Study reveals mental health’s weight bias

Weight Bias
Photo by Karen Tian.

According to Yale’s Rudd Center for Food Policy & Obesity, mental health professionals treating patients with eating disorders are hardly immune to weight bias.

Previous research teams have tackled the question of how mental health professionals view their obese patients. A 2003 study published in the journal Obesity Research used an Implicit Associations Test, or IAT — a timed association test that aims to uncover unconscious biases — to show that practitioners exhibited significant weight-related biases against their obese patients. The IAT was also used to show that doctors thought obese patients endorsed the implicit stereotypes associated with obesity such as “laziness, stupidity and worthlessness.”

This new study, which can be found in the latest edition of the annual International Journal of Eating Disorders, takes a more specialized look at mental health practitioners’ biases 10 years later, in a world where obesity is more prevalent. Rudd Center Deputy Director and study coauthor Rebecca Puhl emphasized the current importance of studying this issue.

“Given that many individuals who struggle with eating disorders also struggle with weight, and in light of research showing that individuals who experience weight stigma are at risk for developing symptoms of eating disorders, this is an important group of providers to be reaching,” Puhl said in a Thursday email.

Researchers asked 329 mental health practicioners treating eating disorders about their perceptions of their patients and colleagues. Of the study’s participants, 42 percent believed that mental health professionals specializing in eating disorders often have negative weight biases against obese patients. Other results supported this finding — 56 percent of mental health professionals had heard colleagues make negative comments about patients’ obesity, 35 percent reported that their colleagues feel uncomfortable treating their obese patients and 64 percent believe that obese patients do not follow recommended courses of treatment. The professionals themselves also displayed a lack of faith in obese patients — 76 percent said they are not confident that obese patients can maintain weight loss, with 16 percent claiming that they think obese patients have “no willpower.”

Even though 88 percent of professionals in the study reported that they feel “confident and professionally prepared” to treat obese patients, these results suggest a need for changes to the field.

“Our hope is that these findings will help increase attention to the issue of weight bias and serve as the starting point for discussions on how to implement efforts to reduce stigma as part of training and clinical practice,” Puhl said.

The research team has also laid out some more specific plans for how to fix the problem. According to the study, such measures are needed to ensure patients seek help and do not feel stigmatized by health professionals.

“A first step is for clinicians to identify their personal attitudes or assumptions about weight, as well as the language that they use when talking about weight, that might unintentionally interfere with their ability to effectively treat patients of diverse body sizes,” Puhl said. She added that she believes educational interventions highlighting obesity causes and challenging weight stereotypes could prove effective in reducing weight bias.

Lewis Landsberg, Director of Northwestern University’s Comprehensive Center on Obesity, said he was “not at all surprised” by the study’s conclusions.

“The obese are always stigmatized as having no self-discipline, no willpower, even when there are important biological differences between lean and obese people,” he said. “There is a whole trend in the field of obesity in getting away from thinking about obesity as a character flaw.”

In addition to Puhl, the study was coauthored by associate professor of psychology Janet Latner of University of Hawaii, former Rudd Center research associate Kelly King and Rudd Center statistical consultant Joerg Luedicke.

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