Changes in Obesity-related Attitudes in Women Seeking Weight Reduction

Authors

  • Canice E. Crerand,

    Corresponding author
    1. Department of Psychiatry, Center for Weight and Eating Disorders, The University of Pennsylvania School of Medicine, and The Edwin and Fannie Gray Hall Center for Human Appearance, Philadelphia, Pennsylvania
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  • Thomas A. Wadden,

    1. Department of Psychiatry, Center for Weight and Eating Disorders, The University of Pennsylvania School of Medicine, and The Edwin and Fannie Gray Hall Center for Human Appearance, Philadelphia, Pennsylvania
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  • Gary D. Foster,

    1. Department of Psychiatry, Center for Weight and Eating Disorders, The University of Pennsylvania School of Medicine, and The Edwin and Fannie Gray Hall Center for Human Appearance, Philadelphia, Pennsylvania
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  • David B. Sarwer,

    1. Department of Psychiatry, Center for Weight and Eating Disorders, The University of Pennsylvania School of Medicine, and The Edwin and Fannie Gray Hall Center for Human Appearance, Philadelphia, Pennsylvania
    2. Department of Surgery, Division of Plastic Surgery, The University of Pennsylvania School of Medicine, and The Edwin and Fannie Gray Hall Center for Human Appearance, Philadelphia, Pennsylvania.
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  • Lauren M. Paster,

    1. Department of Psychiatry, Center for Weight and Eating Disorders, The University of Pennsylvania School of Medicine, and The Edwin and Fannie Gray Hall Center for Human Appearance, Philadelphia, Pennsylvania
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  • Robert I. Berkowitz

    Corresponding author
    1. Department of Psychiatry, Center for Weight and Eating Disorders, The University of Pennsylvania School of Medicine, and The Edwin and Fannie Gray Hall Center for Human Appearance, Philadelphia, Pennsylvania
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The Children's Hospital of Philadelphia, Department of Psychology and Division of Plastic and Reconstructive Surgery, 34th and Civic Center Boulevard, Wood Building, First Floor, Philadelphia, PA 19104. E-mail: crerand@email.chop.edu

Abstract

Objective: To examine changes in obesity-related attitudes in a sample of obese women who participated in either dieting or non-dieting interventions.

Research Methods and Procedures: A total of 123 obese women were randomly assigned to one of three weight control programs: meal replacement diet, balanced deficit diet, or a non-dieting program. (The first two groups were combined as a single dieting condition.) Participants completed questionnaires (at baseline, Week 20, and Week 40) to assess beliefs and attitudes about obesity, along with measures of self-esteem, depression, and body image.

Results: At Weeks 20 and 40, participants in the non-dieting condition reported significantly less negativity about obesity than those in the dieting group. Women in the dieting condition did not report an increase in negative attitudes toward obesity, despite losing significantly more weight than non-dieting participants. Both groups experienced improvements in self-esteem, body image, and depressive symptoms. Improvement in self-esteem was associated with a reduction in negativity about obesity and with improvements in body image.

Discussion: The non-dieting program produced greater reductions in negative attitudes toward obesity than the dieting intervention. Dieting (with successful weight loss), however, did not result in greater negativity toward obesity. Non-dieting programs seem to be useful in obese women for improving self-esteem, body image, and internalized negative attitudes about obesity.

Introduction

Negative attitudes and beliefs about obesity are pervasive. Studies have documented the presence of bias and discriminatory behavior against obese persons in numerous domains, including employment, health care, and education (1). In contrast to members of other stigmatized groups (e.g., minority groups), who typically report more favorable opinions about other group members, obese individuals display weight-related bias. This suggests that they have internalized society's negative views of obesity (2, 3).

Little is known about the effects of weight management programs on obesity-related attitudes in persons who are themselves obese. Behavioral weight control programs typically emphasize losing weight through calorie restriction and increased physical activity, without addressing weight-related bias and discrimination. Weight loss resulting from dieting is often associated with numerous psychosocial benefits, including improvements in self-esteem, mood, and body image (4, 5, 6, 7, 8, 9).

In contrast to traditional weight loss interventions, non-dieting programs promote self-acceptance and self-esteem among obese persons in the absence of dieting (10). These programs typically encourage participants to adopt reasonable, unrestrictive eating plans and to challenge weight-related stigma and discrimination. Studies of non-dieting approaches have found improvements in attitudes toward obese persons after treatment (11, 12) and improvements in self-esteem, mood, and body image despite little to no weight loss (13, 14, 15, 16, 17).

To our knowledge, no studies have examined changes in obesity-related attitudes in relation to dieting and weight loss. Dieting has been conceptualized as a means of coping with stigmatization, because it may help to distance oneself from the stigmatized group (18). Dieting may also reduce the amount of negative attention received from others, because it shows that the individual is taking control and responsibility for his or her weight. Alternatively, dieting could increase negative attitudes about obesity, because it may reinforce the belief that weight is solely under personal control, despite the fact that multiple factors (i.e., genetics) affect body weight. An individual who works hard to lose weight may disparage other obese individuals, particularly if he or she believes that others are unconcerned about their excess weight. Thus, weight loss in successful dieters could increase negative attitudes toward obesity.

This study examined changes in obesity-related attitudes in a sample of obese women who participated in either behavioral weight control (i.e., dieting) or non-dieting interventions. We hypothesized that negative attitudes toward obesity would decrease in the non-dieting group but increase in participants in the dieting group who were expected to lose ∼10% of initial weight. These changes would result in significant differences between the two groups. We also explored the relationships between changes in obesity-related attitudes and changes in body image, mood, and self-esteem.

Research Methods and Procedures

Participants

Participants were 123 women who were part of a larger study of the relationship between dieting and binge eating. The principal finding of this study has been reported previously (19). Participants had a mean age of 44.2 ± 10.0 years, weight of 97.3 ± 13.0 kg, height of 164.3 ± 6.4 cm, and BMI of 35.9 ± 4.5 kg/m2. Nearly two thirds (64.2%; n = 79) of the sample were European American; 35% (n = 43) were African-American, and 0.8% (n = 1) were Hispanic American. Participants were recruited from newspaper advertisements that described a program of diet and exercise. Women were eligible to participate if they 1) had a BMI of 30 to 43 kg/m2; 2) were free of significant physical and psychiatric disorders (e.g., hypertension, type 2 diabetes, major depression, binge eating disorder); 3) were not pregnant or lactating; and 4) had not lost >5 kg or used weight loss medications within the past 6 months.

Procedure

As described previously (19), participants were randomly assigned to one of three conditions: 1) a meal replacement diet (n = 41); 2) a balanced deficit diet (n = 43); or 3) a non-dieting program (n = 39). Regardless of condition, all participants attended weekly 90-minute group sessions for the first 20 weeks and biweekly meetings from Weeks 22 to 40. All groups were led by a clinical psychologist, with the exception of six sessions that were co-led by a registered dietitian. All participants were instructed to increase their physical activity to 180 min/wk over the course of the study.

The details of each intervention are described here briefly (19). Participants in the meal replacement group were instructed to consume (for the first 12 weeks) 1000 kcal/d, consisting of four servings of a liquid diet (Optifast 800; Novartis Nutrition Co., Minneapolis, MN) and an evening meal consisting of a frozen entrée, salad, and fruit. Women assigned to the balanced deficit diet group were instructed to consume a self-selected diet of 1200 to 1500 kcal/d, with 30% of kcal from fat. The meal replacement and balanced deficit diet groups were provided behavioral weight control strategies outlined in the LEARN Program for Weight Control (20). Participants learned about monitoring their eating and activity, slowing the rate of eating, obtaining social support, and preventing relapse. One session addressed self-esteem and its relation to weight, including a discussion of how society's emphasis on thinness may affect self-esteem.

In the non-dieting condition, women were specifically asked not to reduce their caloric intake in accordance with a program developed by Polivy and Herman (21). Participants were encouraged to give up dieting and to adopt a new eating plan, which included: 1) eating at least every 4 hours to avoid physical hunger; 2) eating foods that they liked without concern for specific calorie or fat gram goals (i.e., not restricting food intake); 3) choosing foods based on health rather than weight loss; and 4) refraining from weighing themselves. They also received information about the causes of obesity, the role of weight in self-esteem, and weight-related discrimination and bias. Participants were provided materials from Self-Esteem Comes in All Sizes (22), which includes strategies to improve self-esteem, body image, and quality of life, regardless of body weight.

Measures

Participants completed the following measures at baseline and at Weeks 20 and 40.

Attitudes Toward Obese Persons Scale

This scale measures negative attitudes toward obese individuals (23). Respondents indicate the extent to which they agree or disagree with 20 statements (e.g., “Obese people are as happy as non-obese people”) using a six-point Likert scale (−3 = I strongly disagree; +3 = I strongly agree). Higher scores indicate more positive attitudes toward obese persons. The measure appears to have adequate reliability and validity (23). Norms for the scale have been reported for undergraduate students (mean = 63.9 ± 16.7), graduate students (mean = 64.8 ± 14.8), and for members of the National Association to Advance Fat Acceptance (mean = 67.6 ± 18.6) (23).

Beliefs About Obese Persons Scale

This 10-item scale assesses the extent to which respondents believe that obesity is under an individual's control (e.g., “Most obese people eat more than non-obese people”) (23). Respondents indicate the extent to which they agree or disagree with each statement using a six-point Likert scale (−3 = I strongly disagree; +3 = I strongly agree). Higher scores indicate a stronger belief that obesity is not under personal control. The scale has been shown to have adequate psychometric properties (23). Norms for the measure have been reported for undergraduate students (mean = 19.4 ± 8.7), graduate students (mean = 20.8 ± 7.0), and for members of the National Association to Advance Fat Acceptance (mean = 31.7 ± 10.5) (23).

Attitude Scale

The Attitude Scale consists of 16 adjectives (e.g., lazy, energetic) designed to assess stereotypical attitudes toward overweight persons (24). Using a seven-point Likert scale (1 = not at all; 7 = extremely), respondents indicate how overweight women or men are viewed by 1) most people in the United States and 2) by the respondent personally. For the purposes of this study, participants were asked to rate attitudes toward overweight women only. Scores were calculated for the societal (U.S.) and personal view subscales. There is no overlap among the items used to generate each subscale. For each subscale, higher scores indicate more negative views of overweight women. In a sample of 47 overweight women, the mean score for personal attitudes was 4.5 ± 0.7. The mean value for U.S. attitudes was 5.0 ± 0.8 (24).

Sociocultural Attitudes Toward Appearance Questionnaire (SATAQ).1

This 14-item measure evaluates women's recognition and acceptance of society's appearance standards (25). Respondents indicate the extent to which they agree with various statements (e.g., “In our society, fat people are not regarded as attractive”) using a five-point Likert scale (1 = completely disagree; 5 = completely agree). The measure consists of two subscales: 1) internalization of sociocultural standards and 2) awareness of sociocultural standards. There is no overlap among the items used to generate each subscale. Higher scores indicate more awareness and internalization of thin ideals. This measure has been found to have good psychometric properties (25).

Beck Depression Inventory

This inventory provides a 21-item, self-report measure of symptoms of depression (26). Higher scores indicate greater symptoms of depression. Excellent psychometric properties have been reported for this instrument (26).

Rosenberg Self-esteem Scale

Self-esteem was measured using this 10-item self-report measure (27). Respondents used a four-point Likert scale (1 = strongly agree; 4 = strongly disagree) to rate items. Higher scores indicate poorer self-esteem.

Body Shape Questionnaire

This questionnaire provides a 34-item self-report measure that assesses concerns about body weight and shape (28). Respondents indicated, using a six-point Likert scale (1 = never; 6 = always), the frequency with which they experience specific concerns. Higher scores indicate greater body image dissatisfaction. The questionnaire has good psychometric properties (29).

Statistical Analyses

Means ± standard deviation and/or frequencies were computed for demographic variables and questionnaire scores. A preliminary ANOVA showed that there were no statistically significant differences among the three groups on any of the baseline measures. The previous study (19) had shown that both the meal replacement and balanced deficit diet groups lost significantly more weight than the non-dieting condition at Week 40 (the end of treatment). However, there were no significant differences between the meal replacement and balanced deficit diet groups at this time. For this study, the meal replacement and balanced deficit diet groups were combined as a single dieting group to increase the statistical power to detect differences between dieting and non-dieting participants. A series of ANOVAs was used to compare differences between the dieting and non-dieting groups on changes in the attitudinal and other measures described previously. Partial correlations were used to examine the relationship between changes in depressive symptoms, self-esteem, and body image and changes in the attitudinal measures while controlling for treatment condition. All analyses were conducted using absolute values, but the results are presented in the figures as percentage change from baseline to facilitate understanding. Changes in absolute scores are shown in parentheses in the text.

Results

Demographic Characteristics and Weight Change

Table 1 presents the demographic characteristics and baseline questionnaire scores for the dieting and non-dieting groups. There were no significant differences between groups on any of these variables. The dieting group lost significantly (p < 0.0001) more weight than the non-dieting group at both Week 20 (11.4 ± 6.0% vs. 0.2 ± 2.5%) and Week 40 (12.3 ± 8.4% vs. 1.3 ± 3.2%).

Table 1.  Baseline characteristics (mean ± standard deviation) of women in the two treatment groups
VariableDieting group (N = 84)Non-dieting group (N = 39)
  1. SATAQ, Sociocultural Attitudes Toward Appearance Questionnaire.

  2. There were no significant differences between treatment conditions for any of these variables.

Age (yrs)44.3 ± 9.943.9 ± 10.2
Weight (kg)97.8 ± 13.596.1 ± 12.1
Height (cm)164.4 ± 6.6164.5 ± 6.0
BMI (kg/m2)36.2 ± 4.535.5 ± 4.3
Attitudes Towards Obese Persons Scale62.8 ± 15.061.0 ± 16.2
Beliefs About Obese Persons Scale17.0 ± 7.417.5 ± 9.0
Attitude Scale  
 U.S.4.9 ± 0.74.8 ± 0.7
 Personal3.8 ± 0.73.9 ± 0.7
SATAQ  
 Internalization21.9 ± 5.522.9 ± 6.5
 Awareness22.8 ± 4.123.0 ± 3.3
Beck Depression Inventory7.6 ± 5.27.4 ± 5.9
Rosenberg Self-esteem Scale17.2 ± 4.318.2 ± 5.5
Body Shape Questionnaire100.5 ± 26.297.0 ± 26.5

Attitudes Toward Obese Persons Scale

Figure 1 shows that, at Week 20, the non-dieting group had a significantly (p < 0.0001) greater increase on this scale than the dieting group (9.8 ± 12.1 vs. 0.9 ± 11.7), indicating more improved attitudes toward obese persons in the non-dieting group. (The values in parentheses are absolute change scores.) This group also had significantly (p = 0.001) greater increases at Week 40 than the dieting group (11.2 ± 16.1 vs. 2.4 ± 11.8).

Figure 1.

Percentage change from baseline in scores on the Attitudes Toward Obese Persons Scale. Differences between groups were significant at both Week 20 (p < 0.0001) and Week 40 (p = 0.001).

Beliefs About Obese Persons Scale

At Week 20, the non-dieting group had a significantly (p = 0.03) greater increase on this scale than the dieting group (5.1 ± 11.3 vs. 0.9 ± 8.1), suggesting greater belief among the former group that obesity is not completely under personal control (Figure 2). Comparable differences were observed between groups at Week 40 (4.9 ± 10.4 vs. 0.6 ± 8.3, p = 0.03).

Figure 2.

Percentage change from baseline in scores on the Beliefs About Obese People Scale. Differences between groups were significant at Weeks 20 and 40 (p = 0.03).

Attitude Scale

Figures 3 and 4 show the percentage change on the Attitude Scale (U.S. and Personal subscales). At Week 20, the non-dieting group had a significantly (p = 0.003) greater increase on the Attitude-U.S. subscale than the dieting group (0.2 ± 0.7 vs. −0.2 ± 0.6), showing an increased belief that obese women are viewed more negatively by people in the United States. This difference between groups was not observed at Week 40. At neither time were there significant differences between groups on the Personal subscale scores. However, collapsing across groups, mean values on the Personal subscale fell significantly (p < 0.0001) from baseline to Week 20 and remained significantly below baseline at Week 40 (p < 0.0001). These findings suggest that both groups reported less negative personal views of overweight women over time.

Figure 3.

Percentage change from baseline in scores on the Attitudes-U.S. Scale. At Week 20, differences between groups were significant (p = 0.003).

Sociocultural Attitudes Toward Appearance Questionnaire

There were no significant differences between groups in changes on the SATAQ-Internalization subscale at Weeks 20 and 40 (Figure 5). However, collapsing across groups, mean scores on the Internalization subscale fell significantly (p = 0.003) at Week 20 and remained significantly (p < 0.0001) below baseline at Week 40. This suggests that both groups reported less internalization of society's appearance standards over time. Similarly, there were no significant differences between groups in changes on the SATAQ-Awareness subscale at Weeks 20 and 40 (Figure 6). Collapsing across groups, mean scores on the Awareness subscale declined significantly (p = 0.01) at Week 20 and at Week 40 (p = 0.03). This finding suggests that both groups reported less awareness of societal emphasis on appearance over time.

Figure 5.

Percentage change from baseline in scores on the SATAQ–Internalization Subscale.

Figure 6.

Percentage change from baseline in scores on the SATAQ–Awareness Subscale.

Depression, Self-esteem, and Body Image

Table 2 shows the changes at Weeks 20 and 40 in depression, self-esteem, and body image. At Week 20, the dieting group had significantly (p = 0.001) greater reductions in symptoms of depression than the non-dieting group (−4.8 ± 4.9 vs. −1.1 ± 6.1). The significant (p = 0.001) difference between groups remained at Week 40 (−4.3 ± 4.7 vs. −0.3 ± 6.1). There were no significant differences between groups, at Weeks 20 or 40, on changes in body image or self-esteem. However, collapsing across groups, significant (p < 0.0001) improvements were observed on both measures at both times.

Table 2.  Percentage change from baseline in scores on the Beck Depression Inventory, Rosenberg Self-esteem Scale, and Body Shape Questionnaire
 Week 20Week 40
  • *

    Difference between groups was significant at p < 0.001.

VariableDieting groupNon-dieting groupDieting groupNon-dieting group
Beck Depression Inventory−63.2%−14.9%*−56.6%−4.1%*
Rosenberg Self-esteem Scale−9.3%−6.0%−11.0%−11.5%
Body Shape Questionnaire−18.4%−15.9%−22.0%−26.2%

Correlations with Attitude Measures

At Weeks 20 and 40, improved self-esteem was significantly correlated with: improvements in attitudes toward obese persons (r = 0.27, p = 0.009 and r = 0.30, p = 0.003, for the two times, respectively); improvements in beliefs about the controllability of obesity (r = 0.27, p = 0.01 and r = 0.26, p = 0.02, respectively); and improvements in body image (r = 0.23, p = 0.03 and r = 0.36, p = 0.0001, respectively). At Week 20, improved self-esteem was associated with less internalization of societal appearance ideals, as measured by the SATAQ (r = 0.21, p = 0.05). At Week 40, improvements in body image were significantly correlated with less internalization of society's appearance ideals (r = 0.35, p = 0.001). Also at Week 40, improvements in depressive symptoms were associated with increased belief that obese women are viewed more negatively by people in the United States (r = 0.41, p = 0.003).

Discussion

Participants in the non-dieting group experienced significantly greater improvements in their attitudes toward obese persons than did women in the dieting group, as well as greater reductions in the belief that body weight is under personal control. These findings are consistent with those of Robinson and Bacon (12), who found reductions in anti-fat attitudes in obese women who participated in a non-dieting program. Members of our non-dieting group also reported greater societal perception of negative attitudes toward obese women than did participants in the dieting group. This finding was probably attributable to the discussion, during the first 20 weeks of treatment, of weight-related bias and prejudice in the non-dieting condition. Scores returned toward pretreatment levels at Week 40 when this topic was not as salient in group discussion.

Contrary to expectations, participants in the dieting group did not report increased negativity toward obese persons, despite losing significant amounts of weight. Their lower scores on the Attitudes Toward Obese Persons Scale at Weeks 20 and 40 suggest modest improvements in attitudes. Weight loss also did not seem to reinforce the belief in the dieting group that obesity is solely under personal control, as suggested by reductions on the Beliefs About Obese Persons Scale. On the Attitude Scale, there were small reductions in the dieting group's appraisal of how negatively women with obesity are viewed by most people in the United States and by themselves personally. These results suggested that dieting and weight loss do not increase negative attitudes about obesity or obese persons in successful dieters. These findings may reflect an improved understanding of the causes of obesity, given that the dieting interventions included information about the multiple factors that contribute to obesity (e.g., family history, environmental factors). Furthermore, although participants in the dieting group lost a “significant” amount of weight, many would still be classified as overweight or obese at Week 40. Thus, it is possible that the dieting participants still identified themselves as being obese. It would be interesting to study changes in attitudes toward obesity in a sample of obese persons who lost enough weight to fall into the normal BMI range.

Improvements in self-esteem were associated with decreased negativity toward obese persons, decreased belief that obesity is solely under personal control, and less internalization of societal appearance standards. Improvements in body image were not associated with any changes on the bias measures. However, improvements in body image were significantly associated with less internalization of appearance standards. This finding is consistent with the work of Matz et al. (30), who found that body image dissatisfaction in women with obesity was associated with greater internalization of appearance standards.

Reductions in depressive symptoms were not associated with decreased weight-related bias as measured by the Attitude Toward Obese Persons Scale or the Beliefs About Obese Persons Scale. Improvement in depressive symptoms was associated with increased perception that women with obesity are viewed negatively by people in the United States. However, the fact that the mean Beck Depression Inventory scores for our sample fell in the non-clinical range at all assessment periods potentially limits the clinical significance of this finding.

The dieting and non-dieting groups did not differ with respect to changes in awareness or internalization of societal appearance standards. However, both groups reported less awareness and internalization of appearance standards at both assessments. The greatest reduction in internalization occurred in the non-dieting group.

Consistent with previous studies, both of our treatment groups experienced improvements in self-esteem, body image, and depressive symptoms (4, 5, 6, 7, 8, 9, 12, 15, 16, 17). Of note, the dieting group reported a significantly greater reduction in depressive symptoms than the non-dieting group. However, women with major depression were excluded from participation, and the Beck Depression Inventory scores for both groups fell within the normal range at baseline. This potentially limits the clinical significance of the differences between groups.

Participants in both treatment groups experienced comparable improvements in body image. This finding provides additional evidence that body image can be improved with or without weight loss. Additional studies are needed to determine how to combine approaches (e.g., altering body image by changing physical appearance or through use of psychological interventions) to maximize improvements in body image and health in obese individuals (31). Future studies may also identify physical and psychological characteristics that could be used to match individuals to specific weight management interventions.

Although participants in both treatment conditions reported improvements in self-esteem and mood, such changes likely occurred for different reasons. As noted by Crocker et al. (32), low self-esteem and negative affect may persist among stigmatized groups, particularly among obese persons, because negative social outcomes (e.g., rejection) are typically attributed to personal inadequacy (e.g., overweight) as opposed to prejudice or discrimination. Thus, the improvements in self-esteem and mood in non-dieting participants may have resulted from a shift in attributions. Feelings of personal failure and self-blame for obesity may have declined as awareness of societal bias increased. Our finding that changes in self-esteem were significantly correlated with improvements on measures of obesity-related attitudes supports this relationship. In the dieting group, improvements in self-esteem and mood were most likely related to weight loss. However, we did not objectively assess participants’ attributions for these improvements.

Our study has several limitations. First, this study would have benefited from the inclusion of no-treatment control group to rule out the possibility that changes (or lack of changes) on some measures were attributable simply to repeated administration of the questionnaires. Second, we used explicit self-report measures to assess obesity-related attitudes. Social desirability may have prohibited participants from disclosing the true extent of their negativity toward obese individuals. Future studies should include implicit measures of negative attitudes about obesity (e.g., Implicit Association Test) (33), because they assess negative attitudes without revealing the purpose of the assessment. Third, the generalizability of our findings is limited to obese women with generally good physical and mental health who presented for treatment in a research study. Studies are needed of obesity-related attitudes in obese women and men who seek other weight loss treatments (e.g., bariatric surgery, pharmacotherapy), as well as in persons who elect not to lose weight. Fourth, our study did not assess changes in attitudes beyond 40 weeks of treatment, after which participants were likely to experience weight regain. Weight regain may increase beliefs that obesity is not solely under personal control and may increase empathy for others who struggle to control their weight. Alternatively, weight regain may be interpreted as a personal failure by some individuals. Such a belief could lead to frustration and shame, as well as negative attitudes about oneself and others who are also obese. Future studies should address changes in obesity-related attitudes as dieters regain weight.

Studies also are needed to determine how changes in beliefs about the causes of obesity influence treatment-seeking behaviors. For example, will individuals who come to believe that obesity is not under their control opt not to pursue treatment? In addition, we did not assess the frequency or types of bias or weight-related discrimination that women in either group may have experienced in their lives. Future studies should consider how actual experiences of discrimination influence attitudes toward obesity among persons who seek weight reduction.

Our findings indicate that non-dieting programs reduce negative attitudes about obesity in women who seek treatment. Behavioral weight control interventions also seem to induce small reductions in negative attitudes. More importantly, dieting did not increase negativity toward persons with obesity in this sample. Given the difficulties associated with long-term weight maintenance, interventions that address the psychosocial consequences of obesity may help reduce the stigmatization and distress experienced by obese individuals. Additional studies are needed to determine how to combine elements of dieting and non-dieting approaches to achieve both physical and psychosocial well-being in obese individuals.

Acknowledgments

Completion of this study was supported by Grants DK-50058, K24-DK065018, and DK-60023 from the National Institute of Diabetes, Digestive, and Kidney Disease.

Footnotes

  • 1

    Nonstandard abbreviation: SATAQ, Sociocultural Attitudes Toward Appearance Questionnaire.

  • The costs of publication of this article were defrayed, in part, by the payment of page charges. This article must, therefore, be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

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