Weight Discrimination and Poor Cardiovascular Health

Florida State University

Status: Completed

Conditions: Obesity

Treatments: Behavioral: Control experience; Behavioral: Weight discrimination experience

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT05714696

R56HL159177 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

People with obesity regularly experience discrimination on the basis of their body weight and such experiences are associated with increased risk for poor cardiovascular health. The goal of this clinical trial is to identify cognitive, affective, behavioral, and physiological factors that explain the relationship between weight discrimination and poor health outcomes.

A diverse sample of adults with obesity will be randomly assigned to a social interaction encounter that simulates a typical weight discrimination experience (experimental manipulation) vs. a control manipulation that does not involve discrimination. The investigators will examine the immediate effects of the experimental manipulation on cognitive (e.g., self-regulation), affective (e.g., negative emotion), behavioral (e.g., comfort eating), and physiological (e.g., cortisol secretion) outcomes.

Two additional aims of the study are to identify psychological traits that moderate responses to weight discrimination and to assess whether the negative health effects of weight discrimination differ by age, sex/gender, race, or ethnicity.

Full description

Discrimination is a critical social determinant of health that underlies poor health outcomes. One common but understudied form of discrimination is weight discrimination. Weight discrimination is the behavioral manifestation of weight stigma-the social devaluation of people with excess body weight. Findings suggest that the stress produced by weight discrimination prompts weight gain, creating a vicious cycle between weight discrimination and obesity. Further, there is now well-documented evidence that experiencing weight discrimination is associated with increased risk for cardiovascular disease. Little is known, however, about mechanisms explaining the link between weight discrimination and poor cardiovascular health. Using a rigorous experimental approach, this project will identify mechanisms through which weight discrimination harms health. Findings will facilitate the long-term goal of this research: interventions to decrease the negative health consequences of weight discrimination.

As a step toward this goal, this project proposes to conduct an experiment in which a diverse sample of adults with obesity will be randomly assigned to experience (vs. not experience) weight discrimination in a controlled experimental setting. Drawing on previous research and the investigators' pilot data, the interpersonal context chosen for the study simulates situations in which people with obesity commonly experience weight discrimination in their daily lives (e.g., employment settings).

The study will involve two parts: a pre-session baseline survey and an experimental session that will take place in the lab. The baseline survey will be completed online and will assess individual difference variables/psychological variables and demographic characteristics. The in-person lab visit will take place on campus about one week after completion of the baseline survey. The study manipulation (i.e., intervention) will be delivered during the lab visit. Primary outcome variables will be assessed during the lab visit, after delivery of the intervention.

The following aims will be tested: (1) Identify early-stage cognitive, affective, behavioral, and physiological mechanisms activated by experimentally manipulated weight discrimination; (2) Identify psychological variables (e.g., internalized weight bias) that moderate effects of weight discrimination; and (3) Identify demographic characteristics (e.g., gender, race) that moderate effects of weight discrimination. Exposure to weight discrimination (vs. control) is hypothesized to result in elevated responses on early-stage mechanisms that culminate in poor cardiovascular health (e.g., impaired self-regulation, higher negative emotion, more social withdrawal and comfort eating, increased cortisol secretion). This research will identify novel and highly modifiable targets for interventions designed to reduce the negative health effects of weight discrimination. In testing moderator variables, this work will identify individuals who display vulnerability vs. resilience to the harmful effects of discrimination. Information about moderators will thus help future intervention efforts target those individuals most likely to benefit from intervention. Given the high prevalence of obesity and the millions of Americans affected by weight discrimination, this research will address a crucial public health issue.

Enrollment: 333 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• (1) body mass index (BMI) greater than or equal to 30 (units: weight in kilograms divided by height in meters squared; BMI criteria for obesity)
• (2) 18 years of age or older
• (3) able to read and understand English
• (4) have Internet access (to complete the baseline survey)
• (5) able to come to FSU's campus to take part in a lab-based study

Exclusion criteria

• (1) having participated in any of our pilot studies on weight stigma
• (2) diagnosed with a current major psychiatric disorder (e.g., major depressive disorder, eating disorder)
• (3) pregnant or nursing
• (4) diagnosed with Cushing syndrome or taking steroid-based medications
• (5) having allergies to ingredients in the foods being offered during the taste test (e.g., gluten, peanuts).

Trial design

Primary purpose: Basic Science

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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333 participants in 2 patient groups

Weight discrimination experience

Experimental group

Description:

Participants in the experimental condition will: 1. Learn that their group mates are biased against overweight people (i.e., they have negative attitudes toward people with higher body weight), 2. Receive feedback about their personal attributes that is consistent with negative weight-based stereotypes (e.g., lacking self-discipline), and 3. Not be selected as a partner for the remaining lab tasks (i.e., this experience may prompt feelings of social exclusion).

Treatment:

Behavioral: Weight discrimination experience

Control experience

Active Comparator group

Description:

Participants in the control condition will: 1. Learn that their group mates are very accepting of overweight people (i.e., they have positive attitudes toward people with higher body weight), 2. Receive positive feedback about their personal attributes that is not consistent with negative weight-based stereotypes, and 3. Will be told that one of their group members had to leave early for an emergency so the pairs cannot be assembled as usual (i.e., this experience should not prompt feelings of social exclusion).

Treatment:

Behavioral: Control experience