Date of Award:


Document Type:


Degree Name:

Doctor of Philosophy (PhD)



Committee Chair(s)

Michael E. Levin (Committee Chair)


Michael E. Levin


M. Scott DeBerard


Michael P. Twohig


Rick A. Cruz


Carrie M. Durward


Tyra P. Sellers


Obesity is a serious public health issue within the U.S. and minimal long-term success is found with standard behavioral weight-loss treatments. Typical weight-loss interventions do not acknowledge psychological factors, such as weight-related stigma, which may play a role in the development and maintenance of poor coping behaviors, such as unhealthy eating patterns. Individuals who are obese may often experience weight-related stigma present in society and are ultimately at risk for weight self-stigma, which is related to poor health behaviors and increased psychological distress. Acceptance and commitment therapy (ACT), can be effective for treating numerous mental health presentations, might also be effective in decreasing weight self-stigma and improving health behaviors. Guided self-help may be particularly attractive to individuals struggling with weight self-stigma because it allows for greater flexibility and personal choice. There have been no previous randomized controlled trials evaluating guided self-help for weight self-stigma and health behavior change in obese populations.

This study reports the results of a randomized controlled trial of ACT guided self-help for weight self-stigma comparing two versions of guided self-help with varying levels of support versus waitlist control. Each active condition provided unique levels of guided self-help to evaluate whether phone coaching enhanced the program. Results showed both active conditions were highly acceptable, although greater satisfaction with support and greater follow-through with book reading was found for those who received phone coaching. There were significant improvements at post in binge eating, physical activity, psychological distress, weight self-stigma, and weight-related psychological flexibility for both active conditions versus waitlist. Mediational analyses showed significant treatment effects, such that weight self-stigma and weight-related psychological flexibility fully and separately accounted for the relation between ACT guided self-help and binge eating behavior. The findings from this study provide the first randomized controlled trial data of an effective intervention for weight self-stigma. Clinical implications, limitations, and future directions are discussed.



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