Group cognitive-behavioral treatment for internalized weight stigma: a pilot study

  • Rebecca L. PearlEmail author
  • Christina H. Hopkins
  • Robert I. Berkowitz
  • Thomas A. Wadden
Original Article



This study tested a novel group-based, cognitive-behavioral intervention designed to reduce internalized weight stigma among individuals with obesity.


A total of eight men and women with obesity who had experienced weight stigma and reported high levels of internalized weight stigma attended the Weight Bias Internalization and Stigma (BIAS) Program. The program provided eight weekly sessions of cognitive-behavioral treatment to cope with weight stigma. Participants completed questionnaires pre- and post-intervention, including the Weight Bias Internalization Scale (WBIS), Fat Phobia Scale, Weight Efficacy Life-Style Questionnaire (WEL), and Beck Depression Inventory-II (BDI-II). Six additional participants were included in a quasi-control group that received no intervention until after completing all study measures.


Participants in the Weight BIAS Program reported significantly greater decreases in WBIS and Fat Phobia scores, and greater increases in WEL scores than participants in the quasi-control group (ps < .04). Changes in BDI-II scores did not differ between groups. Treatment-acceptability ratings were high among participants who received the intervention.


Including cognitive-behavioral strategies to address weight stigma in weight management programs could potentially reduce internalized weight stigma and enhance treatment outcomes.


Cognitive-behavioral Internalized weight stigma Obesity Self-efficacy 


Compliance with ethical standards


None to report.

Conflict of interest

TAW discloses serving on advisory boards for Novo Nordisk, Nutrisystem, and Weight Watchers, as well as receiving grant support, on behalf of the University of Pennsylvania, from Eisai Pharmaceutical Co. None of the other authors declares any conflicts.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

40519_2016_336_MOESM1_ESM.docx (65 kb)
Supplementary material 1 (DOCX 64 kb)


  1. 1.
    Puhl R, Suh Y (2015) Health consequences of weight stigma: implications for obesity prevention and treatment. Curr Obes Rep 4:182–190. doi: 10.1007/s13679-015-0153-z CrossRefPubMedGoogle Scholar
  2. 2.
    Sutin AR, Stephan Y, Terracciano A (2015) Weight discrimination and mortality. Psychol Sci 26(11):1803–1811. doi: 10.1177/0956797615601103 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Durso LE, Latner JD (2008) Understanding self-directed stigma: Development of the Weight Bias Internalization Scale. Obesity 16(S2):S80–S86. doi: 10.1038/oby.2008.448 CrossRefPubMedGoogle Scholar
  4. 4.
    Papadopoulos S, Brennan L (2015) Correlates of weight stigma in adults with overweight and obesity: a systematic literature review. Obesity 23:1743–1760. doi: 10.1002/oby.21187 CrossRefPubMedGoogle Scholar
  5. 5.
    O’Brien KS, Latner JD, Puhl RM, Vartanian LR, Giles C, Griva K, Carter A (2016) The relationship between weight stigma and eating behavior is explained by weight bias internalization and psychological distress. Appetite 102:70–76. doi: 10.1016/j.appet.2016.02.032 CrossRefPubMedGoogle Scholar
  6. 6.
    Pearl RL, Puhl RM (2016) The distinct effects of internalizing weight bias: An experimental study. Body Imag 17:38–42. doi: 10.1016/j.bodyim.2016.02.002 CrossRefGoogle Scholar
  7. 7.
    Corrigan PW, Larson JE, Rusch N (2009) Self-stigma and the “why try” effect: impact on life goals and evidence-based practices. World Psychiatry 8(2):75–81. doi: 10.1002/j.2051-5545.2009.tb00218.x CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hubner C, Baldofski S, Zenger M, Tigges W, Herbig B, Jurowich C, Kaiser S, Dietrich A, Hilbert A (2015) Influences of general self-efficacy and weight bias internalization on physical activity in bariatric surgery candidates. Surg Obes Relat Dis 11(6):1371–1376. doi: 10.1016/j.soard.2014.11.013 CrossRefPubMedGoogle Scholar
  9. 9.
    Mensinger JL, Calogero RM, Tylka TL (2016) Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program. Appetite 102:32–43. doi: 10.1016/j.appet.2016.01.033 CrossRefPubMedGoogle Scholar
  10. 10.
    Carels RA, Burmeister JM, Koball A, Oehlhof MW, Hinman N, LeRoy M, Bannon E, Ashrafloun L, Storfer-Isser A, Darby LA, Gumble A (2014) A randomized controlled trial comparing two approaches to weight loss: differences in weight loss maintenance. J Health Psychol 19(2):296–311. doi: 10.1177/1359105312470156 CrossRefPubMedGoogle Scholar
  11. 11.
    Mittal D, Sullivan G, Chekuri L, Allee E, Corrigan PW (2012) Empirical studies of self-stigma reduction strategies: a critical review. Psychiatr Serv 63(10):974–981. doi: 10.1176/ CrossRefPubMedGoogle Scholar
  12. 12.
    Puhl RM, Heuer C, Sarda V (2011) Framing messages about weight discrimination: impact on public support for legislation. Int J Obes 35(6):863–872. doi: 10.1038/ijo.2010.194 CrossRefGoogle Scholar
  13. 13.
    Beck AT, Steer RA, Brown GK (1996) Manual for the BDI-II. Psychological Corporation, San AntonioGoogle Scholar
  14. 14.
    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381. doi: 10.1016/j.jbi.2008.08.010 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Bacon JG, Scheltema KE, Robinson BE (2001) Fat phobia scale revisited: the short form. Int J Obes 25:252–257. doi: 10.1038/sj.ijo.0801537 CrossRefGoogle Scholar
  16. 16.
    Clark MM, Abrams DB, Niaura RS, Eaton CA, Rossi JS (1991) Self-efficacy in weight management. J Consult Clin Psychol 59(5):739–744. doi: 10.1037/0022-006X.59.5.739 CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Rebecca L. Pearl
    • 1
    Email author
  • Christina H. Hopkins
    • 1
    • 2
  • Robert I. Berkowitz
    • 1
    • 3
  • Thomas A. Wadden
    • 1
  1. 1.Department of PsychiatryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of PsychologyDuke UniversityDurhamUSA
  3. 3.Department of Child and Adolescent Psychiatry and Behavioral ScienceChildren’s Hospital of PhiladelphiaPhiladelphiaUSA

Personalised recommendations