Designing Ruby: a brief digital randomized controlled trial for internalized weight bias (Preprint)

UNSTRUCTURED Weight bias internalization – also known as weight self-stigma - is a serious health concern for individuals at higher body weights. Weight bias internalization is associated with more avoidance of healthcare and health-promoting activities, more disordered eating, more social isolation, and weight gain. Elevated weight bias internalization has been associated with low self-compassion, yet few investigations have explored self-compassion as a potential mechanism in reduction of internalized weight bias. Ruby is a two-arm randomized controlled trial designed to test the efficacy of a 4-week digital self-compassion intervention to reduce internalized weight bias, compared to wait list control. Adults with elevated internalized weight bias and a body mass index over 30 kg/m2 (n=80) will be recruited. Ruby is a standalone digital trial and will be delivered entirely via smartphone using web-based data collection and text messages. Intervention content will include psychoeducation and daily mindfulness practices with a focus on self-compassion and body concerns. We will use intent-to-treat analyses to examine changes in weight bias internalization over time by treatment arm using one-way analysis of covariance (ANCOVA) models and linear mixed models. The present protocol was designed in May 2020 and approved in December 2020. Data collection is currently underway. Ruby will be the first digital standalone self-compassion based intervention designed to reduce internalized weight bias. Due to its standalone digital delivery, Ruby may be a highly-scalable treatment for internalized weight bias that can be delivered on its own or combined with other treatments. We expect Ruby to be accessible to many, as participants can access the digital intervention at times of the day most convenient in their schedule and are not burdened by in-person time commitments, which can be a barrier for participants with competing demands on their time and resources. If efficacious, Ruby will be poised to expand a burgeoning body of literature related to psychological intervention in this area of need.

The roles of experienced and internalized weight stigma in healthcare experiences: Perspectives of adults engaged in weight management across six countries

Background/Objectives Considerable evidence from U.S. studies suggests that weight stigma is consequential for patient-provider interactions and healthcare for people with high body weight. Despite international calls for efforts to reduce weight stigma in the medical community, cross-country research is lacking in this field. This study provides the first multinational investigation of associations between weight stigma and healthcare experiences across six Western countries. Methods Participants were 13,996 adults residing in Australia, Canada, France, Germany, the UK, and the US who were actively enrolled in an internationally available behavioral weight management program. Participants completed identical online surveys in the dominant language for their country that assessed experienced weight stigma, internalized weight bias, and healthcare behaviors and experiences including perceived quality of care, avoidance or delay of seeking care, experiences with providers, and perceived weight stigma from doctors. Results Among participants who reported a history of weight stigma (56–61%), two-thirds of participants in each country reported experiencing weight stigma from doctors. Across all six countries, after accounting for demographics, BMI, and experienced stigma, participants with higher internalized weight bias reported greater healthcare avoidance, increased perceived judgment from doctors due to body weight, lower frequency of obtaining routine checkups, less frequent listening and respect from providers, and lower quality of healthcare. Additionally, experienced weight stigma (from any source) was indirectly associated with poorer healthcare experiences through weight bias internalization, consistently across the six countries. Conclusions Weight stigma in healthcare is prevalent among adults actively engaged in weight management across different Western countries, and internalized weight bias has negative implications for healthcare even after controlling for BMI. The similar findings across all six countries underscore the negative consequences of weight stigma on healthcare behaviors and experiences, and emphasize the need for collective international efforts to address this problem.