Weight bias among professionals treating eating disorders: attitudes about treatment and perceived patient outcomes

Examining Weight Bias among Practicing Canadian Family Physicians

OBJECTIVES

The aim of this study was to examine the attitudes of practicing Canadian family physicians about individuals with obesity, their healthcare treatment, and perceptions of obesity treatment in the public healthcare system.

METHOD

A national sample of Canadian practicing family physicians (n = 400) completed the survey. Participants completed measures of explicit weight bias, attitudes towards treating patients with obesity, and perceptions that people with obesity increase demand on the public healthcare system.

RESULTS

Responses consistent with weight bias were not observed overall but were demonstrated in a sizeable minority of respondents. Many physicians also reported feeling frustrated with patients with obesity and agreed that people with obesity increase demand on the public healthcare system. Male physicians had more negative attitudes than females. More negative attitudes towards treating patients with obesity were associated with greater perceptions of them as a public health demand.

CONCLUSION

Results suggest that negative attitudes towards patients with obesity exist among some family physicians in Canada. It remains to be determined if physicians develop weight bias partly because they blame individuals for their obesity and its increased demand on the Canadian public healthcare system. More research is needed to better understand causes and consequences of weight bias among health professionals and make efforts towards its reduction in healthcare.

What's Weight Got to Do With It? Mental Health Trainees' Perceptions of a Client With Anorexia Nervosa Symptoms

This study examined the effect of client body mass index (BMI) on diagnostic impressions and perceptions of mental health trainees. Participants read a vignette of a mock female client presenting for treatment with symptoms of anorexia nervosa. Participants were randomly assigned to one of three conditions in which the client was described as “underweight,” “normal weight,” or “overweight.” Results revealed that participants assigned to the “underweight” condition diagnosed the client with anorexia nervosa or atypical anorexia nervosa more frequently than participants assigned to the “overweight” or “normal weight” conditions. There was no difference based on client BMI when the more general diagnosis of other specified feeding or eating disorder (OSFED; previously known as eating disorder not otherwise specified [EDNOS]) was included, however. Participants in the “overweight” and “normal weight” conditions recommended fewer therapy sessions for the client than participants in the “underweight” condition. Furthermore, participants more strongly endorsed weight-based stereotypes to describe the client when she was “overweight” than “normal weight” or “underweight.” Contrary to hypotheses, however, participants reported moderately positive attitudes toward treating the client regardless of BMI. These preliminary findings support initiatives aimed at providing training on weight stigma and eating disorders to mental health professionals.

The Relationships Between Weight Bias, Perceived Weight Stigma, Eating Behavior, and Psychological Distress Among Undergraduate Students in Hong Kong

Weight bias issues are rarely discussed in Asian. Therefore, we examined the relationships between weight bias, perceived weight stigma (PWS), eating behavior, and psychological distress among Hong Kong people. Using cross-sectional design, 400 undergraduate students (175 men) completed questionnaires and were assigned into a self-reported overweight (n = 61) or nonoverweight group (n = 339) using body mass index, and a self-perceived overweight (n = 84) or nonoverweight group (n = 316) based on self-perception. For self-reported and self-perceived overweight groups, more weight bias was related to higher depression (β = -0.403; p = 0.004). Self-perceived group additionally showed that weight bias was related to PWS and inappropriate eating behaviors; PWS related to inappropriate eating behaviors. For self-reported and self-perceived nonoverweight groups, weight bias was related to PWS, inappropriate eating behaviors, anxiety, and depression (β = -0.228 to -0.148; p's < 0.05); PWS was associated with inappropriate eating behaviors, anxiety, and depression. Thus, weight bias issues should not be ignored for both overweight and nonoverweight people.

Weight Bias and Psychosocial Implications for Acute Care of Patients With Obesity

Obesity is a complex medical condition that has psychosocial and physiological implications for those suffering from the disease. Factors contributing to obesity such as depression, childhood experiences, and the physical environment should be recognized and addressed. Weight bias and stigmatization by health care providers and bedside clinicians negatively affect patients with obesity, hindering those patients from receiving appropriate care. To provide optimal care of patients with obesity or adiposity, health care providers must understand the physiological needs and requirements of this population while recognizing and addressing their own biases. The authors describe psychosocial and environmental factors that contribute to obesity, discuss health care providers' weight biases, and highlight implications for acute care of patients suffering from obesity.

Mechanisms underlying weight status and healthcare avoidance in women: A study of weight stigma, body-related shame and guilt, and healthcare stress

Studies show that women with high BMI are less likely than thinner women to seek healthcare. We aimed to determine the mechanisms linking women's weight status to their healthcare avoidance. Women (N = 313) were surveyed from a U.S. health-panel database. We tested a theory-driven model containing multiple stigma and body-related constructs linking BMI to healthcare avoidance. The model had a good fit to the data. Higher BMI was related to greater experienced and internalized weight stigma, which were linked to greater body-related shame. Internalized weight stigma was also related to greater body-related guilt, which was associated with higher body-related shame. Body-related shame was associated with healthcare stress which ultimately contributed to healthcare avoidance. We discuss recommendations for a Weight Inclusive Approach to healthcare and the importance of enhancing education for health professionals in weight bias in order to increase appropriate use of preventive healthcare in higher weight women.

Weight loss support seeking on twitter: the impact of weight on follow back rates and interactions

People seek weight loss support on online social networks, but little is known about how to build a supportive community. We created four Twitter accounts portraying women interested in weight loss (two obese, two normal weight/overweight) and followed health care professional and peer accounts for 2-5 weeks. We examined follow back rates, interactions, and organic follows from professionals and peers by weight status. Follow back rates did not differ by weight status when following professionals (6.8 % normal weight/overweight vs 11.0 % for obese; p = 0.4167) or peers (6.7 % for normal weight/overweight vs 10.8 % for obese; p = 0.1548). Number of interactions and organic followers also did not differ by weight status. Peers interacted with study accounts significantly more than professionals (p = 0.0138), but interactions were infrequent. Women seeking weight loss support on Twitter may need to be present for more than 5 weeks to build an interactive weight loss community.

Australian Healthcare Professionals' Knowledge of and Attitudes toward Binge Eating Disorder

Objective: This study aimed to investigate Australian healthcare practitioners’ knowledge and attitudes toward binge eating disorder (BED).

Method: Participants were 175 healthcare professionals, who were randomized to one of two conditions that assessed diagnostic and treatment knowledge of either comorbid BED and obesity or only obesity via case vignette, as well as weight bias toward obese patients.

Results: Results suggested that participants demonstrated a reluctance to diagnose comorbid BED and obesity, that their knowledge of physical complications associated with BED was limited, and that they indicated a narrow range of evidence-based treatment options. When compared with levels of weight bias expressed by healthcare professionals in previous international studies, Australian clinicians were significantly less biased, however, still largely endorsed ‘negative’ attitudes toward obesity.

Conclusion: Findings suggest that future clinical training in eating disorders should therefore focus not only on diagnostic criteria, physical complications and treatment options, but also on practitioner attitudes toward eating and weight.

Social Dominance Orientation, Dispositional Empathy, and Need for Cognitive Closure Moderate the Impact of Empathy-Skills Training, but Not Patient Contact, on Medical Students' Negative Attitudes toward Higher-Weight Patients

Anti-fat bias in healthcare providers and medical students has serious implications for quality of care of higher-weight patients. Studies of interventions aimed at reducing anti-fat attitudes in medical students have generally been disappointing, with little enduring effect. It is possible that some students may be more receptive to prejudice-reducing influences than others, due to underlying differences in their personal characteristics. It is also possible that attitudes toward patients, specifically, may differ from anti-fat attitudes in general, and prejudice-reduction effectiveness on patient-specific attitudes has not yet been evaluated. The present study explored the effect on general and patient-specific anti-fat attitudes of (1) contact with higher-weight individuals prior to and during medical school; and (2) training designed to increase medical students' empathy toward patients by encouraging them to take the patient's perspective during clinical encounters. The moderating role of individual difference factors on effectiveness of contact and student-reported hours of empathy training on patient-specific attitudes was assessed. A total of 3,576 students enrolled across 49 US medical schools completed an online survey at the start of their first year of medical school and at the end of their fourth year. Favorable contact experience with higher-weight patients predicted improved attitudes toward heavier patients after 4 years of medical school, and appeared sufficient to partially offset the effects of dislike of higher-weight individuals at baseline. The impact of favorable contact on general anti-fat attitudes was less strong, highlighting the importance of using target-specific outcome measures. The positive effects of favorable contact on attitudes toward higher-weight patients did not differ based on students' baseline levels of social dominance orientation, dispositional empathy, or need for cognitive closure. In contrast, the effectiveness of training did vary by student characteristics, generally being more effective in students who were more egalitarian and empathic at baseline, with little effect, or even adverse effects in students low in these traits. Overall, however, perspective-taking training produced only small improvements in attitudes toward higher-weight patients.

Policy Actions to Address Weight-Based Bullying and Eating Disorders in Schools: Views of Teachers and School Administrators

BACKGROUND

Weight-related bullying is prevalent among youth and associated with adverse health consequences, including increased risk for body dissatisfaction and disordered eating behaviors, which are risk factors for eating disorders. Although concerns about these problems have stimulated calls for broader intervention efforts in schools, actions thus far have been limited. This study examined educators' perspectives about potential policy actions to address these issues in schools.

METHODS

Educators (N = 240) completed an online questionnaire assessing their support for 11 potential school-based policy actions to address weight-related bullying and eating disorders. Participants also rated policies according to their feasibility and potential for positive impact.

RESULTS

Forty-eight percent of participants observed weight-related bullying in their school and 99% expressed the importance of intervening in such incidents. A large majority (75%-94%) supported 8 of the 11 policies, especially actions requiring school-based health curriculum to include content on eating disorder prevention (94%), and addressing weight-bullying through antibullying policies (92%), staff training (89%), and school curriculum (89%). Strongly supported policies were viewed by participants as being the most impactful and feasible to implement.

CONCLUSIONS

Educators recognize weight-related bullying and eating disorders as problems in their schools that warrant improved prevention and intervention efforts at the policy level.

Development and validation of the Nursing Profession Self-Efficacy Scale

AIM

This study describes the development and validation of the Nursing Profession Self-Efficacy Scale.

BACKGROUND

Self-efficacy can be useful in predicting performance, job satisfaction or well-being. In the nursing field, there is a shortage of studies on self-efficacy with regard to nurses' global confidence in coping ability across a range of everyday, challenging work situations.

METHODS

To define the theoretical framework of nursing professional self-efficacy, two focus groups and a literature review were performed. An empirical study was then conducted to test validity and reliability. Face and content validity, construct validity, concurrent validity, internal consistency and test-retest reliability were examined. The content validity index was evaluated by 12 experts who suggested deleting 11 redundant items. The final developed tool was tested for construct analysis using a cross-validation approach, randomly splitting the overall sample of 917 nurses in two sub-groups.

FINDINGS

The construct validity indicated two dimensions. The face and content validity were adequate. Test-retest reliability displayed a good stability, and internal consistency (Cronbach's α) was acceptable. Moreover, concurrent validity using the Generalized Self-Efficacy Scale was in line with the theoretical framework.

CONCLUSION

The scale showed evidence of validity and reliability. The major limitation is the strong influence of the Italian context in the tool development.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The Nursing Profession Self-Efficacy Scale could be a fruitful tool that facilitates the application of theories (i.e. social-cognitive theory) in the nursing field and even development of interventions. Furthermore, a measurement of self-efficacy could be used to predict nursing clinical performance.

A scoping review of weight bias by community pharmacists towards people with obesity and mental illness

BACKGROUND

Community pharmacists are accessible health care professionals who are increasingly offering weight management programs. People living with serious mental illness have markedly higher rates of obesity and associated illness outcomes than the general population, providing pharmacists who are interested in offering weight management services with an identifiable patient subgroup with increased health needs. Issues with stigma within obesity and mental illness care are prevalent and can lead to inequities and reduced quality of care.

METHODS

We conducted a scoping review to map and characterize the available information from published and grey literature sources regarding community pharmacists and weight bias towards obese people with lived experience of mental illness. A staged approach to the scoping review was used.

RESULTS

Six articles and 6 websites were abstracted after we removed duplicates and applied our inclusion and exclusion criteria. The published studies that we found indicated that pharmacists and pharmacy students do demonstrate implicit and explicit weight bias.

CONCLUSIONS

Very limited research is available regarding weight bias in pharmacists and stigma towards people with obesity, and we found no information on these phenomena relating to people with lived experience of mental illness. Investigations are needed to characterize the extent and nature of anti-fat bias and attitudes by pharmacists and the consequences of these attitudes for patient care.

Potential Policies and Laws to Prohibit Weight Discrimination: Public Views from 4 Countries

CONTEXT

People viewed as "overweight" or "obese" are vulnerable to weight-based discrimination, creating inequities and adverse health outcomes. Given the high rates of obesity recorded globally, studies documenting weight discrimination in multiple countries, and an absence of legislation to address this form of discrimination, research examining policy remedies across different countries is needed. Our study provides the first multinational examination of public support for policies and legislation to prohibit weight discrimination.

METHODS

Identical online surveys were completed by 2,866 adults in the United States, Canada, Australia, and Iceland. We assessed public support for potential laws to prohibit weight-based discrimination, such as adding body weight to existing civil rights statutes, extending disability protections to persons with obesity, and instituting legal measures to prohibit employers from discriminating against employees because of body weight. We examined sociodemographic and weight-related characteristics predicting support for antidiscrimination policies, and the differences in these patterns across countries.

FINDINGS

The majority of participants in the United States, Canada, and Australia agreed that their government should have specific laws in place to prohibit weight discrimination. At least two-thirds of the participants in all 4 countries expressed support for policies that would make it illegal for employers to refuse to hire, assign lower wages, deny promotions, or terminate qualified employees because of body weight. Women and participants with higher body weight expressed more support for antidiscrimination measures. Beliefs about the causes of obesity were also related to support for these laws.

CONCLUSIONS

Public support for legal measures to prohibit weight discrimination can be found in the United States, Canada, Australia, and Iceland, especially for laws to remedy this discrimination in employment. Our findings provide important information for policymakers and interest groups both nationally and internationally and can help guide discussions about policy priorities to reduce inequities resulting from weight discrimination.

Obesity Stigmatization and the Importance of the Research of A.J. Stunkard

Obese individuals face weight-based stigmatization and discrimination in virtually all areas of life. These stigmatizing experiences can lead to detrimental psychological, physical, and societal consequences and may further perpetuate the increasing prevalence of obesity. A. J. Stunkard was one of the first medical professionals to identify and address the serious ramifications of obesity stigmatization on both individual and societal levels. Throughout the last half-century, Stunkard contributed numerous findings and publications to the field of obesity stigmatization. His work laid the foundation and direction for important areas of current research, such as the cultural influences on weight bias, stigmatization among healthcare professionals, weight stigma among children, and the internalization of weight bias by obese individuals. His contributions have had an important influence on the current directions of these fields.

Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program

Weight stigma is a significant socio-structural barrier to reducing health disparities and improving quality of life for higher weight individuals. The aim of this study was to examine the impact of internalized weight stigma on eating behaviors after participating in a randomized controlled trial comparing the health benefits of a weight-neutral program to a conventional weight-management program for 80 community women with high body mass index (BMI > 30, age range: 30-45). Programs involved 6 months of facilitator-guided weekly group meetings using structured manuals. Assessments occurred at baseline, post-intervention (6 months), and 24-months post-randomization. Eating behavior outcome measurements included the Eating Disorder Examination-Questionnaire and the Intuitive Eating Scale. Intention-to-treat linear mixed models were used to test for higher-order interactions between internalized weight stigma, group, and time. Findings revealed significant 3-way and 2-way interactions between internalized weight stigma, group, and time for disordered and adaptive eating behaviors, respectively. Only weight-neutral program participants with low internalized weight stigma improved global disordered eating scores. Participants from both programs with low internalized weight stigma improved adaptive eating at 6 months, but only weight-neutral program participants maintained changes at follow-up. Participants with high internalized weight stigma demonstrated no changes in disordered and adaptive eating, regardless of program. In order to enhance the overall benefit from weight-neutral approaches, these findings underscore the need to incorporate more innovative and direct methods to reduce internalized weight stigma for women with high BMI.

Positioning of Weight Bias: Moving towards Social Justice

Weight bias is a form of stigma with detrimental effects on the health and wellness of individuals with large bodies. Researchers from various disciplines have recognized weight bias as an important topic for public health and for professional practice. To date, researchers from various areas have approached weight bias from independent perspectives and from differing theoretical orientations. In this paper, we examined the similarities and differences between three perspectives (i.e., weight-centric, non-weight-centric (health-centric), and health at every size) used to understand weight bias and approach weight bias research with regard to (a) language about people with large bodies, (b) theoretical position, (c) identified consequences of weight bias, and (d) identified influences on weight-based social inequity. We suggest that, despite differences, each perspective acknowledges the negative influences that position weight as being within individual control and the negative consequences of weight bias. We call for recognition and discussion of weight bias as a social justice issue in order to change the discourse and professional practices extended towards individuals with large bodies. We advocate for an emphasis on social justice as a uniting framework for interdisciplinary research on weight bias.

Dietitians and Nutritionists: Stigma in the Context of Obesity. A Systematic Review

Aim

Negative attitudes towards people with obesity are common even in health care settings. So far, the attitudes and causal beliefs of dietitians and nutritionists have not been investigated systematically. The aim of this article was to review the current state of quantitative research on weight-related stigma by dietitians and nutritionists.

Method

A systematic literature review was conducted in 2014 using PubMed, PsycINFO, Web of Science and Cochrane Library.

Results

Eight studies were found that differ in regard to study characteristics, instruments and the origin of the sample. Six out of eight studies reported weight stigma expressed by dietitians and nutritionists. Their believed causes of obesity indicated a defined preference for internal factors rather than genetics or biology.

Discussion

Results of studies were not homogenous. The degree of negative attitudes by dietitians and nutritionists towards people with obesity appeared to be slightly less pronounced compared to the general public and other health care professionals. Stigma and its consequences should be included into educational programs to optimally prepare dietitians and nutritionists.

Identification of educational needs in the management of overweight and obesity: results of an international survey of attitudes and practice

Despite the availability of a growing range of interventions to assist control of body weight for people with excess weight or obesity, only a small proportion of people achieve their weight loss goals and are able to maintain body weight reductions in the long term. Negative attitudes and beliefs are often found among physicians and others involved in treating obesity and may adversely impact the effectiveness of management. In this international study, healthcare professionals were invited to complete an online survey of their attitudes and practice in the management of excess body weight. A total of 335 clinicians completed the survey of whom approximately half were based in Europe. A key finding from the survey is that, while participants are generally confident in their ability to manage overweight and obesity effectively, they also report that most of their patients are not successful in achieving their weight loss goals. At the same time, participants tended to overestimate the effectiveness of current medical management in maintaining reductions in body weight. Educational initiatives addressing the real-life effectiveness of different weight control interventions may help to close the gap between clinicians' perceptions and reality in the management of excess body weight.

A national survey of public views about the classification of obesity as a disease

OBJECTIVE

In 2013, the American Medical Association classified obesity as a disease. This study assessed public opinions about this disease classification.

METHODS

In January 2014, a national sample of 1118 adults completed surveys assessing their agreement with 33 statements in support of and against the disease classification of obesity, as well as measures assessing sociodemographic characteristics.

RESULTS

The majority of participants (51-61.7%) agreed with 11 of 17 statements in support of the disease classification of obesity (average agreement across all statements = 51%), including views that it will help people gain access to obesity treatment. A minority of participants (31-47.3%) agreed with 15 of 16 statements against the disease classification (average agreement across statements = 39.5%), including views that it will increase overreliance on medications or surgery to treat obesity (47.3%). Participants' attitudes were unaffected by sex, income, education, or health status but were related to causal beliefs about obesity. The disease classification received more support from African Americans and more opposition by individuals with higher weight stigma.

CONCLUSIONS

This study found more public agreement supporting the disease classification of obesity than opposing it. Further work should identify whether this classification affects health behaviors among individuals with obesity or societal weight stigmatization.

A multinational examination of weight bias: predictors of anti-fat attitudes across four countries

BACKGROUND/OBJECTIVES

As rates of obesity have increased throughout much of the world, so too have bias and prejudice toward people with higher body weight (that is, weight bias). Despite considerable evidence of weight bias in the United States, little work has examined its extent and antecedents across different nations. The present study conducted a multinational examination of weight bias in four Western countries with comparable prevalence rates of adult overweight and obesity.

METHODS

Using comprehensive self-report measures with 2866 individuals in Canada, the United States, Iceland and Australia, the authors assessed (1) levels of explicit weight bias (using the Fat Phobia Scale and the Universal Measure of Bias) and multiple sociodemographic predictors (for example, sex, age, race/ethnicity and educational attainment) of weight-biased attitudes and (2) the extent to which weight-related variables, including participants' own body weight, personal experiences with weight bias and causal attributions of obesity, play a role in expressions of weight bias in different countries.

RESULTS

The extent of weight bias was consistent across countries, and in each nation attributions of behavioral causes of obesity predicted stronger weight bias, as did beliefs that obesity is attributable to lack of willpower and personal responsibility. In addition, across all countries the magnitude of weight bias was stronger among men and among individuals without family or friends who had experienced this form of bias.

CONCLUSIONS

These findings offer new insights and important implications regarding sociocultural factors that may fuel weight bias across different cultural contexts, and for targets of stigma-reduction efforts in different countries.

Stigma and eating and weight disorders

Although research has consistently documented the prevalence and negative health implications of weight stigma, little is known about the stigma associated with eating disorders. Given that weight stigma is a risk factor associated with disordered eating, it is important to address stigma across the spectrum of eating and weight disorders. The aim of this review is to systematically review studies in the past 3 years evaluating stigma in the context of obesity and eating disorders (including binge eating disorder, bulimia nervosa, and anorexia nervosa). Physical and psychological health consequences of stigma for individuals with obesity and eating disorders are discussed. Recent studies on weight stigma substantiate the unique influence of stigma on psychological maladjustment, eating pathology, and physiological stress. Furthermore, research documents negative stereotypes and social rejection of individuals with eating disorder subtypes, while attributions to personal responsibility promote blame and further stigmatization of these individuals. Future research should examine the association of stigma related to eating disorders and physical and emotional health correlates, as well as its role in health-care utilization and treatment outcomes. Additional longitudinal studies assessing how weight stigma influences emotional health and eating disorders can help identify adaptive coping strategies and improve clinical care of individuals with obesity and eating disorders.

Atitudes de nutricionistas em relação a indivíduos obesos – um estudo exploratório

O objetivo foi identificar atitudes de nutricionistas em relação à obesidade; envolvendo crenças sobre características atribuídas às pessoas obesas, fatores de desenvolvimento e a obesidade em si. Os participantes (N = 344; 97,1% mulheres) foram contatados via conselho profissional e responderam a pesquisa online. As questões do estudo foram adaptadas de trabalhos internacionais com as respostas analisadas por frequência de concordância. As respostas indicaram forte estigmatização da obesidade e preconceito contra o obeso, atribuindo características como: guloso (67,4%), não atraente (52,0%), desajeitado (55,1%), sem determinação (43,6%) e preguiçoso (42,3%). E considerando entre os mais importantes fatores causais: alterações emocionais e de humor, vício ou dependência de comida e baixa autoestima. Esta temática deve ser mais pesquisada uma vez que tais atitudes podem impactar a eficácia do tratamento; também para discussão e formação ampla sobre os significados da obesidade, e tratamento mais individualizado e humanizado para pacientes obesos.

Overcoming weight bias: promoting physical activity and psychosocial health

Purpose

– The purpose of this paper is to evaluate Feel WonderFull Fitness (FWF), a program adhering to the Health At Every SizeTM (HAES) paradigm, on larger women's physical activity and psychosocial health. FWF was tailored to overcome barriers based on weight bias.

Design/methodology/approach

– The study compared “overweight” and “obese” women in FWF to those not currently enrolled in formal exercise programs. Controls were divided into low physical activity (LPA) and moderate physical activity (MPA) conditions based on pretest exercise level. Outcome measures were collected at pretest and three months later at posttest.

Findings

– FWF participants had the greatest gains in physical activity and demonstrated significantly greater improvements in depression than the LPA group. FWF and the MPA group showed more improved scores on perceived body attractiveness than the LPA group. Scores on an eating disorders measure improved for all groups, but somewhat more so for the FWF group. Improvements occurred in the absence of weight loss or decreases in body mass index and body fat percentage.

Research limitation

– The study was based on a small, homogenous sample using a quasi-experimental design.

Practical implications

– The study illustrates HAES strategies that practitioners might incorporate into various health and fitness settings.

Social implications

– The study highlights weight bias as a social justice issue and as a barrier to physical activity participation for larger women.

Originality/value

– The study adds to a growing body of literature evaluating HAES approaches, with HAES representing a novel alternative to weight-loss interventions for improving psychosocial health among larger women. It also contributes to the literature on weight bias that has been understudied relative to bias based on other areas of difference.

Weight-Biased Health Professionals and the Effects on Overweight Patients

A significant number of Americans are obese. Weight bias and negative attitudes have been documented among medical professionals, and these may cause obese patients to avoid seeking health care, leading to undiagnosed pathology. Some physicians lack adequate resources and patient counseling skills when addressing patient weight management. This may lead to continued weight problems and associated complications for the patient. Many physicians do not address patient obesity with urgency and determination, even though most physicians consider obesity a widespread, problematic disease. The purpose of this literature review is to assess weight discrimination and negative attitudes among health professionals and how those attitudes affect quality of care for overweight patients. Through these generalizations, sonographers can become aware of their own biases, which may lead to poor patient care.

Physiotherapists demonstrate weight stigma: a cross-sectional survey of Australian physiotherapists

QUESTION

Do physiotherapists demonstrate explicit and implicit weight stigma?

DESIGN

Cross-sectional survey with partial blinding of participants. PARTICIPANTS responded to the Anti-Fat Attitudes questionnaire and physiotherapy case studies with body mass index (BMI) manipulated (normal or overweight/obese). The Anti-Fat Attitudes questionnaire included 13 items scored on a Likert-type scale from 0 to 8. Any score greater than zero indicated explicit weight stigma. Implicit weight stigma was determined by comparing responses to case studies with people of different BMI categories (where responses were quantitative) and by thematic and count analysis for free-text responses.

PARTICIPANTS

Australian physiotherapists (n=265) recruited via industry networks.

RESULTS

The mean item score for the Anti-Fat Attitudes questionnaire was 3.2 (SD 1.1), which indicated explicit weight stigma. The Dislike (2.1, SD 1.2) subscale had a lower mean item score than the Fear (3.9, SD 1.8) and Willpower (4.9, SD 1.5) subscales. There was minimal indication from the case studies that people who are overweight receive different treatment from physiotherapists in clinical parameters such as length of treatment time (p=0.73) or amount of hands-on treatment (p=0.88). However, there were indications of implicit weight stigma in the way participants discussed weight in free-text responses about patient management.

CONCLUSION

Physiotherapists demonstrate weight stigma. This finding is likely to affect the way they communicate with patients about their weight, which may negatively impact their patients. It is recommended that physiotherapists reflect on their own attitudes towards people who are overweight and whether weight stigma influences treatment focus.

The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss

Using an ethical lens, this review evaluates two methods of working within patient care and public health: the weight-normative approach (emphasis on weight and weight loss when defining health and well-being) and the weight-inclusive approach (emphasis on viewing health and well-being as multifaceted while directing efforts toward improving health access and reducing weight stigma). Data reveal that the weight-normative approach is not effective for most people because of high rates of weight regain and cycling from weight loss interventions, which are linked to adverse health and well-being. Its predominant focus on weight may also foster stigma in health care and society, and data show that weight stigma is also linked to adverse health and well-being. In contrast, data support a weight-inclusive approach, which is included in models such as Health at Every Size for improving physical (e.g., blood pressure), behavioral (e.g., binge eating), and psychological (e.g., depression) indices, as well as acceptability of public health messages. Therefore, the weight-inclusive approach upholds nonmaleficience and beneficience, whereas the weight-normative approach does not. We offer a theoretical framework that organizes the research included in this review and discuss how it can guide research efforts and help health professionals intervene with their patients and community.