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Cited by 3Mindfulness and Compassion InterventionsDiabetes Management and EducationObesity and Health Practices

A Randomized Controlled Trial of an Acceptance and Commitment Therapy-Informed Diabetes Prevention Program Reduces Body Shame and Distress.

Open access
Lipsett, Megan, Berkman, Elliot·2025·Health Psychology
DOI 10.1037/hea0001434PMC PMC12178311
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Abstract

Body shame drives psychological and behavioral precursors of Type 2 diabetes (T2D) prevention and management and may be present in conventional prevention programs. We tested the efficacy of a brief acceptance and commitment therapy (ACT)-informed T2D prevention intervention targeting those outcomes. Method: Participants (N = 298) were at high risk for developing T2D, had not previously attended a diabetes prevention program, and were randomized to a virtual intervention grounded in ACT and diabetes education or diabetes education alone. Intervention-related body shame was the primary outcome, and several secondary outcomes were also examined. Results: Participants in the ACT + diabetes prevention education group (vs. diabetes prevention education only) had significantly lower body shame, which was significantly related to perceptions of diabetes-related threat, diabetes distress, and perceived self-efficacy for diabetes prevention self-management, among others, and also mediated the effect of treatment on threat and anxiety. Conclusions: This randomized controlled trial provides one of the first experimental tests of an ACT-informed diabetes prevention program that can reduce intervention-related body shame and related health and well-being outcomes. Public Significance Statement: Weight-stigmatizing content in standard diabetes prevention programs may lead to body shame, which is linked to psychological distress and hinders effective diabetes management. This study suggests that a health-focused diabetes prevention program incorporating acceptance and commitment therapy may reduce intervention-related body shame, leading to lower threat perceptions and anxiety. These programs may improve outcomes for individuals at high risk for Type 2 diabetes, offering a more inclusive and accessible approach to diabetes prevention.

Integrity signals

Registry

Crossref · 10.1037/hea0001434

Cites

71 of 71 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

22 of 63 cited sources checked · 6 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Conventional type 2 diabetes prevention programs are significantly underutilized.

    “Conventional Type 2 diabetes (T2D) prevention programs provide key educational components but are significantly underutilized (Ali et al., 2019)”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Ali et al., 2019 source
  • Premisecitation

    Part of the reason type 2 diabetes prevention programs are not more effective may be weight stigma, including stigma built into the programs.

    “The limited effectiveness of T2D prevention programs may be due in part to weight stigma, including the weight stigma inherent within prevention programs themselves (A. Brown et al., 2022).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites A. Brown et al., 2022 source

      The ‘obesity strategy’ section says public-health interventions may unintentionally create weight stigma, and the Introduction says addressing stigma is important for obesity prevention. The paper does not establish that type 2 diabetes prevention programs have limited effectiveness or that weight stigma contributes to their limited effectiveness; its discussion concerns obesity policy and prevention more broadly. Our copy provides no page numbers for these passages. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • Rests on an assumption: Whether diabetes prevention programs create body shame, and how to lessen such shame in those programs, remains unknown.
  • Premisecitation

    Together, the cognitive and emotional effects of weight stigma weaken efforts to manage weight.

    “The suite of cognitive and affective factors resulting from weight stigma collectively undermines weight management efforts (e.g., dysregulated eating, weight cycling, and sedentary behaviors; Puhl et al., 2016, 2022; Tomiyama, 2014)”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Puhl et al., 2016, 2022

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Tomiyama, 2014 source

      The Introduction says weight stigma may undermine weight-loss attempts through interacting behavioral and emotional mechanisms. The Eating behavior mechanisms and Fighting against the cycle sections discuss impaired self-regulation, increased eating, and possible exercise avoidance. The paper discusses repeated failed weight-loss attempts, but the cited passages do not establish weight cycling as a resulting behavior; the sentence also states the overall effect more firmly than the review does. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation

    Weight stigma and fat shaming are frequently reported in health care settings.

    “reports of weight stigma and “fat shaming” are common in health care encounters (Jaeb & Pecanac, 2024).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Jaeb & Pecanac, 2024 source

      The section on patients’ descriptions of shame (page unavailable in our copy) reports that 15.8% of participants in one study felt shamed by health professionals for their weight. This supports reports of weight-related shaming in healthcare encounters, but does not establish that such reports are common across healthcare settings. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • Premisecitation

    Weight stigma and body shame produce psychological and emotional distress.

    “Weight stigma and body shame cause psychological and emotional distress (A. Brown et al., 2022; Emmer et al., 2020).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites A. Brown et al., 2022 source
    • cites Emmer et al., 2020

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims. 22
  • Classified as probably not a substantial claim. 34

  • May combine two claims.

    Premisecitation

    Weight stigma and the body shame it produces reduce motivation for diabetes prevention behaviors and influence many health outcomes.

    “Weight stigma and resultant body shame decrease motivation for engaging in diabetes prevention behaviors (e.g., physical activity) and impact numerous health outcomes (Vartanian & Novak, 2011).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Vartanian & Novak, 2011 source

      The Discussion (page unavailable) links weight stigma to greater exercise avoidance and to negative psychological outcomes, including body dissatisfaction. It does not establish that resultant body shame causes reduced motivation, study diabetes prevention specifically, or demonstrate effects on numerous health outcomes. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Research suggests ACT interventions can lower dissatisfaction with body image and internalized weight stigma and improve health, in part by reducing experiential avoidance and shame.

    “There is evidence that ACT interventions reduce body image dissatisfaction and internalized weight stigma, as well as increase health outcomes, partly because of reductions in experiential avoidance and shame (Fletcher, 2011; Griffiths et al., 2018; Lillis et al., 2005).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Fletcher, 2011

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Griffiths et al., 2018 source

      The Results sections on BID and weight self-stigma report reductions with ACT in several studies, and Process Variables Results reports that reduced weight-related psychological inflexibility and shame mediated reduced self-stigma. The review also reports greater weight loss in some ACT groups, but it does not establish broad improvements in health outcomes or show that reductions in avoidance and shame mediated those health outcomes. Pages are not available in our copy. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites Lillis et al., 2005

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Weight stigma and body shame raise the risk of metabolic syndrome, type 2 diabetes onset, type 2 diabetes progression, and death from any cause, even after accounting for BMI.

    “Via the pathways described here, weight stigma and body shame contribute to increased risk for metabolic syndrome (Pearl et al., 2017), T2D onset (Udo et al., 2016), T2D disease progression (Fazli & Booth, 2023; Potter et al., 2015), and all-cause mortality (see Tomiyama et al., 2018 for a review), even when controlling for other risk factors such as body mass index (BMI; Durso & Latner, 2008).”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Pearl et al., 2017

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Udo et al., 2016 source

      The Results report that perceived weight discrimination was associated with higher odds of a diabetes diagnosis after adjustment for BMI and other factors. But the Methods say diabetes was measured by prevalence, not incidence, because it was assessed only at Wave 2. The paper therefore does not establish increased risk of type 2 diabetes onset. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • cites Fazli & Booth, 2023 source

      Fazli and Booth is cited for T2D disease progression, but the Healthcare Approaches to Diabetes Prevention section discusses progression from prediabetes to T2D, not progression of established T2D. Searches for weight stigma, body shame, and weight bias found no passage linking them to disease progression; the copy also does not report a BMI-adjusted association. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Weight stigma shapes cognitive and emotional factors, including how threatening illness seems, beliefs about whether diabetes can be prevented, and worry about symptoms.

    “Weight stigma impacts cognitive and affective factors such as perceptions of illness threat, including beliefs about diabetes preventability and concern about developing associated symptoms (Hopkins & Bennett, 2018)”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Hopkins & Bennett, 2018 source

      The Results section reports that weight-related terms affected perceived control over and understanding of obesity, supporting a narrower claim about cognitive illness perceptions. It found no significant effect on emotional illness perceptions, and the paper does not report effects of weight stigma on beliefs about diabetes preventability or worry about developing symptoms. Its study varied clinical terms rather than weight stigma itself. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Ongoing exposure to weight stigma can create internalized stereotypes and self-devaluation, which can result in body shame.

    “Repeated exposure to weight stigma can lead to internalized stereotypes and self-devaluation, resulting in body shame (Forbes & Donovan, 2019; Pearl & Puhl, 2018)”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Forbes & Donovan, 2019

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Pearl & Puhl, 2018 source

      The Introduction (page unavailable) defines weight-bias internalization as adopting negative weight stereotypes and devaluing oneself. The Results, under Mental Health Outcomes in Adults (page unavailable), report that people who experienced weight stigma had greater internalization, and that internalization was associated with worse body image and greater body dissatisfaction. The review does not establish that repeated exposure causes this sequence or specifically that it results in body shame. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    ACT is an evidence-based third-wave therapy that aims to prevent chronic disease and lessen psychological distress.

    “ACT is an evidence-based third-wave treatment used to prevent chronic disease and reduce psychological distress using acceptance, mindfulness, and behavioral change strategies (Graham et al., 2016; Gregg et al., 2007).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Graham et al., 2016 source

      The Distress section reports that ACT interventions were generally associated with reduced distress in people who already had long-term conditions, while noting uncertainty about whether ACT outperforms other treatments. The State of the evidence section calls the evidence emerging and says more high-quality research is needed for comprehensive empirical support. Neither section supports the claim that ACT prevents chronic disease. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • cites Gregg et al., 2007 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The extent to which body shame and internalized weight bias are distinct constructs lacks clear consensus.

    “The extent to which body shame and internalized weight bias are distinct constructs lacks a clear consensus and warrants further exploration.”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Romano et al., 2022 source

      The Discussion’s Conceptual Overlap section says it is not yet fully understood whether weight bias internalization is distinct from aspects of body image, and the Strengths, Limitations, and Future Directions section calls for further study of that overlap (page numbers unavailable). The paper does not specifically assess body shame as a distinct construct, so its conclusion about body image supports the claim only at a broader level. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites Saunders et al., 2022

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Leget et al., 2023 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Weight stigma and body shame may heighten psychosocial and psychobiological stress responses and impede social connection, including when stemming from prevention programs.

    “Weight stigma and body shame may heighten psychosocial and psychobiological stress responses (e.g., A. Brown et al., 2022; Dickerson, 2008; Vadiveloo & Mattei, 2017) and impede social connection (Hunger et al., 2015)—including when stemming from prevention programs.”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites A. Brown et al., 2022 source
    • cites Dickerson, 2008 source
    • cites Vadiveloo & Mattei, 2017 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    One meta-analysis showed a high correlation between internalized weight bias and self-devaluation but not body shame explicitly.

    “One meta-analysis showed a high correlation between internalized weight bias and self-devaluation (Romano et al., 2022) but not body shame explicitly.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Romano et al., 2022 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Average diabetes risk-related distress scores for both groups reflect moderate distress (scores 2.0-2.9).

    “Average diabetes risk-related distress scores for both the DPE only group (M = 2.65, SD = 1.18) and the ACT + DPE group (M = 2.57, SD = 1.09) reflect “moderate distress” (scores of 2.0–2.9; Fisher et al., 2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Fisher et al., 2012

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The top three goal topics for both groups were weight focused, dietary, and physical activity.

    “The top three goal topics for both groups were weight focused (i.e., listing weight loss as a goal without noting a specific behavior or action), dietary, and physical activity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The DPE only group had 20.8% weight-focused goals, whereas the ACT + DPE group had 2.7% weight-focused goals.

    “The DPE only group had a high frequency of weight-focused goals (20.8%), whereas just 2.7% of responses from the ACT + DPE group reflected weight-focused goals.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants who rated either program as eliciting body shame endorsed higher state anxiety and diabetes distress, but only state anxiety was lower among those who engaged in the ACT-informed program.

    “Participants who rated either program as eliciting body shame endorsed higher state anxiety and diabetes distress, but only state anxiety was lower among those who engaged in the ACT-informed program.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The PBSS adequately measures body shame.

  • May combine two claims.

    Findingown data

    Lower body shame was associated with reduced diabetes-related threat perceptions, lower diabetes distress, and increased self-efficacy for diabetes prevention and self-management.

    “Lower body shame was associated with reduced diabetes-related threat perceptions, lower diabetes distress, and increased self-efficacy for diabetes prevention and self-management.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The PBSS adequately measures body shame.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Weight stigma is a social determinant of health.

    “Weight stigma, described in a position article by the World Obesity Federation as a social determinant of health (Nutter et al., 2024)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Nutter et al., 2024

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    The trial is an early experimental test of an ACT-based diabetes prevention program that may lower body shame tied to the intervention and improve related health and well-being outcomes.

    “This randomized controlled trial provides one of the first experimental tests of an ACT-informed diabetes prevention program that can reduce intervention-related body shame and related health and well-being outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The remaining body shame scale items had high internal consistency (α = .92).

    “Internal consistency for the remaining items was high (α = .92).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisereasoning

    ACT-informed programs work well to reduce psychological factors that get in the way of preventing other diseases.

    “So, ACT-informed programs are effective in reducing proximal psychological factors that undermine the prevention of other disease states but have not yet been applied in the context of reducing weight stigma in diabetes prevention programs.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: ACT-informed programs have not yet been used to address weight stigma within diabetes prevention programs.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    All participants completed all intervention components and assessment measures.

    “All participants completed all intervention components and assessment measures.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    People with overweight or obesity frequently encounter weight stigma.

    “Individuals with overweight or obesity frequently experience weight stigma (Seacat et al., 2016).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Seacat et al., 2016

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    ACT enhances emotion regulation and reduces psychological inflexibility.

    “In contrast with weight-focused approaches that increase psychological drivers of risk behaviors such as psychological inflexibility and experiential avoidance (Espejo et al., 2017; Kangasniemi et al., 2014), ACT enhances emotion regulation and reduces psychological inflexibility.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Espejo et al., 2017 source
    • cites Kangasniemi et al., 2014 source

  • May combine two claims.

    Study design and conductown data

    There were no baseline group differences in age, gender, race, BMI, mean household income, or self-reported diabetes risk indicator.

    “There were no group differences at baseline in age, gender, race, BMI, mean household income, or self-reported diabetes risk indicator”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Self-reported diabetes risk indicator accurately identifies individuals at high risk for T2D.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Randomization to the two digital diabetes prevention interventions was automated.

    “participants were randomized to one of the two digital diabetes prevention interventions using an automated randomizer.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The University of Oregon institutional review board approved all procedures.

    “All procedures were approved by the institutional review board at the University of Oregon.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    During initial prescreening, procedures were used to lower the chance of false responses.

    “Measures were taken to reduce false responses during initial prescreening (see the online supplemental materials).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Internal consistency was assessed for all item scales.

    “Internal consistency was assessed for all item scales.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Study content was validated through focus groups with the target population and assessment of participants' engagement expectations.

    “The study content was validated via focus groups with the population of focus and assessment of engagement expectations by study participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    Body shame involves feelings of social inferiority arising from weight stigma, social comparison, and sociocultural appearance norms.

    “Body shame reflects the feelings of social inferiority driven by weight stigma (Dolezal & Lyons, 2017; Lucibello et al., 2021), social comparison, and sociocultural appearance norms (e.g., the thin ideal; Thompson et al., 1999).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Dolezal & Lyons, 2017

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Lucibello et al., 2021 source
    • cites Thompson et al., 1999

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    Evidence gathered so far shows that weight stigma and body shame worsen type 2 diabetes outcomes, so programs are needed that lower such stigma or at least do not create it.

    “The accumulating evidence described above underscores the harmful effects of weight stigma and body shame on T2D outcomes, necessitating intervention programs that reduce or at least do not cause weight stigma.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Whether diabetes prevention programs create body shame, and how to lessen such shame in those programs, remains unknown.
    • Rests on an assumption: Few empirical studies have examined weight stigma or body shame in conventional diabetes prevention programs.
    • Rests on an assumption: ACT-informed programs have not yet been used to address weight stigma within diabetes prevention programs.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Thematic categorization was done by three trained research staff who independently assessed responses, identified themes collaboratively, and resolved disagreements by consensus with an expert rater.

    “Coders independently assessed responses, collaboratively identified common themes using visual mapping, and reassessed prompts based on agreed-upon thematic structures. Any disagreements in final ratings were resolved through consensus, guided by an expert rater”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Three participants were excluded from analysis due to inconsistent diagnosis responses or computer-generated text.

    “Three participants were excluded from analysis because of inconsistent responses regarding diagnosis on the eligibility form or indications of computer-generated text”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    There was high agreement among three raters for goal topic ratings, with Fleiss' κ = .89, N = 298, z = 49.9, p < .001.

    “We found high agreement among three raters in assigning the ratings for goal topics, with a Fleiss’ κ value of .89 (N = 298, z = 49.9, p < .001).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Interventions are needed that focus on health without perpetuating weight stigma.

    “Therefore, there is a need for health-focused prevention interventions that do not perpetuate weight stigma.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Few empirical studies have examined weight stigma or body shame in conventional diabetes prevention programs.

  • Classified as probably not a substantial claim.

    Premisecitation

    Guidelines for people at high risk of type 2 diabetes recommend referral to prevention programs that support behavioral self-management.

    “Standards of care for those at high risk of developing T2D include referral to prevention programs that support behavioral self-management regimens, including dietary choices, physical activity, glucose monitoring, and regular visits with a physician (American Diabetes Association, 2023).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites American Diabetes Association, 2023

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The item '...made me feel silly' was removed because it correlated poorly (r = .25-.50) with the other items.

    “The item “…made me feel silly” was removed because of poor correlation (r = .25–.50) with other items, resulting in scores ranging from 5 to 35.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A focus group of people with prediabetes examined the study materials for clarity, reduced weight stigma, effectiveness, access, and public relevance.

    “Additionally, a focus group consisting of individuals with prediabetes reviewed study materials (consent form, surveys, intervention materials, and debrief) to ensure clarity, minimize weight stigma, enhance effectiveness, improve access, and ensure relevance to the general public.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Manual review of participant responses was used to minimize the bot issue.

    “we minimized this issue by manually reviewing participant responses during the study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    New research indicates that diabetes prevention programs informed by ACT might lower behavioral risk factors such as emotional eating.

    “Emerging research suggests that ACT-informed diabetes prevention programs could reduce behavioral risk outcomes like emotional eating (Frayn et al., 2020).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Frayn et al., 2020 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The trial design and weight-related outcomes were registered in advance under Clinical Trials identifier NCT05260983.

    “The study design and weight-related outcomes were preregistered with Clinical Trials identifier NCT05260983.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A board of diabetes prevention experts reviewed the study materials and gave the principal investigator feedback for refining both interventions.

    “A community advisory board of diabetes prevention experts reviewed study materials and provided feedback to the principal investigator to refine the two interventions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There is a modest association between internalized weight bias and body shame as measured by the PBSS.

    “Though there is a modest association between internalized weight bias and body shame as measured by the PBSS, these constructs may have separable roles in mediating the relationship between self-compassion and risk behaviors (Huellemann & Calogero, 2020).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Huellemann & Calogero, 2020 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Internalized weight bias and body shame may have separable roles in mediating the relationship between self-compassion and risk behaviors.

    “Though there is a modest association between internalized weight bias and body shame as measured by the PBSS, these constructs may have separable roles in mediating the relationship between self-compassion and risk behaviors (Huellemann & Calogero, 2020).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Huellemann & Calogero, 2020 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Social rejection, exclusion, and isolation are well-known drivers of biological stress reactivity and downstream health outcomes.

    “Social rejection, exclusion, and isolation are themselves well-known drivers of biological stress reactivity and downstream health outcomes (Holt-Lunstad, 2021).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Holt-Lunstad, 2021 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Outcome measures were assessed shortly after the interventions.

    “Also, the outcome measures in the present study were assessed shortly after the interventions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The ACT-informed diabetes prevention intervention is a brief, web-based, low cost, interactive program developed in accordance with RE-AIM principles and can be easily delivered via computer following T2D risk assessment, within primary care and community health settings, or using community-based population-wide screening approaches.

    “The ACT-informed diabetes prevention intervention is a brief, web-based, low cost, and interactive program that was developed in accordance with reach, effectiveness, adoption, implementation, and maintenance principles and can be easily delivered via computer following a T2D risk assessment, within primary care and community health settings, or using community-based population-wide screening”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Body shame experienced within diabetes prevention programs relates to cognitive, affective, and behavioral factors that inform diabetes outcomes, some of which may be mitigated by removal of weight-stigmatizing elements and inclusion of ACT approaches.

    “Body shame experienced within diabetes prevention programs relates to cognitive, affective, and behavioral factors that inform diabetes outcomes, some of which may be mitigated by the removal of weight-stigmatizing elements and the inclusion of ACT approaches.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The PBSS adequately measures body shame.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The gap between intentions and behaviors is well documented.

    “Still, the gap between intentions and behaviors is well documented (Sheeran, 2002)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Sheeran, 2002 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Associations between internalized weight bias and at least one measure of body shame suggest a need for measurements that adequately distinguish these constructs.

    “The associations between internalized weight bias and at least one measure of body shame (Mensinger et al., 2018) suggest a need for measurements that adequately distinguish these constructs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Mensinger et al., 2018 source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Without a baseline measure of body shame, randomization may have failed and baseline group differences may have skewed the findings.

    “Without a baseline measure of body shame, there is the possibility that randomization failed and group differences at baseline skewed our findings.”
    Quote in the paperSubstantial claim
49 of 49

  • The paper relies on this without support.

    Whether diabetes prevention programs create body shame, and how to lessen such shame in those programs, remains unknown.

    “It is presently unknown whether diabetes prevention programs engender feelings of body shame and, if they do, how to mitigate the activation of body shame in prevention programs.”

  • The paper relies on this without support.

    Few empirical studies have examined weight stigma or body shame in conventional diabetes prevention programs.

    “There is little empirical data about weight stigma or body shame related to conventional diabetes prevention programs”

  • The paper relies on this without support.

    ACT-informed programs have not yet been used to address weight stigma within diabetes prevention programs.

    “but have not yet been applied in the context of reducing weight stigma in diabetes prevention programs.”

  • The paper relies on this without support.

    The ACT + DPE intervention's use of countermoralizing language and avoidance of body-size language reduces body shame.

    “The ACT + DPE intervention also aimed to use countermoralizing language (e.g., replacing terms like “unhealthy foods” with “foods that give you important nutrients”) and reduce body shame by avoiding language focused on body size (e.g., “weight loss” and “too heavy”) and framing goals around value identification to guide behaviors, including choices regarding diet and exercise”

  • The paper relies on this without support.

    Body shame temporally precedes and mediates the effect of intervention on threat perceptions and anxiety.

    “A post hoc mediation analysis was conducted to explore whether the effect of the intervention group on (a) threat perceptions and (b) anxiety was mediated by body shame.”

  • The paper relies on this without support.

    The PBSS adequately measures body shame.

    “The PBSS was developed in response to concerns about the measurement of body shame, including concerns about the impact of “shame about shame” on measurement validity and the failure to capture the embodied aspects of shame.”

  • The paper relies on this without support.

    Self-reported diabetes risk indicator accurately identifies individuals at high risk for T2D.

    “There were no group differences at baseline in age, gender, race, BMI, mean household income, or self-reported diabetes risk indicator”
7 of 7

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentz = 49.9reported p < .001 · recomputed p < .001

    “z = 49.9, p < .001”

  • ConsistentF(1, 293) = 7.468reported p = .007 · recomputed p = .007

    “F(1, 293) = 7.468, p = .007”

2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • F statistic is not consistent with the reported t statistic

    Major

    For a model with 1 numerator degree of freedom, F should equal t squared for the main effect. The reported t = −2.773 squares to about 7.689, not the reported F = 7.468, beyond ordinary rounding.

    Reported 7.468 · recomputed 7.689529

  • Threat-mediation t statistic has the opposite sign

    Major

    A positive coefficient divided by a positive standard error gives a positive t statistic, about 1.971. The reported negative t statistic reverses the direction of this conclusion-bearing direct effect.

    Reported -1.976 · recomputed 1.971429

  • Stated body-shame total-score minimum is too low

    Minor

    The paper describes an eight-item scale with one item removed, leaving seven items. With the stated item-score range of 1-5, a seven-item total cannot have a minimum of 5; its minimum would be 7.

3 of 3

Cites

Flagged first, then by citations

25 of the 96 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Lipsett, M., & Berkman, E.
Affiliations
University of Oregon (US)
ORCID
Venue
Health Psychology
Publisher
American Psychological Association (APA)
Published
2025-05
Volume
44
Issue
5
Pages
549-559
ISSN
  • 0278-6133 (ISSN-L)
  • 1930-7810
DOI
10.1037/hea0001434
PMC
PMC12178311
OpenAlex
W4409455630
Cited by
3
References
96
Citations by year
2026: 2 · 2025: 1
FWCI
3.53
Type
journal article
Language
en
Open access
Locations
  • Health Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Cancer Institute (R01CA240452, R01CA211224)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
Keywords
acceptance and commitment therapy, type 2 diabetes prevention, body shame, diabetes distress, diabetes prevention education, virtual intervention, anxiety, high-risk adults
MeSH terms
Self-Management, Psychological Distress, Adult, Aged, Body Image, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Shame, Self Efficacy, Acceptance and Commitment Therapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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