“Going against everything society has told me”: the role of transformative learning in healing internalized weight stigma

Research suggests that directing compassion inward (i.e., self-compassion) is related to better psychological and physical well-being. Little research attention has focused on the links between self-compassion and internalized weight stigma. Internalized weight stigma, or devaluing oneself because of one’s body weight, is pervasive across women regardless of their weight and is particularly detrimental to psychological and physical well-being. This study examined the indirect effects of self-compassion on maladaptive eating behaviors through lower levels of internalized weight stigma and increased psychological well-being in a sample of 266 women. Women completed an online questionnaire assessing self-compassion, internalized weight stigma, anxiety and depressive symptoms, and emotional and restrained eating. Self-compassion was associated with lower levels of internalized weight stigma, which in turn was associated with fewer depressive symptoms and less anxiety. Contrary to expectations, self-compassion was not associated with eating behaviors through the sequence of internalized weight stigma and psychological well-being. However, self-compassion was associated with less emotional and restrained eating through lower internalized weight stigma. The link between self-compassion and fewer maladaptive eating behaviors was explained by internalized weight stigma alone, as opposed to a sequence of internalized weight stigma and psychological well-being.

Many women internalize negative attitudes regarding body shape and size because of the societal standards for women's ideal body shapes and sizes. Internalized weight stigma is related to poorer physical and psychological health. A growing body of research has documented the links between other forms of internalized stigma (e.g., HIV-stigma) and poor sleep quality; however, little research examines the links between internalized weight stigma and sleep or the mechanisms that explain this relationship. Internalized weight stigma may be associated with poor sleep through increases in psychological distress. This study hypothesized that the links between internalized weight stigma and sleep would be mediated by higher levels of depression and anxiety. About 257 women were recruited via social media, word of mouth, and an undergraduate participant pool. Participants completed an online survey assessing various aspects of weight stigma and health through self-report questionnaires. Most women were non-Hispanic White (86.8%) and had a mean age of 31.40. The indirect effects of internalized weight stigma on poorer global sleep quality and daily disturbances through depression and anxiety were significant. In contrast, depressive symptoms but not anxiety explained the links between internalized weight stigma and perceived sleep quality and neither depressive symptoms nor anxiety explained the link between internalized weight stigma and sleep efficiency. Internalized weight stigma is linked to poorer sleep quality, and these links may be explained by psychological well-being. Understanding the mechanisms by which internalized weight stigma is associated with sleep quality can inform the psychological interventions employed.

BackgroundSince the first papers focused on internalized weight stigma were published in the mid 2000’s, the literature has grown into a robust field that complements existing knowledge on weight stigma. Recently, researchers have documented the need for increased conceptual and measurement clarity, to distinguish internalized weight stigma from body dissatisfaction. Although several systematic reviews have been conducted on portions of the internalized weight stigma literature, no review to date has been conducted examining the entirety of the literature.ObjectiveThe aim of this research was to conduct a systematic scoping review and synthesis of research on internalized weight stigma. Specifically, we sought to examine the broad scope of the literature, terms used to refer to internalized weight stigma, how internalized weight stigma is defined, sample characteristics, and weight-based framings of internalized weight stigma research.MethodsWe conducted a single-concept search across six databases (EMBASE, Medline, PsychINFO, PubMed, SCOPUS, and Web of Science) of peer-reviewed papers published in English on internalized weight stigma. Data were extracted for article authors, year published, journal name and type, general article topic(s), study design, study location, sample characteristics, variables measured, paper framing, term used to describe internalized weight stigma, and definition of internalized weight stigma.ResultsOf the 931 unique records screened, 376 were identified for inclusion in the scoping review. The majority of internalized weight stigma research is characterized by cross-sectional methods, has been conducted in the US, and has utilized samples of higher weight white women. Further, 40 unique terms were used across the literature to refer to internalized weight stigma, and 19 different components of definitions of internalized weight stigma were identified. The literature is also characterized by a focus on understanding the association between internalized weight stigma and health outcomes with an emphasis on obesity.ConclusionsThis scoping review confirms a lack of concept clarity of internalized weight stigma, in part influenced by an inconsistency in definitions of internalized weight stigma across the literature. Considerations are provided for steps to enhance conceptual and measurement clarity. Given the obesity focused framing of much of the research on internalized weight stigma, considerations are also provided for reducing weight-centric approaches to research.Plain english summaryIn the early 2000’s, researchers began to pay more attention to the potential health impacts of believing societal stereotypes, negative attitudes, and beliefs about higher weight people. When these stereotypes, negative attitudes, and beliefs are directed towards the self, it can have significant consequences for an individual’s perceptions of self. This research collected and summarized all existing research published in English on internalized weight stigma. Our results highlighted that researchers do not use consistent terminology to refer to internalized weight stigma and that they do not have a consistent definition of internalized weight stigma. Further, a large proportion of the research is focused on obesity or weight loss, which may unintentionally perpetuate weight stigma in scientific research. We provide several recommendations for researchers to address these challenges in future research on internalized weight stigma as well as recommendations to address other identified gaps in the existing literature.

Originating and most often used in the discipline of adult education, the term transformative learning “refers to processes that result in significant and irreversible changes in the way a person experiences, conceptualizes, and interacts with the world” (“Transformative Learning as a Metatheory: Definition, Criteria, and Typology.” Adult Education Quarterly 66.1 [2016]: p. 71, cited under Origins and Overviews). Its origins are in a white paper published in 1978, wherein Jack Mezirow of Teachers College, Columbia University, reported the results of a study of women’s re-entry work programs in community colleges across the United States (Education for Perspective Transformation. Women’s Re-Entry Programs in Community Colleges [1978], cited under Origins and Overviews). In this report, he coined the term perspective transformation to describe the profound changes experienced by some of the women in their study. Over the next several decades, Mezirow developed and continually refined this concept into a comprehensive theory of adult learning, always maintaining a focus on the transformative potential of learning, i.e., its ability to help learners change in fundamental ways rather than merely adding knowledge or skills. During this theory development, his use of terms extended beyond perspective transformation, as he referred to his work as transformation theory and then transformative (or transformational) learning theory. From these beginnings, a large base of literature emerged addressing the profound changes that are possible from learning in adulthood. Of the various names used over time by Mezirow and others, transformative learning is the most ubiquitous term in this scholarship. It is used to refer to Mezirow’s evolving theory of adult learning, but it is also used to refer to any of a number of theories that focus on significant changes that learning can have on people, especially those changes that are not adequately encompassed by the usual descriptors: knowledge, skills, and attitudes. Many of these theories were developed independent of Mezirow’s work, sometimes even prior to it. It is probably most accurate to say that transformative learning is not a single theory, but rather a collection of theories around a similar phenomenon. This collection of theories (and more commonly called “approaches” to transformative learning) derived from numerous, disparate disciplinary perspectives that often had little theoretical connection with each other. Therefore, when scholars write about transformative learning, they may be referring to Jack Mezirow’s theory, another theory in the adult education literature that addresses transformation, or the range of theories (or approaches) as a whole. Nevertheless, beginning with Mezirow there has arisen a literature around the phenomenon of the transformative potential of adult learning. Although historically this literature has been mostly by North American scholars, it is increasingly being used by scholars in other countries (especially Europe) and disciplines. This article organizes and presents some of the most prominent pieces within that literature.

The chapter interprets transformative learning through the lens of Jack Mezirow’s (1991, 2000) transformation theory. The main purpose is to argue that Mezirow’s theory of transformative learning could be a foundation for professional education ‘from which appropriate practices of goal setting, needs assessment, program development, (and) instruction … could be derived’ (Mezirow, 1991: xii). The discussion employs Mezirow’s key concepts of content, process and premise reflection, instrumental, communicative, and emancipatory learning, objective and subjective reframing, and ‘perspective transformation’ to demonstrate the utility of these concepts for describing significant (i.e., transformative) learning on professional programmes, and the development of an identity as change agent. As the discussion unfolds additional literature that does not speak explicitly to transformative learning but is relevant to the argument that professions and professional education should have a social justice orientation are integrated. The chapter makes the point that transformative learning on professional programmes in higher education is a process of developing a more ‘authentic’ professional identity. Canadian adult educator and theorist Patricia Cranton previously linked authenticity, critical reflection, and transformative learning.

Weight stigma is a painful and distressing phenomenon experienced by many individuals with overweight and obesity around the world. Weight stigma, whether experienced from others, or internalised by individuals with overweight, is associated with a myriad of detrimental physical and mental health outcomes (Latner, Durso, & Mond, 2013; Papadopoulos & Brennan, 2015; Pearl, Puhl, & Dovidio, 2015; Puhl & Brownell, 2001). Given the widespread and negative impact of weight stigma, there is a need for strategies to alleviate the effects of weight stigma and assist individuals to better cope with stigmatising situations (Flint, Raisborough, & Hudson, 2020). Concurrently, there has been an increased interest in the field of self-compassion research, for which there is now compelling evidence highlighting that self-compassion is beneficial for mental health and well-being. Evidence shows that self-compassion is particularly important during times of suffering and distress, and can serve to buffer the effects of stigma for various populations, including marginalised groups (Fredrick, Williams, & LaDuke, 2019). Evidence demonstrating the advantages of self-compassion provides a persuasive rationale to argue that self-compassion has the potential to attenuate the negative effects of weight stigma. However, studies merging the fields of weight stigma and self-compassion research are limited, and the role of self-compassion within the context of weight stigma is an understudied area of investigation. Based on empirical evidence available from both fields, it is argued that self-compassion can serve as a protective factor in the lives of weight stigmatised individuals with overweight. It is further argued that a compassion focused method to alleviate the effects of weight stigma and develop the capacity for self-compassion offers an important empirical contribution to the field of weight stigma research, which has not been offered by the approaches currently available. This dissertation aimed to firstly present a review of empirical evidence across the fields of weight stigma and self-compassion. Following this, a series of studies aimed to identify and address gaps in the literature. Specifically, the research presented in this dissertation was designed to address three primary aims: 1) to investigate the role of internalised weight stigma and self-compassion in the relationship between weight stigma and outcomes of psychological distress, body shame, loneliness and life satisfaction; 2) develop a compassion-focused group intervention specifically designed to reduce the adverse effects of weight stigma; and 3) conduct a pilot study to examine the acceptability and feasibility of a compassion-focused group intervention for weight stigmatised women with overweight and obesity. This dissertation presents a compendium of three studies conducted to achieve these aims. Study 1 involved an empirical study that tested the relative contribution of both internalised weight stigma and self-compassion on weight stigma, as mediators in the relationship between weight stigma and outcomes of psychological distress, loneliness, body shame and life satisfaction. Results revealed that internalised weight stigma mediated the relationship between external weight stigma and body shame, while self-compassion mediated the relationship between external weight stigma and psychological distress, loneliness and satisfaction with life. Study 2 provided a detailed account of the development of a 2-day Compassion-Focused Therapy (CFT) intervention, designed to increase self-compassion, and reduce internalised weight stigma for women with overweight and obesity. Two case studies demonstrated improvements in the expected direction for self-compassion, internalised weight stigma, depression, body shame, loneliness, weight self-efficacy, body dissatisfaction, life satisfaction, as well as weight loss. Study 3 tested the feasibility/acceptability of the 2-day, Compassion-Focused Therapy (CFT) program for a group of weight stigmatised females with overweight and obesity in Australia. Significant group improvements were found from pre-treatment to post-treatment for self-compassion and internalised weight stigma, with gains maintained at 3-month follow-up. Significant improvements were also found for psychological distress, life satisfaction, eating self-efficacy, body dissatisfaction and loneliness at the post-treatment assessment. A non-significant trend of mean group weight loss from pre-treatment to three-month follow-up was also observed. Credibility ratings of the program were high. This compendium of research has advanced research knowledge in two main ways. Firstly, the research reported herein is the first to have demonstrated the unique roles of both self-compassion and internalised weight stigma as mechanisms through which experienced weight stigma can affect a range of adverse psychological consequences. Secondly, this dissertation has demonstrated the feasibility and acceptability of a 2-day CFT-based group program specifically designed to increase self-compassion and reduce internalised weight stigma for women with overweight and obesity. The current program has merged two important fields of self-compassion and weight stigma research, thus providing evidence for self-compassion as a promising strategy through which to assist individuals to better cope with the painful effects of weight stigma.

Cross-sectional research has demonstrated that internalized weight stigma (IWS) is associated with less engagement in weight management behaviors, including physical activity. However, limited research has explored longitudinal relationships among IWS, physical activity, and weight loss. This study examined longitudinal associations of changes in IWS, physical activity, and weight and tested whether physical activity mediated the relationship between IWS and weight change. Individuals with obesity and high IWS (N=105) participated in a 72-week behavioral weight loss intervention, with or without a weight stigma intervention. Measures of IWS (Weight Self-Stigma Questionnaire), physical activity (accelerometry and self-report), and weight were collected at baseline and weeks 20, 46 and 72. Correlations examined relationships among changes in variables from baseline to all timepoints, controlling for treatment condition. Mediation, controlling for treatment condition, tested whether IWS reductions during the first 20weeks predicted greater weight loss at weeks 46 and 72 via increased physical activity between weeks 20 and 46 or 72. Decreases in IWS at week 20 were associated with greater week-20 weight loss (r=0.265, p=0.012). Physical activity was not a significant mediator, but greater reductions in IWS at week 20 predicted greater week-46 weight loss with or without controlling for physical activity (WSSQ: b=0.30, confidence interval: 0.12, 0.54). Significant associations were not found at week 72. Initial reductions in IWS were associated with greater week-46 weight loss. Further research should investigate whether reducing IWS early in obesity treatment enhances long-term outcomes. ClinicalTrials.gov (NCT03704064).

Both body dissatisfaction and internalized weight stigma have been identified as risk factors for many negative health outcomes for women, including depression and eating disorders. In addition to these contributions, these concepts have been found to overlap to various degrees in existing literature. We conducted a systematic review and meta-analysis on articles published prior to February 2022 to demonstrate the conceptual and measurement overlap between body dissatisfaction and internalized weight stigma as currently quantified. We identified 48 studies examining the interrelation between body dissatisfaction and internalized weight stigma in predominantly female samples. Stronger correlations between these two constructs, some bordering on multicollinearity, were prevalent in community samples compared to clinical samples and with some but not all the commonly used measures in the body image and weight stigma fields. Body mass index (BMI) moderated these relations such that individuals with higher self-reported BMI were more likely to report lower correlations between the constructs. This concept proliferation, stronger for individuals with lower BMIs and community samples, necessitates the need change how we conceptualize and measure body dissatisfaction and internalized weight stigma. To this end, we conducted study two to refine existing measures and lessen the degree of measurement overlap between internalized weight stigma and body dissatisfaction, particularly in community samples of women. We aimed to clarify the boundaries between these two concepts, ensuring measurement error is better accounted for. Female university students completed existing measures of body satisfaction and internalized weight stigma, which were analyzed using an exploratory followed by a confirmatory factor analysis. In our attempts to modify two existing measures of internalized weight stigma and body dissatisfaction, the majority of the internalized weight stigma items were retained. In contrast, most of the body dissatisfaction items either cross-loaded onto both factors or loaded on to the internalized weight stigma factor despite being intended for the body dissatisfaction factor, suggesting that the measurement issues identified in recent prior research may be due not only to the way we conceptualize and quantify weight stigma, but also the ways in which we quantify body dissatisfaction, across the existing corpus of body dissatisfaction scales.

ObjectivesWeight‐based stigma is often experienced by individuals who are overweight and obese, and is associated with a range of deleterious physical and mental health outcomes. Research is lacking on the mechanisms through which these relationships occur. This paper examines two potential mechanisms: internalised weight stigma and self‐compassion.MethodA sample of 147 overweight and obese Australian females aged between 18 and 45-years completed a series of self‐report questionnaires measuring: experienced weight stigma, internalised weight stigma, self‐compassion, psychological distress, body shame, loneliness, and life satisfaction.ResultsInternalised weight stigma mediated the relationship between experienced weight stigma and body shame such that greater experienced weight stigma led to greater internalised weight stigma, which in turn led to greater body shame. Additionally, self‐compassion mediated the relationship between experienced weight stigma and several psychosocial factors such that greater experienced weight stigma led to lower self‐compassion, which led to greater psychological distress, higher perceived loneliness, and lower satisfaction with life.ConclusionsFindings support previous research indicating that internalised weight stigma plays a mediating role in the relationship between experienced weight stigma and adverse outcomes. This study extends upon prior research by investigating previously unexamined outcome variables and exploring the simultaneous mediating role of self‐compassion. The findings suggest that both internalised weight stigma and self‐compassion each play a different but important role in the way in which weight stigma impacts on overweight and obese women. Results from this study have implications in terms of psychological intervention for overweight and obese individuals in clinical practice.

Physical activity (PA) is one of the most influential and adaptable modifiable behaviors with the potential to reduce chronic disease risk for people of all sizes and ages. Only 24% of U.S. adults currently meet the PA Guidelines for Americans, indicating a critical need for improvement. Experienced (EWS) and internalized weight stigma (IWS) are two factors shown to impact PA behavior. However, a lack of research exists exploring weight stigma within common PA venues such as fitness centers, and how that may be associated with PA behavior among adults. PURPOSE: To explore the general prevalence of EWS and IWS prevalence of EWS within fitness spaces, and the overall association between EWS, IWS, and EWS in fitness spaces with adult PA behavior. METHODS: Quantitative, cross-sectional data from a mixed-methods study were analyzed. Adults (n=217; age=28.1 years; 78% female; 42% overweight; 24.9% BIPOC) reported on sociodemographics, EWS, IWS, EWS in fitness spaces, and PA behavior. Descriptive statistics were used to determine prevalence rates, and correlation analyses and regression models to identify associations between weight stigma variables and PA. RESULTS: On average, participants engaged in 6.0±3.18 hours per week of moderate to vigorous PA (MVPA). Mean levels of EWS, IWS, and EWS in fitness spaces were considered low/mid-level at 4.8±8.58 on a scale from 0-90, 33.0±11.22 on a scale from 11-77, and 7.0±3.32 on a scale from 4-28, respectively. EWS, IWS, and EWS in fitness spaces were not significantly correlated with MVPA levels; however, EWS and IWS were both correlated with EWS in fitness spaces and with each other (p<0.001). After weight stigma variables were split into high vs. low/mid-levels, no significant difference in MVPA was present between high and low/mid-levels of EWS and IWS. However, a significant difference in MVPA levels was found between high (4.9±3.10 hours) and low/mid (6.2±3.12 hours) levels of EWS in fitness spaces (p=0.03). CONCLUSIONS: The current findings suggest a need for interventions to eliminate EWS in contexts such as fitness spaces, where individuals are participating in activities to improve their health. While adults exhibit resiliency by engaging in PA despite high levels of EWS in fitness spaces, there is still potential for reducing barriers to PA within these spaces.

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

Prior research has demonstrated that individuals with a higher body weight (i.e., obesity) have a relatively high incidence of adverse childhood experiences (ACEs) (e.g., abuse, neglect). Individuals with obesity are also susceptible to experiencing and internalizing weight stigma. Negative physical and mental health consequences have been associated with both ACEs and weight stigma, yet the interplay between these factors has not been explored. The current study examined ACEs in a sample of 105 treatment-seeking adults with obesity who all reported having experienced and internalized weight stigma (90.5% women, 70.5% non-Hispanic White, mean age=49.1 years). The study aimed to 1) provide a descriptive overview of rates of ACEs in this unique sample of adults with potentially high psychological vulnerability and 2) assess associations between ACEs, weight stigma, and psychological well-being. Over three-fourths of participants (76.2%) reported experiencing at least one ACE. The total number of ACEs was significantly associated with more frequent experiences of and greater distress about weight stigma during childhood, as well as higher current perceived stress. Experiencing weight stigma for the first time in childhood was also associated with more reported ACEs. ACEs of abuse were associated with more lifetime reported experiences of weight stigma and greater internalization, use of eating as a strategy to cope with weight stigma, and higher perceived stress. These findings have implications for early identification of and tailored interventions for individuals who have experienced adverse events and weight stigma at a young age.

The concept of learning experience holds its eminent place within the paradigm of constructivism in contemporary educational science. The study process is being designed and construed to foster educative experiences in accordance with the desired learning outcomes. Transformative learning theory and the concept of perspective transformation marks a specific type of learning experience – one that reconstructs the frame of reference of the learner. Such a paradigmatic shift is also considered necessary for large-scale educational reforms to succeed. Transformative learning theory itself doesn’t provide clear-cut solutions for implementation of a certain reform ideology, to the contrary – it questions the assumptions that guide one’s action in order to construct a more inclusive, better informed and functional meaning perspective which may disagree with the assumptions that are imposed institutionally. As part of teacher professional development, transformative learning practices hold a promise for emancipation of the teaching profession and the development of agency. This article theorizes the concept of learning experience from the perspective of phenomenology and the theory of transformative learning, bringing forward the concept of transformative learning experience. The aim of the research is to explore the concept of transformative learning experience as an object of study within teacher professional development.

Internalized weight stigma (IWS) is highly prevalent and associated with deleterious mental and physical health outcomes. Initiatives are needed to address IWS and promote effective coping and resilience among individuals who are exposed to weight stigma. We conducted a systematic review of psychological interventions for IWS and examined their feasibility, acceptability, and preliminary efficacy at reducing IWS and related negative physiological and psychological health outcomes. Eight databases were searched. Inclusion criteria included: (1) psychological intervention; (2) published in English; and (3) included internalized weight stigma as an outcome. Exclusion criteria included: (1) commentary or review; and (2) not a psychological intervention. A systematic narrative review framework was used to synthesize results. Of 161 articles screened, 20 were included. Included interventions demonstrated high feasibility, acceptability, and engagement overall. Sixteen of 20 included studies observed significant reductions in IWS that were maintained over follow-up periods, yet data on whether interventions produced greater reductions than control conditions were mixed. Studies observed significant improvements in numerous physical and mental health outcomes. Findings indicate that existing interventions are feasible, acceptable, and may provide meaningful improvements in IWS and associated health outcomes, highlighting the potential for psychological interventions to promote improved health and wellbeing in individuals with IWS. Additional research using rigorous study designs (e.g., randomized controlled trials) is needed to further evaluate the efficacy of interventions for IWS.

Background: Drawing upon concepts from Mezirow's transformative learning theory, this research investigated the process of perspective transformation in three purposively sampled youth sport coaches in the UK. Perspective transformation is the process by which adults revise their culturally defined frames of reference which have arisen out of their unique, personal meaning perspectives and individual meaning schemes. Give Us Back Our Game (GUBOG) is an approach to youth sport which aims at developing sporting talent while, at the same time, fulfilling the human rights and dignity of children in its various programmes. The emphasis of the GUBOG perspective is upon fun, age-appropriate game forms, child consultation, inclusivity, mutual respect and other elements.Aim: This research comes at a time when there is a call for a more sensitive and inclusive approach to youth sport and its coaching. While referring to the GUBOG perspective, we investigated the processes of critical reflection, rational discourse and action affecting a perspective transformation from a reified, outcome-oriented, winning-at-all-costs approach to the more child-centred, GUBOG approach.Method: The participants in this study consisted of three youth sport coaches who had ‘self-professed’ to dramatically altering their approach to coaching youth sport. Using in-depth, individual and semi-structured interviews for data gathering, validity was advanced by the use of purposive sampling, theoretical and analytical triangulation and member checking.Results: The data revealed that instrumental and communicative learning contributed significantly to a change in the coaches' frames of reference as they set about altering their coaching practice, the training environments and game forms towards a more child-centred focus. Substantial elements in the process of transformation were congruent with the Phases of Meaning Change identified within Transformative Learning Theory.Conclusion: Coach educators and youth sport administrators wishing to affect perspective change, which may lead to subsequent action within existing youth sport programmes, require general and specific information relating to the individual and group processes of adult change. This is where, we suggest, Transformative Learning Theory may offer insight.