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Long-term effects of an internalized weight stigma intervention: A randomized controlled trial.
Open accessAbstract
OBJECTIVE: To test the long-term effects of a group-based, psychological intervention designed to reduce internalized weight stigma (IWS, i.e., self-stigma), delivered in combination with behavioral weight loss (BWL) treatment, compared to BWL alone. METHOD: = 38 kg/m²) were randomized to receive BWL with the Weight Bias Internalization and Stigma (BIAS) Program or BWL alone. Participants received weekly group treatment for 20 weeks, followed by 52 weeks of monthly and every-other-month sessions. Percent weight change at Week 72 was the primary outcome, with secondary outcomes of weight change at other time points; physical activity (measured by accelerometry, interview, and self-report); cardiometabolic risk factors; and psychological and behavioral outcomes. Intention-to-treat analyses used linear mixed models to test for between-group differences. Treatment acceptability was assessed. RESULTS: = 0.18). The BWL + BIAS (vs. BWL) group produced significantly greater improvements in weight self-stigma, eating self-efficacy, and some aspects of quality of life at specific time points. Most outcomes improved significantly over time but did not differ between groups. The trial had high retention and treatment acceptability, with higher ratings in the BWL + BIAS versus BWL group. CONCLUSIONS: No significant differences in weight loss were observed between the BWL + BIAS versus BWL group. Possible benefits of addressing weight stigma in weight management warrant further investigation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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The possibility of increased psychiatric events with second-generation anti-obesity medications owes principally to the elevated current and lifetime rates of depression and anxiety in persons with obesity, particularly those with a BMI >40 kg/m2, who often experience the greatest ill effects of weight-related stigmatization.
“We believe this possibility owes principally to the elevated current and lifetime rates of depression and anxiety in persons with obesity, particularly those with a BMI > 40 kg/m2, who often experience the greatest ill effects of weight-related stigmatization [99, 114, 115].”
From The Role of Lifestyle Modification with Second-Generation Anti-obesity Medications: Comparisons, Questions, and Clinical Opportunities (2023) · cites this paper as [99]
More frequent lifestyle meetings do not appear necessary to induce a 15-20% weight loss with the new anti-obesity medications, and some visits likely can be conducted by telephone or video-conferencing without loss of efficacy.
“More frequent meetings do not appear necessary to induce a 15–20% weight loss with the new AOMs, and some visits likely can be conducted by telephone or video-conferencing without loss of efficacy [31, 99].”
From The Role of Lifestyle Modification with Second-Generation Anti-obesity Medications: Comparisons, Questions, and Clinical Opportunities (2023) · cites this paper as [99]
Citations
Cited by
Sorted by citations
Wadden, T. A., Chao, A. M., Moore, M., Tronieri, J. S., Gilden, A., Amaro, A., Leonard, S., & Jakicic, J. M. (2023) · Current Obesity Reports · doi:10.1007/s13679-023-00534-z · Cited by 129
“More frequent meetings do not appear necessary to induce a 15–20% weight loss with the new AOMs, and some visits likely can be conducted by telephone or video-confer-encing without loss of efficacy [31, 99].”
BackgroundSelf-citationEnglish, S., & Vallis, M. (2023) · Clinical Obesity · doi:10.1111/cob.12615 · Cited by 28
“20,21 Recent literature on self-compassion interventions is also positive.”
BackgroundD’Adamo, L., Shonrock, A. T., Monocello, L. T., Goldberg, J., Yaeger, L., Jebeile, H., Pearl, R. L., & Wilfley, D. E. (2024) · Journal of Eating Disorders · doi:10.1186/s40337-024-01132-7 · Cited by 26
Self-citationAssessing Weight Stigma Interventions: A Systematic Review of Randomized Controlled Trials
Wang, C., Murley, W. D., Panda, S., Stiver, C., Garell, C. L., Moin, T., Crandall, A. K., & Tomiyama, A. J. (2025) · Current Obesity Reports · doi:10.1007/s13679-025-00628-w · Cited by 22
“Four of these studies focused on adults [73, 75, 79, 80], with three targeting external weight bias and reporting mixed results in bias reduction.”
Patient perspectives of weight stigma across the cancer continuum: A scoping review
Hawley, N. A., Green, J., Ahlich, E. M., Hauff, C., Hermer, J., Skiba, M. B., James, D. L., & Nash, S. H. (2024) · Cancer Medicine · doi:10.1002/cam4.6882 · Cited by 10
“56 Teaching patients self-compassion may also moderate weight bias internalization among individuals with overweight and/ or obesity.”
BackgroundPearl, R., Hernández, M., Bach, C., Groshon, L. C., & Wadden, T. (2023) · Obesity Science & Practice · doi:10.1002/osp4.700 · Cited by 9
Self-citationWetzel, K. E., & Himmelstein, M. S. (2024) · Annals of Behavioral Medicine · doi:10.1093/abm/kaae044 · Cited by 9
Wetzel, K. E., Himmelstein, M. S., & Ciesla, J. A. (2025) · Social Science & Medicine · doi:10.1016/j.socscimed.2025.117904 · Cited by 8
Longitudinal associations of internalized weight stigma with physical activity and weight loss
Sheynblyum, M., Wadden, T. A., Latner, J. D., & Pearl, R. L. (2024) · Obesity Science & Practice · doi:10.1002/osp4.773 · Cited by 5
“9,12 However, no study to date has investigated whether initial reductions in IWS may predict subsequent engagement in physical activity and long ‐ term weight loss.”
BackgroundResultSelf-citationAbordaje Integral de la Obesidad
Cuvi, N. J. T., Robayo, C. P. V., Saltos, K. Y. G., Marizande, F., Castillo-Mayorga, A. M., Jara, A. G. P., Sánchez, G. P. V., Arteaga, C., Bustillos-Ortiz, D. I., Bustillos, A., et al. (2024) · Editorial Grupo AEA eBooks · doi:10.55813/egaea.l.77 · Cited by 6
Pearl, R. L., Groshon, L. C., Hernandez, M., Bach, C., LaFata, E. M., Fitterman-Harris, H. F., Leget, D. L., Sheynblyum, M., & Wadden, T. A. (2025) · Clinical Obesity · doi:10.1111/cob.70005 · Cited by 4
“18,19 22 The majority of individuals with a high body weight report experiencing weight stigma during their lifetime, 23 – 25 yet levels of distress in response to stigmatising experiences and internalisation of this stigma are variable across individuals.”
Self-citationSanzari, C. M., & Lydecker, J. A. (2025) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2025.02.015 · Cited by 1
Hogan, L. E., Johnson, K. J., & Faw, M. H. (2025) · Emerging Adulthood · doi:10.1177/21676968251338573 · Cited by 1
“Research speci fi cally targeting IWS as a point of intervention has found some promising results (see Pearl et al., 2023), and evidence into the impact of interventions targeting social support among individuals struggling with body image and IWS highlight the value of encouraging individuals to…”
Pearl, R. L., Saunders, D., Groshon, L. C., Li, Y., Shonrock, A. T., Puhl, R. M., Driscoll, K. A., Manavalan, P., Gelfand, J. M., Wadden, T. A., et al. (2025) · JMIR Formative Research · doi:10.2196/69548 · Cited by 2
“Some studies have found benefits of these interventions when tested to reduce internalized stigma due to mental illness, HIV, or obesity [22-26].”
Self-citationFahami, M. S., Lame-Jouybari, A. H., & Farhangi, M. A. (2025) · Trials · doi:10.1186/s13063-025-09113-0 · Cited by 1
“A more recent study, published in 2023 and involving 105 participants, mostly women and with an average BMI of 38, found that CBT was related to improved eating self-efficacy and certain aspects of quality of life [29].”
Brownstone, L. M., Harrop, E. N., Cool, J., Kelly, D. A., Norling, H. N., Daley, K., & Kivlighan, D. M. (2026) · International Journal of Group Psychotherapy · doi:10.1080/00207284.2025.2600103 · Cited by 1
“Currently, most IWS interventions have targeted weight loss or weight management as primary outcomes and have demonstrated some success in lowering IWS (e.g., Braun et al., 2022; Palmeira et al., 2019; Pearl et al., 2023).”
Development and validation of the EDIT weight stigma reduction checklist
Garcia, X. D. L. P., Cooper, K., Jardine, I. R., Alberga, A. S., Darling, K. E., Hill, A. J., Howes, E. M., Vidmar, A. P., Yourell, J., Lister, N. B., et al. (2026) · International Journal of Obesity · doi:10.1038/s41366-026-02045-y · Cited by 1
“Finally, we hope that this checklist encourages healthcare professionals and researchers working in weight management to consider the steps that they can take to reduce weight stigma in their interactions with their clients, and to empower them to manage the stigma they face in the world.”
Manzoni, G. M., Tomba, E., Gardini, V., Cena, H., Schumann, R., Ballardini, D., Donini, L. M., Manzato, E., Gravina, G., Pauli, D. D., et al. (2026) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-026-01818-8 · Cited by 1
Experienced Weight Stigma Changes Following Bariatric Surgery: a Systematic Review and Meta‐Analysis
Farnsworth, H. R., Leget, D. L., LaCaille, L. J., LaCaille, R. A., Koball, A. M., Niemann, A., Backderf, C. Z., Mastrian, C. R., & Duyke, E. M. V. (2026) · Obesity Reviews · doi:10.1111/obr.70179 · Cited by 1
Intervención psicológica en el sobrepeso y la obesidad
Núñez, M. N., Zumbaña, L. C. E., & Rubio, A. D. R. M. (2024) · Editorial Grupo AEA eBooks · doi:10.55813/egaea.cl.55
Pearl, R. L., Anton, S. D., Saunders, D., Hernandez, M., Groshon, L. C., Sheynblyum, M., Leget, D. L., McLaren, C., Vial, S., Gonzalez, L., et al. (2025) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2025.101129
Self-citationPoole, L., & Hackett, R. A. (2025) · International Journal of Behavioral Medicine · doi:10.1007/s12529-025-10421-7
“However, it should be noted such interventions are still under development and require further testing in healthcare settings to establish the longevity of any observed effects [66].”
Sheynblyum, M., & Pearl, R. L. (2026) · Journal of Health Psychology · doi:10.1177/13591053251408886
“…(Russell, 2024), it was selected as a criterion for this study due to in part to evidence that individuals with a higher BMI are more likely to experience and internalize weight stigma (Pearl et al., 2023; Puhl and Brownell, 2006), making this population ideal for addressing the study’s question.”
Self-citationCorrado, R., Raffa, S. D., Bauer, E. M., Eisenberg, D., Weare-Regales, N., Antonovich, N., Loblack, A., Berdiel, E., Kelber, M. S., Klimovich, J., et al. (2026) · Annals of Internal Medicine · doi:10.7326/annals-26-00676
Behavior change support in the new era of obesity care
Boaventura, B. C. B., & Flint, S. W. (2026) · BMC Medicine · doi:10.1186/s12916-026-05167-2
“Addressing weight stigma in obesity care has been associated with improvements in psychological and behavioral outcomes, including eating self-efficacy, quality of life, treatment acceptability, and reduction of internalized weight stigma [6].”
Linardon, J., & Tylka, T. L. (2026) · International Journal of Eating Disorders · doi:10.1002/eat.70229
Metadata
- Authors
- Pearl, R. L., Wadden, T. A., Bach, C., LaFata, E. M., Gautam, S., Leonard, S., Berkowitz, R. I., Latner, J. D., & Jakicic, J. M.
- Affiliations
- University of Florida (US)
- University of Pennsylvania (US)
- Drexel University (US)
- University of Hawaiʻi at Mānoa (US)
- University of Kansas Medical Center (US)
- ORCID
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2023-07
- Volume
- 91
- Issue
- 7
- Pages
- 398-410
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W4375860225
- Cited by
- 27
- References
- 0
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 6 · 2023: 4
- FWCI
- 11.08
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (K23HL140176)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity and Health Practices
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- internalized weight stigma, weight self-stigma, behavioral weight loss, long-term weight loss, dietary self-efficacy, quality of life, physical activity, cardiometabolic risk factors, treatment acceptability, obesity
- MeSH terms
- Weight Prejudice, Adult, Female, Humans, Male, Middle Aged, Obesity, Quality of Life, Weight Loss, Treatment Outcome
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