Exploring the addition of self-compassion skills training to a behavioral weight loss program delivered using video conferencing software

Brief Self-Compassion Intervention for Women of Higher Weight and Internalized Weight Bias: A Randomized Pilot Study

BACKGROUND

Internalized weight bias (IWB) negatively impacts mental and physical health, and disproportionately affects women of higher weight. Although self-compassion training may be advantageous for reducing IWB and associated sequalae, further examination of its clinical significance and cultural acceptability is warranted.

METHOD

A randomized pilot study was conducted to evaluate the feasibility, including cultural acceptability, and clinical significance of a 3-session self-compassion intervention (SCI) for women with IWB. Women with BMIs of > 25 and IWB (N = 34) were randomly assigned to the SCI or a waitlist control group. Participants completed pre, post, and 1-month follow-up surveys on IWB, self-compassion, body image, eating behaviors, physical activity, and affect. Analyses of covariance were employed and percentages of change were calculated to examine post-intervention between-group differences in outcomes. Cultural acceptability was evaluated through participants' ratings of the perceived inclusivity and relevancy of the SCI.

RESULTS

There were 59% (n = 10) and 47% (n = 8) completion rates in the SCI and waitlist control groups, respectively. Compared to the waitlist control group, SCI participants reported greater pre-post improvements in self-compassion, IWB, body shame and surveillance, uncontrolled eating, and physical activity with medium to large effect sizes, and emotional eating with small effects. The SCI was perceived to be beneficial overall, and cultural acceptability ratings were mostly favorable despite individual differences.

CONCLUSION

This brief SCI may be beneficial for women impacted by weight stigma and IWB. Attention to increased diversity and cultural acceptability is warranted in future trials.

Internalized weight stigma in women with class III obesity: A randomized controlled trial of a virtual lifestyle modification intervention followed by a mindful self-compassion intervention

Background

Internalized weight stigma (Internalized-WS) is prevalent among individuals with severe obesity, particularly women, and is associated with shame, disordered eating, and weight gain. Effective, accessible interventions that address both severe (Class-III) obesity and Internalized-WS are needed. This randomized pilot trial evaluated the feasibility, acceptability, and preliminary efficacy of a fully-remote lifestyle modification intervention (LM) followed by mindful self-compassion training (MSC) or control.

Methods

Twenty-eight women with Class-III obesity (46.6 ± 3.7 kg/m2) and elevated Internalized-WS were randomized to a virtually-delivered 4-month LM followed by a 2-month MSC or cooking/dietary education (CON). Psychosocial measures/weight were assessed at baseline, 4-(post-LM), 6-(post-MSC/CON), and 9-month (follow-up).

Results

Improvements in Internalized-WS, shame, and self-compassion were observed with LM. Mean 4-month weight loss was 6.3 ± 3.7%. MSC had lower attendance and usefulness ratings versus CON. Post-MSC/CON, MSC yielded significant and/or meaningful improvements in Internalized-WS, self-compassion, and intuitive eating relative to CON. Weight loss did not differ by group at 6-month, and at 9-month trended lower in MSC versus CON.

Conclusion

Virtual LM is feasible, acceptable, and leads to significant weight loss among women with severe obesity; MSC led to further improved Internalized-WS, self-compassion, and intuitive eating. Continued work is needed to elucidate effects of self-compassion training on Internalized-WS, its mechanisms, and linkages to cardiometabolic health and long-term weight loss.