Psychological factors proved to have significant influence on the outcome and success of the treatment of obesity, and there might be a psychological mechanism explaining why only a subgroup of the obese population suffers from being overweight. The main hypothesis of this work is that weight-related shame and guilt feelings are psychological factors crucial for both emotional well-being and the success of weight loss attempts. Prior studies found suggestive evidence that this hypothesis might be valid: Obese individuals are likely to experience weight-related shame feelings through the contrast of an overtly visible stigma and the omnipresent thin ideal in society. Weight-related guilt feelings are likely experienced since weight control is still viewed as a matter of willpower by obese as well as nonobese individuals, but unfortunately most weight loss attempts do not remain successful.
Consequently, the three manuscripts address the following research questions: Are weight-and body-related shame and guilt concerning weight control separate constructs? Are weight-related shame and guilt feelings associated to BMI? Are shame-based or guilt-based coping responses predictive of weight change? Is it possible to minimize guilt and shame feelings about eating through a counseling approach emphasizing genetic factors in the development of obesity?
The first manuscript presents the evaluation of the psychometric properties of a new self-report measure of weight- and body-related shame and guilt (WEB-SG) in a sample of 331 obese individuals. The factorial structure of the WEB-SG supported a two-factor conceptualization. The WEB-SG subscales proved to be internally consistent and temporally stable. The construct validity of the subscales was evidenced by a substantial overlap of common variance with other shame and guilt measures. Also, the subscales showed differential correlation patterns to other scales, but were not substantially associated to BMI. Thus, it appears that the frequency of weight-related shame and guilt feelings in obese individuals may be affected by factors other than weight.
The second manuscript presents the longitudinal associations among weight-related coping, guilt, and shame in a sample of 98 obese individuals. The study explored the kind and frequency of typical coping situations in which obese individuals become aware of being obese. Individuals reported mostly negative evaluations through others/self, physical exercise situations, or environmental hazards. Again, the perceived distress about those situations did not differ significantly between levels of obesity, but was strongly correlated to weight-related shame and guilt. Excessive body weight itself does not appear to be the determinant of distress about weight-related situations, but cognitive appraisal of the situation. Furthermore, the study sought to determine the predictive utility of weight-related shame and guilt concerning coping responses. Contrary to the hypothesis, weight-related shame at baseline was a significant negative predictor for problem-focused engagement coping, whereas, as expected, weight-related guilt was a significant positive predictor for problem-focused engagement strategies and dietary restraint at follow-up. Finally, weight loss was accompanied by a substantial drop in problem-focused disengagement coping.
The study outlined in the third manuscript tested the effects of a consultation using genetic information about obesity on attitudes about weight loss goals, self-blame about eating, and weight-related coping in obese individuals. For that purpose, we chose a longitudinal experimental design with two intervention groups (n1 = 126; n2 = 127) and a control group (n = 98). Independent variables were the experimental variation of the consultation (with and without genetic information), the familial predisposition (at least one parent/sibling obese vs. no parent/sibling obese), and two assessment points (after consultation and 6-month follow-up). Individuals with and without a familial predisposition profited in different ways from a consultation using genetic information about obesity: At follow-up, individuals with a familial predisposition reported mainly a relieving effect in the form of less self-blame about eating. Both experimental groups, independent of the factors Consultation and Familial Predisposition, reported an adjustment to more realistic weight loss goals and a greater satisfaction with a 5% weight loss. Regarding weight change, the less satisfied obese individuals felt about their current weight at baseline, the higher the risk that these individuals had gained weight at follow-up. In summary, a consultation with genetic information about obesity and feedback of the familial susceptibility seem to be helpful especially for obese individuals with a familial predisposition.