Marissa Wagner Oehlhof

Implicit, explicit, and internalized weight bias and psychosocial maladjustment among treatment-seeking adults

OBJECTIVE Weight bias among weight loss treatment-seeking adults has been understudied. This investigation examined the 1) levels of implicit, explicit, and internalized weight bias among overweight/obese treatment-seeking adults, 2) association between weight bias and psychosocial maladjustment (binge eating, body image, depression), and 3) association between participation in weight loss treatment and changes in weight bias. METHODS Fifty-four overweight and obese individuals (BMI > or = 27) recruited for a weight loss intervention completed measures of depression, body image, binge eating, and implicit, explicit, and internalized weight bias. RESULTS Participants evidenced significant implicit, explicit, and internalized weight bias. Greater weight bias was associated with greater depression, poorer body image, and increased binge eating. Despite significant reductions in negative internalized and explicit weight bias following treatment, weight bias remained strong. CONCLUSIONS Weight bias among treatment-seeking adults is associated with greater psychological maladjustment and may interfere with their ability to achieve optimal health and well-being.

A randomized trial comparing two approaches to weight loss: differences in weight loss maintenance.

This study compared treatment outcomes for a new weight loss program that emphasized reducing unhealthy relationships with food, body image dissatisfaction, and internalized weight bias (New Perspectives) to a weight loss program that emphasizes environmental modification and habit formation and disruption (Transforming Your Life). Fifty-nine overweight and obese adults (body mass index ≥ 27 kg/m2) were randomly assigned to either a 12-week New Perspectives or Transforming Your Life intervention. Despite equivalent outcomes at the end of treatment, the Transforming Your Life participants were significantly more effective at maintaining their weight loss than New Perspectives participants during the 6-month no-treatment follow-up period.

Self-objectification and ideal body shape for men and women.

Objectification theory posits that valuing ones body for appearance rather than performance is associated with a range of negative psychological outcomes. This theory has been tested in women, but has received less empirical attention in men. This study examined the relation between self-objectification and ideal body shape in both men and women. One hundred eighty-three college students (111 women, 72 men) completed a questionnaire containing measures of self-objectification and ideal body shape (using a figure array ranging from non-muscular to very muscular). Consistent with hypotheses, women desired a less muscular body and men desired a more muscular body. Women also self-objectified more than men. In addition, there was an interaction between sex and self-objectification on ideal body shape. For women, higher self-objectification scores were related to a desire for a less muscular body. For men, higher self-objectification scores were related to a desire for a more muscular body. Self-objectification theory is a useful framework for understanding body image issues in men. However, the relation between self-objectification and other body related variables may differ for men and women.

Internalized weight bias: ratings of the self, normal weight, and obese individuals and psychological maladjustment.

Current measures of internalized weight bias assess factors such as responsibility for weight status, mistreatment because of weight, etc. A potential complementary approach for assessing internalized weight bias is to examine the correspondence between individuals’ ratings of obese people, normal weight people, and themselves on personality traits. This investigation examined the relationships among different measures of internalized weight bias, as well as the association between those measures and psychosocial maladjustment. Prior to the beginning of a weight loss intervention, 62 overweight/obese adults completed measures of explicit and internalized weight bias as well as body image, binge eating, and depression. Discrepancies between participants’ ratings of obese people in general and ratings of themselves on both positive and negative traits predicted unique variance in measures of maladjustment above a traditional assessment of internalized weight bias. This novel approach to measuring internalized weight bias provides information above and beyond traditional measures of internalized weight bias and begins to provide insights into social comparison processes involved in weight bias.

Transforming your life: an environmental modification approach to weight loss.

This investigation compared a traditional behavioral weight loss program with a weight loss intervention emphasizing environmental modification and habit formation and disruption. Fifty-four overweight and obese adults (BMI ≥ 27 kg/m2) were randomly assigned to either a 14-week LEARN or TYL intervention. Forty-two participants completed the six-month follow-up assessment. Treatment outcomes between LEARN and TYL participants were equivalent. During the six-month no-treatment follow-up period, participants evidenced a 3.3 lb (SD = 9.2) weight gain. The TYL intervention appears to represent an attractive option for individuals seeking an alternative to the traditional behavioral approach to weight loss.

Children’s Sensitivity to External Food Cues: How Distance to Serving Bowl Influences Children’s Consumption

Overweight is increasing in children, leading to negative health consequences. Children also lack appropriate levels of important vitamins and nutrients in their diets. Environmental cues, such as food proximity, have been shown to influence consumption rates in adults. The present study has tested whether proximity to either a nutrient-dense or caloric-dense food would influence children’s snack consumption in a day care setting. Children (N = 46, age range 3.4-11) consumed more of both nutrient- and energy-dense foods when they are sitting closer to the food than if they are sitting farther away from the food, above and beyond the effects of age. The data indicate that it may be possible to increase the consumption of nutrient-dense foods or decrease the consumption of energy-dense foods, respectively, by modifying the proximity of such foods within a child’s environment.

Emerald dragon bites vs veggie beans: Fun food names increase children’s consumption of novel healthy foods

Caregivers often struggle with food neophobia on the part of young children. This study examined whether labeling novel healthy foods with fun names would increase children’s willingness to try those foods and encourage them to eat more of those foods in a child care setting. Thirty-nine toddler and preschool age children (mean age = 3.9 years) were served each of three foods twice, once labeled with a fun name and once with a healthy name. Percentage of the food consumed by each child was recorded. Overall, children ate a greater percentage of the target foods when they were labeled with fun names. Also, a larger percentage of the children tasted the foods when they were labeled with fun names. This simple strategy could be effective for increasing consumption of healthy foods among young children.

The self-protective nature of implicit identity and its relationship to weight bias and short-term weight loss.

Background/Aims: Research suggests that making overly positive self-evaluations is the norm rather than the exception. However, unlike other stigmatized groups, overweight individuals do not exhibit a positive in-group social identity and instead exhibit significant explicit, implicit, and internalized weight bias. Therefore, it is not known whether overweight/obese individuals will evidence self-enhancement on general traits (good, attractive), or on traits inconsistent with fat stereotypes (disciplined, active, healthy eater), on an assessment of implicit attitudes. Similarly, it is not known whether these ratings will be associated with preexisting levels of weight bias, gender, or short-term weight loss. Methods: At baseline, 53 overweight/obese adults (BMI > 27 kg/m2, mean BMI = 37.3 kg/m2, SD = 6.6 kg/m2, 89% Caucasian, and 77% female) participating in a weight loss intervention completed measures of explicit and internalized weight bias as well as implicit weight bias and identity (self-other comparisons). Results: Although participants evidenced significant anti-fat attitudes, they implicitly identified themselves as significantly thinner, better, more attractive, active, disciplined, and more likely to eat healthy than ‘other’ people. Compared to men, women were less likely to view themselves as thin and attractive relative to others. Greater implicit anti-fat bias and implicitly seeing the self as thin relative to others was associated with less short-term weight loss. Conclusion: Despite evidence for explicit, implicit, and internalized weight bias, participants generally evidenced a positive implicit self-identity, including areas consistent with negative fat stereotypes.

Step-down approach to behavioural weight loss treatment: a pilot of a randomised clinical trial

Background: In a stepped-down approach, patients begin with a more intensive treatment and are stepped down to a less intensive treatment based on achieving treatment goals. This study compared a standard behavioural weight loss programme (BWLP) to a stepped-down approach to treatment. Methods: Fifty-two overweight/obese adults (Age: M = 47 years, SD = 13.5; female = 67%) participated in an 18-week BWLP. Half of them were randomly assigned to be stepped down from weekly group meetings based on completion of weight loss goals (3%) every 6 weeks, while the other half remained in their groups regardless of weight loss. Results: There was a significant difference favouring the BWLP in the proportion of participants who met or exceeded their 3% weight loss goal during the first six weeks. While not statistically significant by the end of treatment, the BWLP participants lost nearly 3% more body weight than stepped-down participants (SC = 4.9% vs. BWLP = 7.8%; p = .10). Greater self-monitoring was associated with increased likelihood of stepped-care eligibility and higher percent weight loss at the end of treatment (p < .01). Conclusion: There was little evidence to support the efficacy of the stepped-down approach for behavioural weight loss treatment employed in this investigation.

Stepped-care in obesity treatment: Matching treatment intensity to participant performance

This investigation examined the effectiveness of a self-help (SH), stepped-care (SC) weight loss program. Based on a failure to achieve pre-assigned weight loss goals, participants were eligible to be stepped-up from a SH program to two levels of treatment intensity (weight loss group [WLG]; individual counseling [IC]) beyond SH. The primary outcome was change in body weight. Fifty-three overweight/obese adults (BMI≥27 kg/m(2); mean BMI of 37.3, SD=6.6, 89% Caucasian, and 77% female) participated in an 18-week weight loss intervention. During several phases of the investigation, those stepped-up to more intensive treatment lost comparable weight to those who were not stepped-up. Nevertheless, by the end of treatment, individuals who remained in SH (M=8.6%) lost a significantly greater percentage of weight than individuals who received SH+IC (M=4.7%; p<.05) and individuals in SH+IC lost a significantly greater percentage of weight than individuals who received SH+WLG+IC (M=1.6%; p<.05). While some individuals benefited from being stepped-up to greater intensity treatment, other individuals experienced little benefit. The application of SC principles to the treatment of obesity needs further study.