A new kind of weight loss approach helps people deal with self-loathing instead of just ignoring it

Weight stigma is associated with depression, anxiety, binge eating and even increased risk of cardiovascular disease.

A new study found positive results in helping people grapple with their internalized self-loathing, along with traditional weight loss methods.

While it might seem contradictory to tell people to accept themselves as they are while losing weight, study authors found that increasing acceptance actually made people more open to changing.

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When Aaron Thompkins got on the plane, someone else got off. 

Thompkins was on his way to California, to participate in the filming of season 10 of The Biggest Loser, a reality show dedicated to competitive weight loss. 

"I was over 400 pounds at that point," Thompkins said. "We were about to take off, and this guy was so upset that he had to sit next to me." 

The man got up, complained to a flight attendant, and got off the plane. 

"He said nothing to me, but I remember I put my head down," Thompkins said. "I always think back on that moment, and think I should've just said something, but I didn't. I put my head down and I was so ashamed that I didn't want to bring more attention to myself and the situation."

Thompkins got sent home from The Biggest Loser during the eighth episode. He was nervous entering the airport, hoping there wouldn't be another incident. "I was scared that whole scenario was going to happen all over again, where somebody was going to be mad because they were sitting next to me," he said.

This sort of internalized weight stigma which emerges from public fat shaming is common for fat people, and is associated with some serious health outcomes, from depression to anxiety to binge eating and even increased risk of  cardiovascular disease.

But a new study — led by former Weight Watchers consultant and current Assistant Professor of Psychology at the University of Pennsylvania Rebecca Pearl — experimented with a newer method of weight loss, where people are encouraged to accept themselves, even as they try to change their bodies.

Study participants who received 'stigma reduction intervention' were less likely to hate themselves because of their weight

The study divided participants into two groups.

One group received a typical weight loss management program, with the usual cooking tips and recipes, while the other received a specialized "stigma reduction intervention," along with the typical weight loss management program. The stigma intervention used gave participants the skills to cope with self-hating thoughts, experiences where they are treated badly due to their weight, and increase feelings of self and body acceptance.

In the screening process, applicants had to confirm to a psychologist that their weight negatively affected how they felt about themselves. They were only eligible for the study if they reported a history of being bullied or discriminated against due to their weight. 

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For 12 weeks, participants attended regular group meetings. At the end of the six month study, participants filled out surveys with self-evaluating questions like "I am less attractive than most other people because of my weight" and "I hate myself for being overweight."

The second group was less likely to hate themselves due to their weight compared to participants who only received weight loss treatment. While it may sees obvious that a comprehensive approach to weight loss would involve tackling people's mental health as well as their physical health, this is the first study with proof that advocating for a weight loss management routine involving mental health treatment is beneficial .

The study was conducted on 72 participants, 84% of them female, and 66% of them black. (That the study was conducted on a majority of black women was unintentional. Pearl recruited her participants in West Philadelphia, where there is a sizable black population.)

 All participants had a body mass index of 35 or higher. The BMI cutoff for obesity is 30. 

The study told participants to accept their bodies while encouraging them to lose weight

"Acceptance and change might seem to be on opposite poles, but actually what we find is that by increasing acceptance, we can also open up people for change and vice versa," Pearl told Insider. 

In designing the study, Pearl drew on the work of Dialectical Behavior Therapy developer Marsha Linehan, with phrases like "I can accept and love myself as I am right now, while also working to change my health behaviors and lose weight to improve my health."

Some participants told Pearl they almost felt guilty because, as feminists, they knew that they should love themselves for how they were, but wanted to lose weight for health reasons. Many participants told Pearl they wanted to lose weight to lower their blood pressure and run around with their grandkids, not to look a certain way.

"I've certainly talked to researchers and clinicians who worry that if we promote too much body acceptance, or focus too much on reducing stigma, that people will get the message that it's accepted, or that people will feel less motivated to want to change their health behaviors or lose weight," Pearl told Insider.

Though Pearl's study used traditional weight loss methods, it also used aspects of Health At Every Size philosophy, which espouses intuitive eating, giving up diets and accepting bodies as they are. 

The study was limited in its small size and short duration, especially given that research shows many diets don't work in the long term. Pearl is currently recruiting for a 16-month version of the study with more participants, hoping to repeat the same results.

The study was funded by Weight Watchers, and three of the study authors were former Weight Watchers consultants, but Pearl says Weight Watchers was not involved in the study design at all. 

One expert was impressed that this study found a happy medium between the two extremes of diet and self-acceptance

Charlotte Markey, a Professor of Psychology at Rutgers University who wasn't involved in the study, said she isn't too concerned about the Weight Watchers connection.  Markey told Insider she feels the study's weight loss method exists in a happy medium between the anti-diet Health At Every Size movement and traditional diet culture — which Health At Every Size was created to combat. 

"In this area of research too many people have taken sides," said Markey. "You're either pro self-acceptance, just love yourself as you are, it doesn't matter if you have type two diabetes, or you're pro-weight loss, because we have this accumulation of research suggesting that it would benefit people's health in some cases."

But Markey pointed out that you'd have to ignore a lot of research to say that weight and health aren't at all linked, and that some people would benefit from weight loss. If you think you have to beat yourself up in order to lose weight, however, Pearl's study suggests that isn't the best approach. 

"Consider having a little self-compassion while working on improving health behaviors," said Pearl.

The Biggest Loser also offered therapy, even though it wasn't often shown onscreen

During Thompkins' time on The Biggest Loser, the contestants were taken to an upscale community pool to swim.

"That was probably the most overweight people that pool has ever seen in their entire lives come out all at once," he said. "I told them 'I do not take my shirt off for anybody, I'm not going to do this.'" 

But seeing everyone else strip down to their bathing suits, Thompkins did as well. Watching all those people out there that day, proudly splashing around in bathing suits on camera, Thompkins stopped being embarrassed for a moment.

He chalked that growth up to the therapy the show offered, even if wasn't shown onscreen very often.

"When it comes to weight, there's a mental part of it that you've got to try to figure out and work through," he said. "It's about figuring out why you're doing the things you're doing." 

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