Book Description

Internalization of weight bias occurs when one believes negative weight-related stereotypes to be true of themselves, such as believing that one is deserving of disrespect, or unworthy of partnership due to weight status (Durso & Latner, 2008). The deleterious consequences of IWB are widespread, as higher levels of IWB are associated with poor body image, maladaptive eating patterns, less physical activity, psychological distress, and less improvement in healthy lifestyle interventions (Mensinger et al., 2016; Pearl & Puhl, 2018). Further, IWB has been shown to uniquely contribute to harmful outcomes, above and beyond other risk factors such as body mass index alone (BMI; Durso & Latner, 2008). Thus, IWB represents an important target for intervention. Women have been shown to endorse higher levels of IWB relative to men and may be at greater risk for harmful consequences due to additional sociocultural factors (Fredrickson & Roberts, 1997; Himmelstein et al., 2017; Moradi & Huang, 2008). For women with obesity, the shame of not living up to a pervasive societal ideal for a woman's body, culminated with the widespread impacts of weight stigma, may increase the need for protective factors in this population (Moradi & Huang, 2008; Tylka & Hill, 2004). While there is growing empirical support for the benefits of psychological approaches for reducing IWB and associated sequalae, there is still a need for interventions that are accessible, inclusive, and relevant for a range of women (Pearl & Puhl, 2018). Many of IWB intervention studies lack diversity in their participant sample (e.g., Levin et al., 2018; Lillis et al., 2009). This not only limits the generalizability of findings but neglects the importance of developing interventions that are inclusive and relevant to different lived experiences of internalized weight bias associated impacts (i.e., Himmelstein et al., 2017). Self-compassion -- relating to oneself with a sense of kindness and support, may be a viable treatment approach for this population (Forbes & Donovan, 2019; Neff, 2003a). Self-compassion has been shown to protect against risk factors for poor body image, is inversely related to IWB, and is related to better psychological well-being overall (i.e., Braun et al., 2016; Hilbert et al., 2015; Webb & Hardin, 2016). The efficacy of self-compassion interventions for improving body image and weight-related behaviors (i.e., eating behaviors) has garnered preliminary support, and self-compassion has been a component of a few successful IWB interventions (Levin et al., 2018; Rahimi-Ardabili et al., 2018; Palmeira et al., 2017a). Thus, self-compassion interventions may hold promise for reducing IWB, and enhancing health and well-being for women with obesity and IWB. Parallel to many IWB intervention samples, however, many self-compassion interventions for weight-related and body image concerns lack racial/ethnic diversity and representation in their sample (e.g., Albertson et al., 2015). Therefore, the aim of the current study is to investigate the feasibility, acceptability, and preliminary efficacy of a three-session self-compassion intervention for women with overweight/obesity and IWB, and to assess the inclusivity and relevancy of the intervention with an emphasis on feedback from women of color (WOC). A randomized, waitlist-controlled design was implemented to evaluate the impacts of the second iteration of a self-compassion intervention tailored to IWB. This was an extension of a single group, pre-post design pilot study examining the feasibility and short-term impacts of a general self-compassion intervention for women with overweight/obesity and IWB. In the current study, feasibility and acceptability were examined through recruitment, attendance, retention, and evaluation data. Repeated measures ANCOVA were employed to examine between group differences in pre-post changes in self-compassion, IWB, body shame, body surveillance, body appreciation, intuitive eating, uncontrolled and emotional eating, and affect following the intervention. Participants included 18 women (comprised of ECU faculty/staff, students, and Pitt County, NC residents) with overweight/obesity and IWB. In terms of acceptability, participants perceived the program to be moderately beneficial for improving both self-image and well-being. Regarding assessment of inclusivity and relevancy, White and Latina participants evaluated the program to be extremely inclusive and relevant, whereas an Asian American participant rated the program to be moderately inclusive and moderately to extremely relevant, and a Black participant rated the program to be neither inclusive/exclusive or relevant/irrelevant in terms of in session content and assigned home practices, and moderately inclusive and relevant for facilitator instruction and overall inclusivity and relevancy. Regarding preliminary efficacy, participants in the self-compassion intervention (n = 10) reported significantly greater pre-post increases in self-compassion, decreases in IWB, and decreases in body shame with large effect sizes compared to the waitlist control group. Additionally, paired samples t-tests revealed significant within-group decreases in IWB, body shame, body surveillance, emotional and uncontrolled eating, negative affect, and increases in physical activity with medium to large effect sizes in the self-compassion condition following the intervention, whereas there were no within-group changes in the waitlist-controlled group. Additionally, many of the pre-post changes were maintained one month following the intervention for the self-compassion intervention participants. Overall, preliminary findings from the current pilot study suggest that brief self-compassion training tailored to IWB is feasible, acceptable, and may be beneficial for reducing IWB and associated sequalae in this population of women. Further, from this small sample, the intervention was less inclusive and relevant for Black and Asian American participants relative to White and Latina participants0́4and therefore suggests a need for enhancing these aspects of the intervention in subsequent iterations. Ultimately, development of culturally inclusive self-compassion interventions for women with obesity/IWB is a valuable avenue to for continued research to support the health and well-being of a range of women negatively affected by IWB.