Weight Stigma and DT in People with Overweight/Obesity - V0.1

  • Research type

    Research Study

  • Full title

    A Two-Part Study Exploring How the Relationship Between Weight Self-Stigma and Dichotomous Thinking (DT) Impacts the Health Outcomes of People with Overweight or Obesity.

  • IRAS ID

    318064

  • Contact name

    Veronika Nagy

  • Contact email

    v.nagy@surrey.ac.uk

  • Sponsor organisation

    RIGO

  • Clinicaltrials.gov Identifier

    N/A, N/A

  • Duration of Study in the UK

    1 years, 11 months, 28 days

  • Research summary

    Weight stigma is highly pervasive in Western societies, with 40% of adults reporting unkind treatment due to their size (Himmelstein, Puhl, & Quinn, 2017). Some individuals may internalise these difficult experiences through a process called self-stigmatisation. It has been shown that weight self-stigmatisation has a profound impact on the health outcomes of people who are overweight and obese (Palmeira, Pinto-Gouveia, & Cunha, 2016). However, the specific mechanisms by which this occurs is poorly understood (Puhl, Himmelstein, & Pearl, 2020). The current studies will contribute to this academic discourse.

    Study A will use a quantitative approach to examine whether dichotomous thinking mediates the relationship between weight self-stigma and the health outcomes of adults who are overweight or obese. Dichotomous thinking refers to an individual’s tendency to see the world as polarised opposites rather than as a continuum. Participants will be asked to complete four validated questionnaires at a single time-point. Following this, a mediation analysis will be conducted.

    Study B aims to understand how weight self-stigma impacts the thinking styles and health outcomes of adults who are overweight and obese using a qualitative methodology named photovoice (Wang, Yi, Tao, & Carovano, 1998). Participants will be asked to complete a photography task where they capture situations which they felt were stigmatising over a two week period; they will then be invited to discuss their pictures in a 60-minute interview. The data will be analysed using Interpretative Phenomenological Analysis. Research has found this approach to be empowering for marginalised communities (Catalani & Minker, 2010), and members of our service user advisory panel support its use.

    A Specialist Weight Management Service at Ashford and St. Peter’s Hospital will act as a participant identification centre for these projects. Furthermore, we will use social media and third sector organisations to enhance recruitment.

    Lay summary of study results:

    Individuals who devalue themselves due to their body size are said to hold internalised weight stigma (IWS). IWS has received increased research attention in recent years, with studies highlighting its links to a multitude of adverse physical and mental health outcomes (Pearl & Puhl, 2018). Despite such advances, the specific mechanisms by which IWS affects health are under-researched. Moreover, there is a lack of consensus around the conceptualisation of IWS (Romano et al., 2022), and there is a need for further research within this field. Part A of this portfolio consists of an empirical study designed to examine whether dichotomous thinking – a cognitive distortion whereby an individual processes the world through binary categories - mediates the relationship between IWS and mental health outcomes in adults who are overweight or obese. Participants were asked to complete four validated questionnaires on an online platform at a single time-point. Mediation analysis indicated that dichotomous thinking fully mediates the relationship between IWS and anxiety, and partially mediates the relationship between IWS and both depression and impairment in functioning. Part B consists of a second empirical paper which aimed to understand the psychological process through which IWS becomes internalised amongst those who are overweight or obese using a combination of two qualitative research approaches: Interpretative Phenomenological Analysis (IPA; Smith, Flowers, & Larkin, 2021), and Photovoice (Wang, Yi, Tao, & Carovano, 1998). Participants were asked to complete a photography task where they captured situations in which they experienced weight stigma over a two-week period; they were then invited to discuss their pictures in a 60-minute interview. Analysis of interview data using IPA identified four processes as contributors of IWS: the self-application of stigmatised narratives, ascribing to an undesired fat identity, experiencing a socially focused anxiety response, and psychological distress managed through unhelpful coping behaviours

  • REC name

    South Central - Hampshire A Research Ethics Committee

  • REC reference

    22/SC/0375

  • Date of REC Opinion

    21 Nov 2022

  • REC opinion

    Further Information Favourable Opinion