Nova Hinman

Food addiction in adults seeking weight loss treatment. Implications for psychosocial health and weight loss

The present study examined food addiction symptomology and its relationship to eating pathology and psychological distress among adults seeking weight loss treatment. A primary interest was an examination of the relationship between food addiction symptoms and short-term weight loss. Adults beginning a behavioral weight loss program (N=57) were given the Yale Food Addiction Scale (YFAS) as well as measures of psychological distress, disordered eating, weight bias, and weight-focused attitudes. Weight loss was measured after 7 weeks. Severity of food addiction was related to increased depression, emotional eating, binge eating, anti-fat attitudes, internalized weight bias, body shame, and low eating self-efficacy, but not body satisfaction. Increased food addiction symptomology was also related to less weight lost at 7 weeks. Findings suggest that individuals attempting to lose weight while combating symptoms of food addiction may be especially prone to eating-related pathologies, internalized weight bias, and body shame. Importantly, findings provide evidence that food addiction may undermine efforts to lose weight. The pathology associated with addiction (e.g., tolerance, withdrawal) could make the adoption of more healthful eating habits especially difficult.

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.

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.

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.

Stereotypical images and implicit weight bias in overweight/obese people

PurposeIn this brief report, an unanswered question in implicit weight bias research is addressed: Is weight bias stronger when obese and thin people are pictured engaging in stereotype consistent behaviors (e.g., obese—watching TV/eating junk food; thin—exercising/eating healthy) as opposed to the converse?MethodsImplicit Associations Test (IAT) data were collected from two samples of overweight/obese adults participating in weight loss treatment. Both samples completed two IATs. In one IAT, obese and thin people were pictured engaging in stereotype consistent behaviors (e.g., obese—watching TV/eating junk food; thin—exercising/eating healthy). In the second IAT, obese and thin people were pictured engaging in stereotype inconsistent behaviors (e.g., obese—exercising/eating healthy; thin—watching TV/eating junk food).ResultsImplicit weight bias was evident regardless of whether participants viewed stereotype consistent or inconsistent pictures. However, implicit bias was significantly stronger for stereotype consistent compared to stereotype inconsistent images.ConclusionImplicit anti-fat attitudes may be connected to the way in which people with obesity are portrayed.

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.

Changes in Weight Bias and Perceived Employability Following Weight Loss and Gain

BackgroundThe present weight stigma study examined whether attitudes toward and employability of a normal weight person can change after learning that the person had been obese.MethodsParticipants (N = 154) viewed an image of a normal weight woman and rated their impression of her. Next, participants rated their impression of her overweight image after learning how she had previously gained and subsequently lost weight.ResultsParticipants rated the model far less favorably including perceived employability if they thought the once overweight model lost weight through surgery vs. diet and exercise. How the model initially gained the weight had little impact on participant ratings.ConclusionsSurgical weight loss had a significant impact on personality judgments. These negative views extended to hiring decisions.

Implicit bias about weight and weight loss treatment outcomes.

OBJECTIVES The goal of the current study was to examine the impact of a weight loss intervention on implicit bias toward weight, as well as the relationship among implicit bias, weight loss behaviors, and weight loss outcomes. Additionally, of interest was the relationship among these variables when implicit weight bias was measured with a novel assessment that portrays individuals who are thin and obese engaged in both stereotypical and nonstereotypical health-related behaviors. METHODS Implicit weight bias (stereotype consistent and stereotype inconsistent), binge eating, self-monitoring, and body weight were assessed among weight loss participants at baseline and post-treatment (N=44) participating in two weight loss programs. RESULTS Stereotype consistent bias significantly decreased from baseline to post-treatment. Greater baseline stereotype consistent bias was associated with lower binge eating and greater self-monitoring. Greater post-treatment stereotype consistent bias was associated with greater percent weight loss. Stereotype inconsistent bias did not change from baseline to post-treatment and was generally unrelated to outcomes. CONCLUSION Weight loss treatment may reduce implicit bias toward overweight individuals among weight loss participants. Higher post-treatment stereotype consistent bias was associated with a higher percent weight loss, possibly suggesting that losing weight may serve to maintain implicit weight bias. Alternatively, great implicit weight bias may identify individuals motivated to make changes necessary for weight loss.