoidance). Discussion of these findings focuses on the issue of possible effects of weight-related feelings of guilt and shame on coping behavior, the link between weight loss and disengaging coping strategies, and the possible use of the findings for cognitive-behavioral therapy for obesity.

Development of the Weight- and Body-Related Shame and Guilt scale (WEB-SG) in a nonclinical sample of obese individuals.

In this article, we present the evaluation of the psychometric properties of a new self-report measure of Weight- and Body-Related Shame and Guilt (WEB–SG). The main purpose of the study was to measure shame and guilt feelings separately in obese individuals and investigate differing behavioral and emotional correlates of these emotions. Altogether, 331 obese participants completed the WEB–SG and other established self-report measures. A subset of the participants completed a 6-month follow-up. The WEB–SG proved to be internally consistent and temporally stable over a 6-month period. Regarding the factorial structure, a two-factor conceptualization was supported. The construct validity of the WEB–SG subscales was evidenced by a substantial overlap of common variance with related measures. The subscales Shame and Guilt showed differential correlation patterns to other scales. The WEB–SG is a brief, psychometrically sound measure for assessing body shame and guilt concerning weight control in obese individuals.

Body image, emotions and thought control strategies in body dysmorphic disorder compared to eating disorders and healthy controls.

OBJECTIVE A disordered body image, emotions such as shame and disgust, and intrusive thoughts are described as important and interdependent features of body dysmorphic disorder (BDD). However, research in this field is scarce and knowledge is often based on clinical observation. METHODS The present study examined body image dimensions, emotions, and thought control strategies in individuals with: BDD (n=31), anorexia nervosa (n=32), bulimia nervosa (n=34), and healthy controls (n=33). Assessment was based on structured diagnostic interviews and self-report questionnaires. RESULTS Individuals with BDD scored higher on psychosocial and appearance manipulation dimensions of body image compared to healthy controls. Furthermore, they reported higher psychosocial impairment due to appearance than both eating disorder groups. In terms of emotions, BDD subjects reported a higher degree of negative emotions compared to healthy controls, whereas no differences were found in comparison to eating-disordered patients. Individuals with BDD reported using maladaptive strategies such as worrying and confrontation more often than healthy controls, when encountering intrusive and unwanted thoughts. CONCLUSION The results indicate that individuals with BDD experience substantial psychosocial impairment due to appearance, high levels of various negative emotions and frequently use maladaptive thought control strategies.

A consultation with genetic information about obesity decreases self-blame about eating and leads to realistic weight loss goals in obese individuals ☆

OBJECTIVE This study tested the effects of a consultation using genetic information about obesity on attitudes relating to weight loss goals, self-blame about eating, and weight-related coping in obese individuals. Furthermore, the study sought to explore possible predictors for weight gain/loss. METHOD A total of 411 obese individuals were randomly assigned to two standardized consultations, with and without genetic information about obesity, and a control group without any intervention. After a 6-month follow-up, 253 obese individuals of the intervention groups and 98 individuals of the control group had a complete dataset. Data were analyzed regarding the independent variables assessment time, treatment group, and the familial predisposition (at least one obese parent or sibling). As dependent measures, attitudes about weight loss goals, weight-related self-blame, coping, and body shame were assessed via questionnaire or interview. RESULTS Individuals with and without a familial predisposition profited in different ways from a consultation using genetic information about obesity: at follow-up, individuals with a familial predisposition reported mainly a relieving effect (less self-blame about eating). Both groups reported an adjustment to more realistic weight loss goals and a greater satisfaction with a 5% weight loss. Furthermore, the more negative obese individuals felt about their current weight at baseline, the higher the risk that these individuals had gained weight at follow-up. CONCLUSION A consultation focusing on genetic factors might be helpful for obese individuals regardless of their familial predisposition, but only predisposed individuals showed a decrease in self-blame about eating. Negative thoughts and feelings about current weight might predict future weight gain.

Genetische Aspekte in der Adipositas-Beratung – Auswirkungen auf Körperakzeptanz und subjektives Wohlbefinden

Obesity has nearly reached endemic proportions. Environmental as well as genetic factors significantly contribute to the development of being overweight and obesity. Despite these findings, neither obese persons nor normal-weight people claim genetic factors to be relevant here. Objective: It has been examined, if a structured psychological counselling approach regarding eating behaviour and physical activity is more effective with respect to body acceptance and subjective well-being of obese people if genetic information is provided as well. Methods: 260 subjects with a mean body mass index (BMI) of M ± SD = 35.3 ± 5.1 received counselling. Within a randomised-controlled study design, the counselling also included genetic information for about half of the participants. Additionally, 98 controls without counselling were investigated on the same measures. So-called body shapes were used to assess family history of obesity. Shortand long-term effects (6-month follow-up) were assessed. Results: The counselling approach was experienced as beneficial by a large majority of the participants. The group that also received genetic information reported having gained more knowledge about obesity. Concerning the questionnaires used in this study, positive effects were found in both intervention groups immediately after counselling but could no longer be observed at 6 month follow-up. Discussion: A structured counselling approach including genetic information was considered helpful by the participants. However, a single counselling session apparently does not suffice to include the acquired knowledge into daily experience and behaviour and to achieve long-term effects. Therefore, long-term interventions should be developed that also consider subjective causal attributions of obese people.

Stationäre Behandlung depressiver Erkrankungen wohnortnah oder wohnortfern: Gibt es Unterschiede im Therapieergebnis?

Hintergrund: Seit der Psychiatrie-Enquete werden die Vor- und Nachteile wohnortferner und wohnortnaher stationärer Behandlung psychisch Erkrankter kontrovers diskutiert. Ob die Distanz des Wohnorts zur Klinik Einfluss auf den Behandlungserfolg hat, wurde bisher jedoch nur in der stationären medizinischen Rehabilitation bei Patienten mit Abhängigkeitserkrankungen untersucht. Ziel der vorliegenden Studie ist deshalb die Untersuchung des Einflusses der Distanz zwischen Wohnort und Behandlungseinrichtung auf den Behandlungserfolg depressiver Patienten. Patienten und Methoden: Hierzu wurden die Routinedaten von 1959 stationär behandelten Patienten mit der Diagnose einer depressiven Erkrankung analysiert. Depressivität, Ängstlichkeit und Somatisierungsbeschwerden wurden zur Erfassung des Therapieerfolgs bei Aufnahme, bei Entlassung und katamnestisch 6 Monate später mit dem Patient Health Questionnaire erfasst. Ergebnisse: Die Ergebnisse zeigen, dass die Distanz zwischen Wohnort und Klinik die Veränderung der depressiven, ängstlichen und somatoformen Symptomatik während und nach der Behandlung nicht moderiert. Auch zeigen sich keinerlei Zusammenhänge zwischen der Distanz Wohnort-Klinik und den Symptomveränderungen zwischen Aufnahme und Katamnese. Schlussfolgerungen: Empirische Belege für Unterschiede im Outcome in Abhängigkeit von der Distanz zwischen Wohnort und Klinik liegen nicht vor. Zukünftig sollte deshalb der Einfluss der inhaltlichen Aspekte wohnortnaher und -ferner Behandlung, wie der Spezialisierungsgrad der Einrichtung sowie die Umsetzung individueller Nachsorgemaßnahmen, auf den Erfolg stationärer Therapien systematisch untersucht werden.