Addressing Weight Bias Internalization to Improve Adolescent Weight Management Outcomes

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PROJECT SUMMARY/ABSTRACT Weight bias internalization (WBI), or self-directed weight-based stigma, has been associated with a number of negative physical and mental health consequences for adolescents with obesity, including negative weight- related outcomes (e.g., increased calorie consumption, poorer weight loss outcomes). The prevalence and salience of WBI as a stressor impacting weight-related outcomes in adolescents paired with the heterogeneous response to interventions for adolescents with obesity highlights the potential utility of combined intervention for WBI and obesity in youth to promote improved weight management outcomes during this critical developmental period. This K23 award is designed to fill gaps in my training and support a research study that will provide next steps in improving the health of adolescents with obesity. The first phase of the research project will employ focus groups and an open pilot trial to develop and test feasibility of an integrated intervention that combines treatment for WBI with an evidence-based adolescent behavioral weight control (BWC). I will then conduct a small RCT to test the effects of the newly designed WBI+BWC intervention on WBI and mechanisms of weight- stigma stress induced weight gain, specifically physiological markers of stress (diurnal cortisol) and inflammation (c-reactive protein, interleukin-6), and dysregulated eating behaviors (emotional eating, loss of control, unhealthy weight control behaviors). I hypothesize that BWC combined with intervention for WBI, will lead to improvements in mechanisms of weight-stigma stress induced weight gain, in turn promoting improved weight loss outcomes. This research project has significant clinical implications for the improvement of adolescent BWC and reduction of the negative effects of weight-based stigma in adolescents. To conduct this research and fill critical gaps in my training that will facilitate becoming an independent investigator focused on behavioral treatment of obesity in adolescents, I will complete a rigorous, targeted training program. The proposed training plan includes developing expertise in 1) conducting RCTs to develop and test BWC interventions for adolescents; 2) theoretical and conceptual models of weight-based stigma and WBI; 3) integration of mechanisms in clinical trials focused on biological markers and dysregulated eating behaviors; and 4) professional development. This training will be conducted under the primary mentorship of Dr. Elissa Jelalian, with co-mentors Drs. Rebecca Puhl, Stephanie Parade, Andrea Goldschmidt, and contributor Dr. David Barker. The skills I will acquire map directly onto the proposed research project and provide the knowledge and expertise necessary to prepare a successful R01 application by the end of the award period. The mentorship team, in combination with the rigorous academic and training environment provided by the Weight Control and Diabetes Research Center at The Miriam Hospital and Brown University, represent an ideal environment to accomplish these training and research goals. Through this Career Development Award, I will establish myself as an independent investigator dedicated to the development of novel interventions to improve health outcomes for adolescents with obesity.