Internalized weight stigma mediates and moderates physical activity outcomes during a healthy living program for women with high body mass index |
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| Institution: | 1. Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, USA;2. Drexel University, College of Nursing and Health Professions, 1601 Cherry Street, 3 Parkway Building, 9th floor, MS 9503, Philadelphia, PA 19102, USA;3. University of Birmingham, School of Psychology, Birmingham, B15 2TT, UK;1. Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Suite 3022, Philadelphia, PA 19104, United States;2. Department of Human Development & Family Studies, Rudd Center for Food Policy & Obesity, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT 06103, United States;1. Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany;2. Department for Medical Psychology and Medical Sociology, Leipzig University Medical Center, Leipzig, Germany;3. Department of General Surgery, Asklepios Clinic, Hamburg, Germany;4. Schön Klinik Hamburg Eilbek Bariatric Clinic, Hamburg, Germany;5. Department of General Surgery, University Hospital Würzburg, Würzburg, Germany;6. Department of Visceral, Pediatric, and Vascular Surgery, Hospital Konstanz, Konstanz, Germany;1. Monash University, Australia;2. University of Hawaii, Manoa, USA;3. University of Connecticut, USA;4. University of New South Wales, Australia;5. National University of Singapore, Singapore |
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| Abstract: | ObjectivesTo investigate the influence of internalized weight stigma (IWS) on physical activity (PA) outcomes among women with body mass index (BMI) over 30 kg/m2.Design and methodData were drawn from an RCT that included 80 primarily inactive women (94% non-Hispanic/Latina white; mean age = 39.6, SD = 4.1, range = 30.0 to 45.0; mean BMI = 38.0 kg/m2, SD = 3.9, range = 30.2–44.8 kg/m2. Participants completed a 6 month weight-neutral, health-at-every-size or weight-loss-focused group-based healthy living program. PA enjoyment and engagement in moderate-intensity PA (MI-PA) (at least 30 minutes most days of the week) were assessed at baseline and immediately post-intervention. We used intention-to-treat linear mixed-effects modeling to test IWS as a moderator of changes in MI-PA engagement. We also tested a model whereby the positive effects of participating in the program on engagement in MI-PA would be serially mediated by a reduction in IWS and a concomitant increase in MI-PA enjoyment.ResultsThe weight-neutral and weight-loss-focused data were combined for all analyses. The moderation hypothesis was supported with a significant interaction between IWS and time. Participants had significant gains overall in MI-PA engagement from baseline to post-intervention; however, those with high IWS had an attenuated response. The serial mediation model was also supported. The positive effect of the program on engagement in MI-PA occurred through decreased IWS and increased MI-PA enjoyment.ConclusionsSelf-directed stigma and holding negative attitudes about one's weight interferes with positive changes in PA outcomes. Healthy living programs may be less effective for those most vulnerable unless we aim to reduce IWS. |
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| Keywords: | Weight bias internalization Exercise enjoyment Weight self-stigma Obesity Serial mediation Exercise motivation |
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