The impact of weight self-stigma on weight-loss treatment engagement and outcome.

Abstract

Individuals with overweight or obesity often endure significant weight-based prejudice and discrimination in various settings. Experiencing weight-related stigma is linked to many adverse psychosocial outcomes. Weight self-stigma is when an individual internalizes and identifies with negative attributes ascribed to people with larger bodies and has self-devaluing thoughts because of their weight and is associated with poorer health outcomes. This study explored how weight self-stigma may impact weight management efforts and outcomes for adults participating in an onlight weight-loss intervention. 508 adults (86.2% female, 84.6% White) with overweight or obesity participated in an asynchronous 12-week online weight-loss intervention with computer-generated feedback. Weight and weight self-stigma were measured at baseline and 3 months later. Thirty-one point five percent of the sample reported high levels of stigma, which was associated with greater program dropout than those who did not report high stigma (32.5% vs. 21.6%). Program completers reporting high self-stigma showed better treatment engagement (77.0% vs. 69.7% lessons viewed) and weight loss (M = -6.31% vs. -5.08%); these differences were not observed when using intent-to-treat assumptions. When analyzed as a continuous variable, weight self-stigma showed no association with treatment engagement and outcome. These findings highlight the complexity of understanding how self-stigma affects treatment engagement and outcome in behavioral weight loss and the need for more targeted research in this understudied area. Results suggest that weight self-stigma plays a role in weight management during an online weight-loss intervention, affecting engagement and outcomes.