Motivated, fit, and strong – using counter-stereotypical images to reduce weight stigma internalization in women with obesity


Background: This study aimed to use implicit retraining to change automatic associations between body size and physical activity (PA) in women with obesity to reduce weight bias internalization (WBI). Methods: A Solomon-square experimental design was used to determine the effect of a four-week online implicit retraining intervention on WBI (primary measure) and PA attitudes, self-efficacy, and self-reported behaviour (secondary measures). The intervention was a visual probe task pairing counter-stereotypical images of active individuals with obesity with positive PA-related words. In qualitative interviews, a sub-sample of participants provided feedback and recommendations for using counter-stereotypical images in PA promotion. Results: Women completed the intervention (n=48) or a control task (n=55). Results of a RM-ANOVA showed no interaction or main effect of group on WBI. A main effect of time demonstrated that both groups had reduced WBI between pre-test and post-test, through to one-week follow-up. There were no differences between groups or over time for PA attitudes, self-efficacy, or behaviour. Women who participated in an interview (n=16) discussed several benefits and drawbacks of using counter-stereotypical images. Conclusion: WBI can be reduced over a few weeks, and counter-stereotypical images may have a role.