SILVER SPRING, Md.—New findings show that healthcare professionals hold implicit and explicit weight-biased attitudes towards people with overweight and obesity. The extent and nature of these results, however, are mixed, according to a paper published online in Obesity, The Obesity Society’s flagship journal. The new review is the first meta-analysis of pooled estimates of implicit and explicit weight biases across healthcare disciplines and found no presence of publication bias within the implicit bias pooled effect.
“It is important to emphasize that health care professionals’ endeavor to provide the highest quality of care for their patients, but this review shows that weight-biased attitudes may be present within many healthcare settings. It is important that clinicians are aware of how their attitudes may affect their provision of care when working with people with overweight or obesity,” said Blake Lawrence, PhD, BPsych (Hons), MAPS, research fellow, Western Australia Cancer Prevention Research Unit; Discipline of Psychology, Curtin School of Population Health; associate investigator, Curtin Health Innovation Research Institute; Faculty of Health Sciences. Lawrence is the corresponding author of the paper.
Experts note people living with overweight and obesity rely on healthcare providers when seeking advice to improve their health, and a supportive patient-provider relationship is of the utmost importance for successful, long-term weight loss and improvements in health. Weight bias has been reported in physicians, nurses, dieticians, physiotherapists, psychologists, nutritionists and exercise professionals. Weight biases include assumptions that people living with overweight or obesity are lazy, incompetent, lacking willpower and self-discipline, and not motivated to improve their health, which can lead to depression, anxiety, substance use or suicidality. Longitudinal evidence shows that irrespective of baseline body mass index, adults who experienced weight discrimination have a 60% increased risk of death.
Electronic databases were searched such as MEDLINE, Embase, Web of Science and PsycInfo to identify published articles reporting weight bias in healthcare professionals. Gray literature and pre-print databases were also searched (e.g., OpenGrey, biorxiv, psyrxiv) to identify unpublished manuscripts that were relevant to this topic. Reference lists of previous systematic reviews were searched for relevant articles, and studies were included from 1989–2020. Searches were limited to adult participants.
More than 40 studies consisting of 12,818 healthcare professionals met inclusion criteria with 17 studies providing sufficient data to be meta-analyzed. Among the studies that reported sample demographics, participants were middle-aged and more frequently female. A moderate pooled effect (standardized mean difference = 0.66; 95% CI: 0.37-0.96) showed that healthcare professionals demonstrate implicit weight bias. There was also a large degree of heterogeneity within the pooled effect (Q = 114.99, p < 0.001; I2 = 94.78). Healthcare professionals also report explicit weight bias on the Fat Phobia Scale, Antifat Attitudes Scale and Attitudes Towards Obese Persons Scale. More than 25 different outcomes were used to measure weight bias and the overall quality of evidence was rated as very low. Most studies that used or developed original outcomes did not report sufficient psychometric properties to determine their reliability or validity.
The study’s researchers noted that any future attempts at assessing the extent of weight bias in healthcare professionals must either administer an existing outcome measure with sufficient psychometric properties or use a theoretical framework to develop a global measure, including context-specific sub-scales to assess weight bias across all healthcare disciplines and follow established psychometric conventions for questionnaire development. Researchers have recommended the Type 2 Diabetes Stigma Assessment Scale as an example. Each construct of the assessment scale, as well as the overall factor structure of the questionnaire, demonstrated high internal consistency and sufficient concurrent validity, convergent validity and discriminant validity. After development of a questionnaire, future research also needs to explore potential interventions to reduce weight bias in healthcare settings. Results of the review suggest that improving healthcare professionals’ knowledge of obesity as a disease instead of a lifestyle choice may begin to change their attitudes toward people living with obesity, and therefore, reduce weight bias in healthcare settings.
“Awareness is an important first step toward combatting weight bias. Research is now needed to determine concrete steps that can prevent these negative attitudes from affecting patient care, and how to implement such strategies into healthcare policies and practices,” said Rebecca Pearl, PhD, assistant professor, Department of Clinical and Health Psychology, University of Florida, Gainesville. Pearl was not associated with the research.
Other authors of the study include Deborah Kerr and Christina Pollard of the School of Population Health, Curtin University, Perth, Australia; Elise Alexander, Darren Haywood and Moira O’Connor of the School of Population Health and the Western Australia Cancer Prevention Research Unit, Curtin University, and Mary Theophilus of St. John of God Hospital in Perth, Australia.
The paper, titled “Weight Bias Among Health Care Professionals: A Systematic Review and Meta-Analysis", is published online in Obesity and is freely available. The paper will be published in the November 2021 print issue.
The authors declared no conflicts of interest.
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The Obesity Society (TOS) is the leading organization of scientists and health professionals devoted to understanding and reversing the epidemic of obesity and its adverse health, economic and societal effects. Combining the perspective of researchers, clinicians, policymakers and patients, TOS promotes innovative research, education and evidence-based clinical care to improve the health and well-being of all people with obesity. For more information, visit www.obesity.org.
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