Weight Stigma and Weight-Related Health: Associations of Self-Report Measures Among Adults in Weight Management.

BACKGROUND: Weight stigma impairs health. Few studies have disentangled the associations of experienced versus internalized stigma with weight-related outcomes. PURPOSE: To examine weight and health variables associated with weight stigma experiences and internalization in the largest-to-date sample of adults in weight management. METHODS: WW (formerly Weight Watchers) members (N = 18,769, 94.6% female, 91.1% white) completed an online survey from 2017 to 2018. Participants reported whether they had experienced weight stigma and, if so, the onset, past-year frequency and distress, and interpersonal sources of stigma. Participants completed the Modified Weight Bias Internalization Scale (WBIS-M) and self-reported: past-year weight and lifetime weight cycles; current self-monitoring behaviors; eating self-efficacy; physical activity; perceived stress; eating to cope; body image; and mental and physical health-related quality-of-life (HRQOL). Participants reported their demographic characteristics, including height and weight to compute body mass index. RESULTS: In logistic and linear regression analyses (controlling for participant characteristics), WBIS-M scores were negatively associated with weight loss, self-monitoring, eating self-efficacy, body image, and mental HRQOL and positively associated with weight gain, weight cycling, perceived stress, and eating to cope (p < .001). Experiencing weight stigma was associated with greater weight loss and less weight gain, although associations with other variables had small effect sizes (absolute ß values < 0.10). WBIS-M scores remained significantly associated with all variables when including stigma onset, frequency/distress, and sources. CONCLUSIONS: Internalized, but not experienced, weight stigma was consistently associated with adverse weight and health factors. Developing and testing interventions targeting internalized stigma in the context of weight management should be a research priority.

Coping with Weight Stigma Among Adults in a Commercial Weight Management Sample.

BACKGROUND: Coping responses to weight stigma can adversely affect health. Using data from a large commercial weight management sample, this study examined how adults cope with weight stigma, relationships among experienced weight stigma, weight bias internalization, and coping, as well as coping strategies as mediators of the stigma-health relationship. METHOD: Participants were adults enrolled in WW (formerly Weight Watchers) who reported at least one lifetime experience of weight stigma (N = 11,924). Participants completed questionnaires about the type and frequency of stigma experiences, weight bias internalization, strategies used to cope with weight stigma, and health-related quality of life. RESULTS: Active coping, planning, positive reframing, acceptance, emotional support, and exercise avoidance were the most common coping strategies employed in response to acute weight stigma experiences. Weight bias internalization was more strongly associated with coping strategies likely to exacerbate health (e.g., disordered eating, substance use, self-blame) than positive reframing, acceptance, and emotional support. More types of experienced weight stigma (e.g., teasing, unfair treatment) were associated with more frequent use of all coping strategies. Coping strategies did not mediate the stigma-health relationship, and several strategies were associated with poor mental health. CONCLUSION: More types of experiences with weight stigma were associated with more attempts to cope generally, while weight bias internalization was associated with coping strategies which were in turn associated with poor mental health. Developing effective approaches for identifying individuals likely to internalize weight stigma and helping individuals adopt effective coping strategies in response to stigma are important avenues of future research.

Efficacy of a Commercial Weight Management Program Compared With a Do-It-Yourself Approach: A Randomized Clinical Trial.

Importance: Given the prevalence of obesity, accessible and effective treatment options are needed to manage obesity and its comorbid conditions. Commercial weight management programs are a potential solution to the lack of available treatment, providing greater access at lower cost than clinic-based approaches, but few commercial programs have been rigorously evaluated. Objective: To compare the differences in weight change between individuals randomly assigned to a commercial weight management program and those randomly assigned to a do-it-yourself (DIY) approach. Design, Setting, and Participants: This 1-year, randomized clinical trial conducted in the United States, Canada, and United Kingdom between June 19, 2018, and November 30, 2019, enrolled 373 adults aged 18 to 75 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45. Assessors were blinded to treatment conditions. Interventions: A widely available commercial weight management program that included reduced requirements for dietary self-monitoring and recommendations for a variety of DIY approaches to weight loss. Main Outcomes and Measures: The primary outcomes were the difference in weight change between the 2 groups at 3 and 12 months. The a priori hypothesis was that the commercial program would result in greater weight loss than the DIY approach at 3 and 12 months. Analyses were performed on an intention-to-treat basis. Results: The study include 373 participants (272 women [72.9%]; mean [SD] BMI, 33.8 [5.2]; 77 [20.6%] aged 18-34 years, 74 [19.8%] aged 35-43 years, 82 [22.0%] aged 44-52 years, and 140 [37.5%] aged 53-75 years). At 12 months, retention rates were 88.8% (166 of 187) for the commercial weight management program group and 95.7% (178 of 186) for the DIY group. At 3 months, participants in the commercial program had a mean (SD) weight loss of -3.8 (4.1) kg vs -1.8 (3.7) kg among those in the DIY group. At 12 months, participants in the commercial program had a mean (SD) weight loss of -4.4 (7.3) kg vs -1.7 (7.3) kg among those in the DIY group. The mean difference between groups was -2.0 kg (97.5% CI, -2.9 to -1.1 kg) at 3 months (P < .001) and -2.6 kg (97.5% CI, -4.3 to -0.8 kg) at 12 months (P < .001). A greater percentage of participants in the commercial program group than participants in the DIY group achieved loss of 5% of body weight at both 3 months (40.7% [72 of 177] vs 18.6% [34 of 183]) and 12 months (42.8% [71 of 166] vs 24.7% [44 of 178]). Conclusions and Relevance: Adults randomly assigned to a commercial weight management program with reduced requirements for dietary self-monitoring lost more weight and were more likely to achieve weight loss of 5% at 3 and 12 months than adults following a DIY approach. This study contributes data on the efficacy of commercial weight management programs and DIY weight management approaches. Trial Registration: ClinicalTrials.gov Identifier: NCT03571893.

Pilot evaluation of a personalized commercial program on weight loss, health outcomes, and quality of life.

WW is a validated behavioral weight management program that encourages healthy habits. WW developed a method of personalizing the SmartPoints® budget depending on dietary and lifestyle preferences, and participants were placed into one of three plans as a pilot evaluation of this new program. In this 6-month, single-arm pilot study, participants attended weekly workshops and used an app to monitor eating and physical activity. Baseline and 6-month assessments included weight, waist circumference, blood pressure, energy intake, cravings, happiness, health-related quality of life, hunger, and fullness. Of 145 adults assessed at baseline, 126 (87%) provided follow-up data. Pre-post changes showed significant reductions in body weight (7.39% ± 5.93%), calories consumed (24.79% ± 32.35%) and significant improvements in cravings, happiness, all SF-36 scales and hunger but not in fullness. Greater % weight loss was related to greater improvements in happiness (r = .38, p < .001), general health perceptions (r = .29, p = .001), and health change (r = .31, p = .001), and greater reduction in role limitations due to personal or emotional problems (r = .24, p = .01). Greater % reduction in caloric intake was associated with greater reductions in cravings (r = .23, p = .01), as well as with greater improvements in happiness (r = .23, p = .01), physical functioning (r = .23, p = .01), and general health perceptions (r = .23, p = .01). Participants in this modified program achieved significant weight loss, regardless of dietary plan, as well as improvements in a variety of other physical and psychological constructs. Those who achieved greater reductions in weight also reported greater improvements in cravings, happiness and some quality of life measures.

Examination of a partial dietary self-monitoring approach for behavioral weight management.

INTRODUCTION: Dietary self-monitoring in behavioral weight loss programmes traditionally involves keeping track of all foods and beverages to achieve a calorie deficit. While effective, adherence declines over time. WW™ (formerly Weight Watchers), a widely available commercial weight management programme, sought to pilot an approach that permitted participants to consume over 200 foods without monitoring them. METHODS: The current study used a pre-post evaluation design with anthropometric, psychosocial and physical health assessments at baseline, 3 and 6 months. RESULTS: Participants (N = 152) were, on average, 48.4 (±12.3) years old, with body mass index (BMI) of 32.8 (±4.8) m/kg2 and 94% female. Mean weight loss was 6.97 + 5.55 kg or 7.9 ± 6.1% of initial body weight (ps < .0001) at 6 months. One third (32.6%) of the sample lost 10% or more of initial body weight. Significant improvements in hunger, cravings, happiness, sleep, quality of life, aerobic stamina, flexibility and blood pressure were observed. Attendance at group meetings, as well as decreases in hunger, and fast food cravings from baseline to 3 months were associated with achieving 10% weight loss at 6 months (p < .01). CONCLUSIONS: Using an approach that does not require self-monitoring of all foods and beverages produced significant weight losses and other physical and psychosocial improvements.

Should patients with diabetes be encouraged to integrate social media into their care plan?

AIM: To evaluate the use of social media of individuals with diabetes mellitus (DM). MATERIALS & METHODS: Both web-based and in-clinic surveys were collected from individuals with DM. Descriptive and correlation analyses were employed to evaluate respondents' diabetes-specific social networking site behaviors. RESULTS: Forty-five patients with DM completed the web-based survey and 167, the clinic-based survey, of whom only 40 visited diabetes-specific social networking sites. Analysis of online survey data indicated that self-reported adherence to lifestyle recommendations was significantly correlated (p < 0.01) with visiting the sites. Clinic-based survey data found that patients who reported using DM-specific web sites monitored home glucose values more often and had better compliance with insulin administration (both p < 0.05) compared with nonusers. CONCLUSION: This study provides insight into why individuals visit DM-specific social networking sites. Certain self-management behaviors may improve as a result of visiting these sites. Further work is needed to explore how to leverage social media technology to assist patients with the management of DM.

A statewide intervention reduces BMI in adults: Shape Up Rhode Island results.

Given the epidemic of obesity, approaches to weight loss that can be applied on a community, state, or national level are needed. We report results from Shape Up Rhode Island 2007 (SURI), a statewide Internet-based program involving team-based competition to increase physical activity and achieve weight loss. A total of 4,717 adults (84% women; mean BMI = 29.6 kg/m(2)) enrolled in the 16-week weight loss competition of SURI and 3,311 completed at least 12 weeks. Completers reported losing 3.2 +/- 3.4 kg, and 30% achieved a clinically significant weight loss of >or=5%. Although modest, these weight losses shifted the BMI distribution from a mean BMI of 29.4 to a mean of 28.2 kg/m(2) and reduced the population that was obese from 39 to 31%. More conservative intent-to-treat analyses and analysis of 132 participants with objective weights still showed a significant reduction in BMI of -0.8 units. These findings suggest that statewide weight loss campaigns can produce modest weight losses in large numbers of participants. These data provide a benchmark that can be used for comparisons with other statewide campaigns. Research on ways to improve such campaigns is needed.