Developing a justice-focused body image program for U.S. middle schoolers: a school-based community-engaged research process.

We describe a community-engaged research process to co-create and implement an evidence-informed, diversity-focused body image program for early adolescents. Our team included middle school staff, students, and teachers, and university faculty and students. Team members had a diverse range of intersecting cis- and transgender, racial, sexuality, and disability identities. Specific steps to the research process included: (1) establishing team leads at each site to maintain a collaborative and non-hierarchical team structure; (2) bi-weekly advisory team meetings to establish program needs and discuss curriculum and implementation options; (3) a year-long youth co-design process to generate content ideas, pilot pieces of programming, and incorporate youth leadership through an equity lens; (4) inclusive program writing from members of socially marginalized groups; (5) program piloting to solicit feedback from teachers, facilitators, and students; and (6) collaboratively incorporating feedback. The resulting 8-session (6 hours total) Body Justice Project has both dissonance-based and media literacy foundations, with topics related to cultural appearance ideals, diet culture and non-diet nutrition, media and appearance pressure, and body autonomy. It is designed for in-class delivery to middle school students by trained college and youth co-facilitator teams. We emphasize guiding principles and lessons learned, along with next steps in implementation.

Expert peer facilitation of the EVERYbody Project: A randomized-controlled evaluation of a diversity-focused, dissonance-based, universal body image program for college students.

OBJECTIVE: A novel peer facilitation model was used to deliver a two session, dissonance-based, inclusive body image intervention that critically examines how internalized size-based oppression intersects with race, class, gender, sexuality, and ability. METHOD: The EVERYbody Project was open to all college students and delivered by "expert" peer facilitators with body image and diversity experience and advanced facilitation skills. Recruitment was halted due to COVID-19; 90 students in the Northwest US (M age = 19.83 years, SD = 2.38; 80% female-identified, 13% male-identified, 7% gender expansive) were randomized to receive the EVERYbody Project or a video-based, low-dissonance comparison intervention. RESULTS: Around half of students (56%) held one or more specific socially marginalized identity (26% with a racial or ethnic identity other than white and non-Hispanic, 39% with a sexual identity other than straight, 7% with a gender identity other than cisgender). The EVERYbody Project produced greater reductions in three outcomes associated with poor body image (internalized appearance norms, body dissatisfaction, and negative affect) compared to the video intervention through 3-month follow-up (ps < .003) with medium between group effects. Both conditions experienced small reductions in eating disorder psychopathology over time. DISCUSSION: Expert peer facilitation may be a viable delivery model for inclusive, diversity-focused dissonance-based body image programs. PUBLIC SIGNIFICANCE: This study explored a novel facilitation approach for a diversity-focused body image program for college students. A brief (4 h) dissonance-based program was open to all college students and delivered by "expert" diverse peer leaders who were screened for facilitation readiness. Body image and related outcomes were improved through 3-month follow-up relative to a comparison condition, suggesting that expert peer facilitation may be a viable option for delivering universal, inclusive body image programming.

A qualitative examination of adolescent and parent perspectives on early identification and early response to eating disorders.

This qualitative study examined adolescent and caregiver perspectives on identification and early response in emerging eating disorders. Fifteen female-identified adolescents with an eating disorder diagnosis (M age = 15.20 years; 93% White; 20% Hispanic) and 12 caregivers (all biological parents: 1 father, 11 mothers; M age = 51.56 years) participated in semi-structured interviews about their experience identifying and responding to the eating disorder, eventually seeking treatment. Participants were recruited from three eating disorder treatment centers in the United States. Interview responses were coded by three raters using inductive consensual qualitative methods. Results found that parents were typically the first to notice and confront the eating disorder, and weight loss and thinness usually were the earliest symptoms identified. The most common adolescent response to detection was mixed (e.g., relief and anger), and common parental reactions included seeking professional consultation and creating limitations on disordered behaviors (e.g., encouraging eating). Barriers to earlier detection were highlighted (e.g., parental hesitancy to act on suspicions), suggesting that parents need greater support for swift and confident responding. To combat this, parents recommended increasing knowledge of eating disorder symptoms. Parents and adolescents both recommended parent-led monitoring of eating and exercise behaviors to increase the chance of noticing changes and responding quickly with aggressive and supportive action. These experiences provide a framework for early identification and the role of caregiver response, highlighting the need for assertive yet compassionate efforts to combat emerging eating disorders.

Inclusive dissonance-based body image interventions for college students: Two randomized-controlled trials of the EVERYbody Project.

OBJECTIVES: Two randomized-controlled studies explored the feasibility, acceptability, and efficacy of the EVERYbody Project, a gender-inclusive, diversity-focused, dissonance-based body image intervention for college students. METHOD: Trial 1 (N = 98; 80% female, 14% male, and 6% gender-expansive) piloted the two-session intervention delivered by an expert (faculty or staff) and peer cofacilitators compared to a waitlist control. Trial 2 (N = 141; 79% female, 15% male, and 6% gender-expansive) utilized peer leaders, comparing the EVERYbody Project to a video and expressive writing intervention. Around half of the participants in both trials self-identified in one or more specific marginalized identity category. Changes in eating disorder symptoms and risk factors were assessed through 1-month follow-up. Trial 1 also assessed the intervention's impact on students with marginalized identities through qualitative interviews. RESULTS: In Trial 1, the EVERYbody Project produced greater reductions in eating disorder symptoms, internalized appearance norms, body dissatisfaction, and negative affect compared to the waitlist control through 1-month follow-up, with medium effect sizes. The impact was similar in students with marginalized and majority identities, and qualitative interviews suggested specific positives of the intervention. In Trial 2, there were significant changes in two of four outcomes for participants in the EVERYbody Project compared to the video and expressive writing intervention, but overall, the intervention impact was modest. CONCLUSIONS: The EVERYbody Project is a feasible and acceptable inclusive dissonance-based body image program. It appears to be beneficial when delivered via experts, but research is needed to establish whether the program can be delivered using peer leaders with greater impact. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The influence of gender on the evaluation of anorexia nervosa.

A stereotype exists that anorexia nervosa (AN) is a "female" disorder. As a result, men with AN may face harsher stigmatization from their peers or go undiagnosed. The shifting standards model provides a framework to explore how gender stereotypes impact perceptions of AN. Participants (N = 438) were given a vignette of a person with symptoms of AN labeled as either male or female. Assessments were experimentally manipulated according to the shifting standards perspective: participants were asked if they were concerned (or convinced) that the target had AN and then indicated the severity of behavioral symptoms (calorie reduction, pounds lost per week, and hours of exercise) needed to make them concerned (or convinced) of AN. Participants were more likely to state that the male target had AN compared to the female target (p = .036) whereas women were more likely to believe an individual had AN than men, regardless of the target gender (p < .001). In addition, men required that the male target have more severe symptoms to assign an AN diagnosis than women (p = .005). In general, severity ratings for symptoms were quite high, indicating a normalization of unhealthy weight loss practices. These results confirm that gender affects the perception of AN, though they do not conform to expectations within the shifting standards model. Instead, they suggest that a male target is more readily identified as having AN than a female target with AN when exhibiting identical symptoms.

Should body image programs be inclusive? A focus group study of college students.

OBJECTIVE: Most evidence-based body image programs for college students (e.g., the Body Project) are designed for female-only audiences, although body dissatisfaction is not limited to female-identified individuals. Furthermore, programs do not explicitly discuss diversity, although individuals with marginalized gender, racial, and sexual identities may be particularly vulnerable to body image disturbances. Making programs more inclusive may increase their disseminability. METHOD: This qualitative study examined the feasibility of adapting the Body Project for universal and inclusive use with college students. Participants (N = 36; M age = 21.66 years; 73% female-identified; 20% sexual minority; 23% racial minority) attended one of five semi-structured focus groups to explore the inclusivity of appearance-based cultural norms using adapted Body Project activities and discuss the feasibility of universal and inclusive interventions. Inductive qualitative content analysis with three-rater consensus identified focus group themes. RESULTS: There was consensus that inclusive interventions could have a positive impact (broadening perspectives, normalizing body image concerns, increasing awareness) despite potential barriers (poor diversity representation, vulnerability). There was strong consensus regarding advice for facilitating inclusive interventions (e.g., skilled facilitation, education, increasing diversity). DISCUSSION: Results suggest that inclusive body image programs are desirable and provide a framework for creating the EVERYbody Project, a program for more universal audiences.

The effects of psychotherapy treatment on outcome in bulimia nervosa: Examining indirect effects through emotion regulation, self-directed behavior, and self-discrepancy within the mediation model.

OBJECTIVE: The purpose of this investigation was to examine the indirect effects of Integrative Cognitive-Affective Therapy (ICAT-BN) and Cognitive-Behavioral Therapy-Enhanced (CBT-E) on bulimia nervosa (BN) treatment outcome through three hypothesized maintenance variables: emotion regulation, self-directed behavior, and self-discrepancy. METHOD: Eighty adults with BN were randomized to 21 sessions of ICAT-BN or CBT-E. A regression-based bootstrapping approach was used to test the indirect effects of treatment on outcome at end of treatment through emotion regulation and self-directed behavior measured at mid-treatment, as well as the indirect effects of treatment at follow-up through emotion regulation, self-directed behavior, and self-discrepancy measured at end of treatment. RESULTS: No significant differences in outcome between treatment conditions were observed, and no significant direct or indirect effects were found. Examination of the individual paths within the indirect effects models revealed comparable treatment effects. Across treatments, improvements in emotion regulation and self-directed behavior between baseline and mid-treatment predicted improvements in global eating disorder scores but not binge eating and purging frequency at end of treatment. Baseline to end of treatment improvements in emotion regulation and self-directed behavior also predicted improvements in global eating disorder scores at follow-up. Baseline to end of treatment improvements in emotion regulation predicted improvements in binge eating and baseline to end of treatment increases in positive self-directed behavior predicted improvements in purging at follow-up. DISCUSSION: These findings suggest that emotion regulation and self-directed behavior are important treatment targets and that ICAT-BN and CBT-E are comparable in modifying these psychological processes among individuals with BN.

Weight bias internalization in treatment-seeking overweight adults: Psychometric validation and associations with self-esteem, body image, and mood symptoms.

Internalized weight bias has been previously associated with impairments in eating behaviors, body image, and psychological functioning. The present study explored the psychological correlates and psychometric properties of the Weight Bias Internalization Scale (WBIS) among overweight adults enrolled in a behavioral weight loss program. Questionnaires assessing internalized weight bias, anti-fat attitudes, self-esteem, body image concern, and mood symptoms were administered to 90 obese or overweight men and women between the ages of 21 and 73. Reliability statistics suggested revisions to the WBIS. The resulting 9-item scale was shown to be positively associated with body image concern, depressive symptoms, and stress, and negatively associated with self-esteem. Multiple linear regression models demonstrated that WBIS scores were significant and independent predictors of body image concern, self-esteem, and depressive symptoms. These results support the use of the revised 9-item WBIS in treatment-seeking samples as a reliable and valid measure of internalized weight bias.

A naturalistic examination of social comparisons and disordered eating thoughts, urges, and behaviors in college women.

OBJECTIVE: We examined the effects of body, eating, and exercise social comparisons on prospective disordered eating thoughts and urges (i.e., restriction thoughts, exercise thoughts, vomiting thoughts, binge eating urges) and behaviors (i.e., restriction attempts, exercising for weight/shape reasons, vomiting, binge eating) among college women using ecological momentary assessment (EMA). METHOD: Participants were 232 college women who completed a 2-week EMA protocol, in which they used their personal electronic devices to answer questions three times per day. Generalized estimating equation models were used to assess body, eating, and exercise comparisons as predictors of disordered eating thoughts, urges, and behaviors at the next report, adjusting for body dissatisfaction, negative affect, and the disordered eating thought/urge/behavior at the prior report, as well as body mass index. RESULTS: Body comparisons prospectively predicted more intense levels of certain disordered eating thoughts (i.e., thoughts about restriction and exercise). Eating comparisons prospectively predicted an increased likelihood of subsequent engagement in all disordered eating behaviors examined except vomiting. Exercise comparisons prospectively predicted less-intense thoughts about exercise and an increased likelihood of subsequent vomiting. DISCUSSION: Social comparisons are associated with later disordered eating thoughts and behaviors in the natural environment and may need to be specifically targeted in eating disorder prevention and intervention efforts. Targeting body comparisons may be helpful in terms of reducing disordered eating thoughts, but eating and exercise comparisons are also important and may need to be addressed in order to decrease engagement in actual disordered eating behaviors.

Restrictive eating in anorexia nervosa: Examining maintenance and consequences in the natural environment.

OBJECTIVE: This study examined negative and positive affect in relation to restrictive eating episodes (i.e., meals/snacks perceived as restrictive) and whether restrictive eating was associated with likelihood of subsequent eating disorder behaviors (i.e., additional restrictive eating, binge eating, vomiting, laxative use, weighing, exercising, meal skipping, drinking fluids to curb appetite, body checking). METHOD: Women with anorexia nervosa (N = 118) completed a 2-week ecological momentary assessment protocol. RESULTS: For both restrictive and nonrestrictive eating, negative affect significantly increased from prebehavior to the time of the behavior but remained stable thereafter, while positive affect remained stable from prebehavior to the time of the behavior but decreased significantly thereafter. Across time, negative affect was significantly lower and positive affect was significantly greater in restrictive than nonrestrictive episodes. Engagement in restrictive eating was associated with an increased likelihood of subsequent restrictive eating, laxative use, and body checking, but not other behaviors. Engagement in nonrestrictive eating was associated with a decreased likelihood of subsequent restrictive eating, binge eating, vomiting, laxative use, weighing, meal skipping, drinking fluids to curb appetite, and body checking. DISCUSSION: Despite similar patterns of affect across eating episodes over time, results suggest affect may be involved in the maintenance of restrictive eating in anorexia nervosa since restrictive episodes were associated with lower negative and greater positive affect across time compared to nonrestrictive episodes. Further, while restrictive episodes increased the likelihood of only three subsequent eating disorder behaviors, nonrestrictive episodes were protective since they decreased likelihood of all but one behavior.

Effectiveness of a peer-delivered dissonance-based program in reducing eating disorder risk factors in high school girls.

OBJECTIVE: This pilot study investigated the feasibility, acceptability, and effectiveness of a peer-led dissonance-based eating disorders (ED) prevention/risk factor reduction program with high school girls. METHOD: Ninth grade girls (n = 50) received the peer-led program within the school curriculum. A quasi-experimental design was used to assess changes in ED risk factors preintervention and postintervention compared with waitlist control. Participants were followed through 3-month follow-up. RESULTS: Peer-leader adherence to an intervention manual tailored for this age group was high. The intervention was rated as highly acceptable, with a large proportion of participants reporting that they enjoyed the program and learned and applied new information. Intervention participants exhibited significantly greater pre-post reductions in a majority of risk-factor outcomes compared to waitlist controls. When groups were combined to assess program effects over time there were significant pre-post reductions in a majority of outcomes that were sustained through 3-month follow-up. DISCUSSION: This pilot study provides tentative support for the effectiveness of using peer leaders to implement an empirically supported ED risk factor reduction program in a high school setting. Additional research is needed to replicate results in larger, better-controlled trials with longer follow-up.

Predictors and moderators of psychological changes during the treatment of adolescent bulimia nervosa.

This study examined predictors of psychological change among 80 adolescents with bulimia nervosa (BN) participating in a randomized-controlled trial comparing family-based treatment (FBT) to supportive psychotherapy (SPT). Psychological outcomes (cognitive eating disorder pathology, depression, and self-esteem) were explored at baseline, post-treatment, and 6-month follow-up. Multi-level growth models examined predictors of rate of change in psychological outcomes and moderators of treatment effects. All psychological outcomes improved through 6-month follow-up (moderate to large effect sizes) across both treatments. Overall, few significant predictors were identified. Older adolescents had faster change in self-esteem relative to younger adolescents (p = 0.03). Adolescents taking psychotropic medication at baseline had faster change in eating concerns relative to adolescents not taking medication (p = 0.02). Age (p = 0.02) and baseline purging severity (p = 0.03) moderated the relationship between treatment condition and change in eating concerns, where younger adolescents and individuals with high baseline purging had greater change when treated with FBT relative to SPT. Age and purging did not significantly moderate change in other psychological outcomes. Bulimic symptom improvement did not predict change in psychological symptoms. Generally, FBT and SPT were equally efficacious with respect to psychological improvement, although FBT may be more efficacious in younger adolescents and those with more frequent purging.

From efficacy to effectiveness: comparing outcomes for youth with anorexia nervosa treated in research trials versus clinical care.

This study examined outcomes for 84 youth with anorexia nervosa (AN) who received family-based treatment (FBT) in a research trial (randomized trial care [RTC]: n = 32) compared to fee-for-service care (specialty clinical care [SCC]: n = 52) at an outpatient eating disorder clinic. Weight was collected up to 12 months post-baseline. Survival curves were used to examine time to weight restoration as predicted by type of care, baseline demographic and clinical characteristics, and their interaction. There was not a significant main effect for type of care, but its interaction with initial %EBW was significant (p = .005), indicating that weight restoration was achieved faster in RTC compared to SCC for youth with a lower initial %EBW (i.e., ≤81), while rates of weight restoration were comparable for those with a higher initial %EBW (i.e., >81). These data suggest that FBT is as effective as it is efficacious, except for youth with lower initial body weights. Therefore, clinicians may need to be particularly active in encouraging early weight gain for this subset of patients. Nevertheless, this study suggests that FBT is appropriate as a first-line treatment for youth with AN who present for clinical care.

Family functioning in two treatments for adolescent anorexia nervosa.

OBJECTIVE: Family functioning impairment is widely reported in the eating disorders literature, yet few studies have examined the role of family functioning in treatment for adolescent anorexia nervosa (AN). This study examined family functioning in two treatments for adolescent AN from multiple family members' perspectives. METHOD: Participants were 121 adolescents with AN ages 12-18 from a randomized-controlled trial comparing family-based treatment (FBT) to individual adolescent-focused therapy (AFT). Multiple clinical characteristics were assessed at baseline. Family functioning from the perspective of the adolescent and both parents was assessed at baseline and after 1 year of treatment. Full remission from AN was defined as achieving both weight restoration and normalized eating disorder psychopathology. RESULTS: In general, families dealing with AN reported some baseline impairment in family functioning, but average ratings were only slightly elevated compared to published impaired functioning cutoffs. Adolescents' perspectives on family functioning were the most impaired and were generally associated with poorer psychosocial functioning and greater clinical severity. Regardless of initial level of family functioning, improvements in several family functioning domains were uniquely related to full remission at the end of treatment in both FBT and AFT. However, FBT had a more positive impact on several specific aspects of family functioning compared to AFT. DISCUSSION: Families seeking treatment for adolescent AN report some difficulties in family functioning, with adolescents reporting the greatest impairment. Although FBT may be effective in improving some specific aspects of family dynamics, remission from AN was associated with improved family dynamics, regardless of treatment type.

Subjective and objective binge eating in relation to eating disorder symptomatology, depressive symptoms, and self-esteem among treatment-seeking adolescents with bulimia nervosa.

This study investigated the importance of the distinction between objective (OBE) and subjective binge eating (SBE) among 80 treatment-seeking adolescents with bulimia nervosa. We explored relationships among OBEs, SBEs, eating disorder (ED) symptomatology, depression, and self-esteem using two approaches. Group comparisons showed that OBE and SBE groups did not differ on ED symptoms or self-esteem; however, the SBE group had significantly greater depression. Examining continuous variables, OBEs (not SBEs) accounted for significant unique variance in global ED pathology, vomiting, and self-esteem. SBEs (not OBEs) accounted for significant unique variance in restraint and depression. Both OBEs and SBEs accounted for significant unique variance in eating concern; neither accounted for unique variance in weight/shape concern, laxative use, diuretic use, or driven exercise. Loss of control, rather than amount of food, may be most important in defining binge eating. Additionally, OBEs may indicate broader ED pathology, while SBEs may indicate restrictive/depressive symptomatology.

Preventing eating disorder pathology: common and unique features of successful eating disorders prevention programs.

Over the past two decades, the field of eating disorders has made remarkable strides in identifying, evaluating, and disseminating successful prevention programs. The current review identifies and discusses nine distinct eating disorders prevention programs that reduce existing eating disorder pathology or prevent the onset of future pathology. Each program was evaluated in one or more controlled trial with a follow-up period of at least six months. We review the evidence base for these nine successful programs and discuss their common and unique features. Based on authors' descriptions of their programs in published trials, we found that all programs were theory-driven, targeted one or more eating disorder risk factor (e.g., body dissatisfaction), were delivered across multiple group sessions, and included at least some interactive content. Most programs included content related to healthy eating/nutrition, media literacy/sociocultural pressures, and body acceptance/body satisfaction. Notably, there was wide variation in some participant features (e.g., participant age, sex, risk status) and intervention features (e.g., setting and format, length and dose, providers), suggesting that a variety of programs are beneficial in impacting eating disorder pathology. Implications and directions for future research are discussed, including an increased focus on universal and indicated prevention programs, expanding programs to a wider age range and a broader spectrum of weight-related problems, and rigorous evaluation of programs through efficacy, effectiveness, and implementation research.

Is weight gain really a catalyst for broader recovery?: The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa.

The main aims of this study were to describe change in psychological outcomes for adolescents with anorexia nervosa across two treatments, and to explore predictors of change, including baseline demographic and clinical characteristics, as well as weight gain over time. Participants were 121 adolescents with anorexia nervosa from a two-site (Chicago and Stanford) randomized controlled trial who received either family-based treatment or individual adolescent supportive psychotherapy. Psychological symptoms (i.e., eating disorder psychopathology, depressive symptoms, and self-esteem) were assessed at baseline, end of treatment, 6-month, and 12-month follow-up. Conditional multilevel growth models were used to test for predictors of slope for each outcome. Most psychological symptoms improved significantly from baseline to 12 month follow-up, regardless of treatment type. Depressive symptoms and dietary restraint were most improved, weight and shape concerns were least improved, and self-esteem was not at all improved. Weight gain emerged as a significant predictor of improved eating disorder pathology, with earlier weight gain having a greater impact on symptom improvement than later weight gain. Adolescents who presented with more severe, complex, and enduring clinical presentations (i.e., longer duration of illness, greater eating disorder pathology, binge-eating/purging subtype) also appeared to benefit more psychologically from treatment.

Weight-loss history as a predictor of obesity treatment outcome: prospective, long-term results from behavioral, group self-help treatment.

Weight-loss history was examined as a predictor of outcome in group self-help obesity treatment. Participants (n = 128; 83% women; mean body mass index = 34.2 kg/m(2); mean age = 47.2 years) in self-help, group behavioral weight-loss treatment reported a mean of 5.1 prior weight-loss attempts and lost 13.8 percent of initial weight in current treatment. A greater number of past attempts independently predicted greater 6-month, 18-month, and intent-to-treat weight losses. Greater magnitude of largest past loss predicted greater 18-month weight loss. In contrast to studies on professional treatment, group self-help participants might benefit from repeated weight-loss efforts despite previous failures.

Community-based behavioral weight-loss treatment: long-term maintenance of weight loss, physiological, and psychological outcomes.

Obesity is a significant public health problem, and sustainable long-term treatments are needed. This study examined a community-based model of weight-loss treatment. Ninety participants were recruited from eight community organizations (mean age: 49.65 years, mean body mass index: 35.80 kg/m(2); 64% female). Treatment groups were randomly assigned to two maintenance conditions: 1) self-help continuing care, or 2) assessment-only. Both received the same initial 20-session group behavioral treatment. Those randomized to continuing care were additionally instructed to meet as self-sustaining groups for 18 months post-treatment. Weight, physiological, behavioral, and psychological outcomes were assessed at baseline, post-treatment, and at six-month and 18-month follow-up. Eighty-seven percent of participants completed treatment. Participant treatment satisfaction and therapist adherence to treatment protocol were high. No group differences or time by group interaction effects emerged. Participants achieved significant weight losses at post-treatment, with no significant weight regain at six-month or 18-month follow-up. Treatment produced sustained changes in waist circumference, cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, insulin, eating patterns, physical activity, quality of life, and body image. A community-based treatment program may be an effective form of behavioral-weight-loss treatment for overweight/obese adults. Weight losses, along with physiological and psychological benefits, were sustained over time.

Reducing obesity stigma: the effectiveness of cognitive dissonance and social consensus interventions.

Obese individuals experience pervasive stigmatization. Interventions attempting to reduce obesity stigma by targeting its origins have yielded mixed results. This randomized, controlled study examined the effectiveness of two interventions to reduce obesity stigma: cognitive dissonance and social consensus. Participants were college undergraduate students (N = 64, 78% women, mean age = 21.2 years, mean BMI = 23.1 kg/m2) of diverse ethnicities. Obesity stigma (assessed with the Antifat Attitudes Test (AFAT)) was assessed at baseline (Visit 1) and 1 week later, immediately following the intervention (Visit 2). Participants were randomly assigned to one of three intervention groups where they received standardized written feedback on their obesity stigma levels. Cognitive dissonance participants (N = 21) were told that their AFAT scores were discrepant from their values (high core values of kindness and equality and high stigma), social consensus participants (N = 22) were told their scores were discrepant from their peers' scores (stigma much higher than their peers), and control participants (N = 21) were told their scores were consistent with both their peers' scores and their own values. Following the intervention, omnibus analyses revealed significant group differences on the AFAT Physical/Romantic Unattractiveness subscale (PRU; F (2, 59) = 4.43, P < 0.05). Planned contrasts revealed that cognitive dissonance group means were significantly lower than control means for AFAT total, AFAT PRU subscale, and AFAT social/character disparagement subscale (all P < 0.05). No significant differences were found between social consensus and controls. Results from this study suggest that cognitive dissonance interventions may be a successful way to reduce obesity stigma, particularly by changing attitudes about the appearance and attractiveness of obese individuals.