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Obesity and Internalized Weight Stigma: A Formulation Model for an Emerging Psychological Problem

Published online by Cambridge University Press:  04 September 2013

Denise Ratcliffe  and
Nell Ellison
Denise Ratcliffe*
Affiliation:
CNWL NHS Foundation Trust, and Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
Nell Ellison
Affiliation:
University College London, UK
*
Reprint requests to Denise Ratcliffe, Consultant Clinical Psychologist, Psychological Medicine Unit, South Kensington and Chelsea Mental Health Unit, 1 Nightingale Place, Chelsea and Westminster Hospital, London SW10 9NG, UK. E-mail: d.ratcliffe@nhs.net
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Abstract

Background: Obese individuals frequently experience weight stigma and this is associated with psychological distress and difficulties. The process of external devaluation can lead to negative self-perception and evaluation and some obese individuals develop “internalized weight stigma”. The prevalence of weight stigma is well established but there is a lack of information about the interplay between external and internal weight stigma. Aims: To synthesize the literature on the psychological effects of weight stigma into a formulation model that addresses the maintenance of internalized weight stigma. Method: Current research on the psychological impact of weight stigma was reviewed. We identify cognitive, behavioural and attentional processes that maintain psychological conditions where self-evaluation plays a central role. A model was developed based on clinical utility. Results: The model focuses on identifying factors that influence and maintain internalized weight stigma. We highlight the impact of negative societal and interpersonal experiences of weight stigma on how individuals view themselves as an obese person. Processing the self as a stigmatized individual is at the core of the model. Maintenance factors include negative self-judgements about the meaning of being an obese individual, attentional and mood shifts, and avoidance and safety behaviours. In addition, eating and weight management behaviours become deregulated and maintain both obesity and weight stigma. Conclusion: As obesity increases, weight stigma and the associated psychological effects are likely to increase. We provide a framework for formulating and intervening with internalized weight stigma as well as making therapists aware of the applicability and transferability of strategies that they may already use with other presenting problems.

Keywords

Case formulationcognitive behaviour therapyobesitysocial anxietyshameself-esteem
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 43 , Issue 2 , March 2015 , pp. 239 - 252
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013 

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