By Carli Friedman, CQL Director of Research
Fat1 people face a significant amount of stigma and discrimination, despite the fact that weight is determined by a combination of biological, social, and environmental factors – people’s weight is not necessarily within their control (Daníelsdóttir et al., 2010). While anti-fat bias is pervasive in society, it can be particularly problematic among health care professionals because it directly impacts the health care and services people receive. In fact, health care professionals’ anti-fat biases contribute to health disparities and poorer health outcomes for fat people (Brewis et al., 2018; O’Brien et al., 2010; Ramos Salas et al., 2017). For example, shaming people about their health not only does not result in weight loss, it actually negatively impacts people’s physical and mental health and can result in people gaining weight (Alberga et al., 2016; Brewis et al., 2018; Daníelsdóttir et al., 2010; Miller Jr et al., 2013; Tomiyama et al., 2018). For these reasons, the aim of this study was to examine the anti-fat biases of occupational and physical therapy assistants. To do so, we analyzed data about 5,671 occupational and physical therapy assistants’ implicit (unconscious) attitudes about weight.
Our findings revealed the overwhelming majority of occupational and physical therapy assistants – 82.4% – had implicit anti-fat bias (see figure); in fact, 38.7% had strong biases against fat people.
Implicit Anti-Fat Attitudes
In addition, a number of factors were associated with occupational and physical therapy assistants having more anti-fat bias. For example, older occupational and physical therapy assistants and occupational and physical therapy assistants that were men had more anti-fat bias than younger and women occupational and physical therapy assistants, respectively. Meanwhile, occupational and physical therapy assistants who said their weight was very or extremely important to their sense of self were more biased against fat people.
“Not only do fat people deserve equal and unbiased health care regardless of if they can control their weight or not, empathy is key to creating a trusting therapeutic relationship… Results from this study demand that educators and health care administrators recognize the impact these attitudes can have on the therapeutic relationship as well as how they might impact the rehabilitation outcomes and quality of life of fat clients” (Friedman et al., 2021, pp. 13-16)
- Alberga, A., Pickering, B., Alix Hayden, K., Ball, G., Edwards, A., Jelinski, S., Nutter, S., Oddie, S., Sharma, A., & Russell‐Mayhew, S. (2016). Weight bias reduction in health professionals: a systematic review. Clinical obesity, 6(3), 175-188. https://doi.org/10.1111/cob.12147
- Brewis, A., SturtzSreetharan, C., & Wutich, A. (2018). Obesity stigma as a globalizing health challenge. Globalization and health, 14(20), 1-6. https://doi.org/10.1186/s12992-018-0337-x
- Daníelsdóttir, S., O’Brien, K. S., & Ciao, A. (2010). Anti-fat prejudice reduction: A review of published studies. Obesity facts, 3(1), 47-58. https://doi.org/10.1159/000277067
- Fikkan, J. L., & Rothblum, E. D. (2012). Is fat a feminist issue? Exploring the gendered nature of weight bias. Sex roles, 66(9-10), 575-592. https://doi.org/10.1007/s11199-011-0022-5
- Friedman, C., Feldner, H., & VanPuymbrouck, L. (2021). Anti-Fat biases of occupational and physical therapy assistants. Occupational Therapy in Health Care. Advanced online publication. https://doi.org/10.1080/07380577.2021.1972380
- Miller Jr, D. P., Spangler, J. G., Vitolins, M. Z., Davis, M. S. W., Ip, E. H., Marion, G. S., & Crandall, S. J. (2013). Are medical students aware of their anti-obesity bias? Academic medicine: Journal of the Association of American Medical Colleges, 88(7), 978-982. https://doi.org/10.1097/ACM.0b013e318294f817
- O’Brien, K. S., Puhl, R. M., Latner, J. D., Mir, A. S., & Hunter, J. A. (2010). Reducing anti‐fat prejudice in preservice health students: a randomized trial. Obesity, 18(11), 2138-2144. https://doi.org/10.1038/oby.2010.79
- Ramos Salas, X., Alberga, A., Cameron, E., Estey, L., Forhan, M., Kirk, S., Russell‐Mayhew, S., & Sharma, A. (2017). Addressing weight bias and discrimination: Moving beyond raising awareness to creating change. Obesity Reviews, 18(11), 1323-1335. https://doi.org/10.1111/obr.12592
- Tomiyama, A. J., Carr, D., Granberg, E. M., Major, B., Robinson, E., Sutin, A. R., & Brewis, A. (2018). How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC medicine, 16(1), 123-129. https://doi.org/10.1186/s12916-018-1116-5
- Vartanian, L. (2010). “Obese people” vs “Fat people”: Impact of group label on weight bias. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 15(3), e195-e198. https://doi.org/10.1007/BF03325299
1 The word ‘fat’ is used, rather than other descriptors, for the reasons detailed by Fikkan and Rothblum (2012): “we prefer to use the term ‘fat,’ as it is descriptive, whereas the term ‘overweight’ implies unfavorable comparison to a normative standard and ‘obese’ is a medical term with its own negative connotations” (p. 577). In addition, Vartanian (2010) found the word ‘obese’ produces more stigma than ‘fat people’.
Anti-Fat Bias in Health Care