Weight-Related Self-Esteem, Group Behavioral Therapy, and Weight Loss

Patients with obesity report experiencing weight stigma resulting in poor self-esteem. Based on baseline self-esteem, this paper explores recommendations for group versus individual visits for lifestyle components of comprehensive obesity treatment in primary care.

Participants (n = 1220) were rural primary care patients in a 24-month cluster randomized controlled trial that demonstrated superior weight loss with group versus individual treatment. Baseline weight-related self-esteem scores (0-100), as measured by the Impact of Weight on Quality of Life-Lite (IWQOL-L), were used. A Bayesian normal dynamic linear model with a changepoint parameter estimates the relationship between self-esteem and weight loss across group versus individual treatment at the 24-month primary endpoint.

The posterior probability that patients receiving group lost more weight than those receiving individual visits remained $>$  0.999 for patients with self-esteem scores greater than 60. Those with the highest self-esteem (scores 80-100) receiving group visits lost 6.7 kg (95% CI, -8.15 to -5.20) at 24 months compared to 3.9 kg (95% CI, -5.45 to -2.39) for those receiving individual visits.

People may benefit more from group than individual intervention if their self-esteem is above an IWQOL-L score of 60 when starting an intensive behavioral intervention for weight loss.

ClinicalTrials.gov identifier: NCT02456636.