Success in Reducing Self-Stigma

Despite a great deal of progress in recognizing weight bias and stigma, many challenges remain in overcoming it. Explicit expressions of weight bias no longer get a free pass. So they are becoming less common. But implicit weight bias is as strong as ever. Perhaps even more challenging is the weight bias that people direct at themselves – internalized or self-stigma. Because this is a hard challenge we find particular encouragement in a new study that shows success in reducing self-stigma related to weight.

Rebecca Pearl and colleagues recently published this work in the Journal of Consulting and Clinical Psychology.

A Randomized Controlled Trial

Pearl et al set out to test the long-term effects of a group-based psychological intervention on internalized weight stigma in the context of a behavioral weight loss program. They randomly assigned 105 adults to either participate in the weight loss program alone or with cognitive behavioral therapy designed to reduce internalized weight stigma. Only ten percent of the participants were men and 25 percent were Black. All of them had experienced weight stigma and internalized it.

This was a long-term program. In both study groups, people participated in 20 weekly group sessions and then another 52 weeks of monthly and every-other-month sessions.

The primary outcome in this study was weight loss. People in the group that received therapy for internalized stigma lost two percentage points more of weight than the group that did not – a statistically insignificant difference.

Notable Success Reducing Self-Stigma

So providing therapy to reduce internalized stigma did not detract from the goal of weight loss. At the same time, it did show success in reducing self-stigma.

To be clear, the outcomes of this study were marginal gains over a conventional behavioral weight loss program that was already intended to provide patients with a measure of psychological support. The group setting gives people peer support and encouragement in feeling that they are not alone in their struggles – even when explicit therapy for self-stigma is not built into the program.

Thus, both groups saw significant improvements in self-stigma and quality of life. But at specific time points, advantages in these measures showed up for the group that received therapy for self-stigma.

Refuting a False Narrative

We view this as a success because it refutes a false narrative that people must choose between overcoming stigma and overcoming obesity. Pearl et al explain:

“The Weight BIAS Program did not appear to deter participants’ efforts to change their health behaviors and lose weight. This dispels a common narrative that stigma is needed to motivate weight loss and should appease concerns that promoting size acceptance and reducing weight stigma will undermine health promotion and weight loss. No such effect was observed in the present or previous studies.”

We find that false narrative at two extremes of public dialogues about obesity. One is from bullies like Bill Maher who take delight in shaming people. The other comes from a few in the fat acceptance movement who would shame people seeking obesity care or weight loss.

Neither extreme is helpful.

Click here for the study by Pearl et al and here for more on investigating self-stigma and its effects.

Woman Looking at Herself in a Mirror, painting by Katsushika Hokusai / WikiArt

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May 22, 2023