A new Australian study asserts that like other health care professionals, physiotherapists stigmatize patients who are overweight and obese, and that this stigma "has the potential to negatively affect physiotherapy treatment."
The findings were based on a 2-part survey in which physiotherapists commented on 3 case studies and then completed the Anti-Fat Attitudes Questionnaire, a 13-item instrument designed to measure explicit weight stigma. The case studies (docx file) presented a mix of patient characteristics that included weight, and directed participants to read the case studies and respond to questions about attitudes and recommendations—a measure of implicit stigma, according to the authors. Results were published online in the July 30 issue of the Journal of Physiotherapy.
After analyzing 265 questionnaires and 520 case study responses, authors found that the physiotherapists demonstrated both explicit and implicit weight stigma. As a group, the physiotherapists responding to the questionnaire showed overtly negative attitudes in all 3 areas measured—the characterization of individuals who are overweight as lacking sufficient willpower, an overall dislike of individuals who are overweight, and a fear of becoming overweight oneself. Of the 3, Australian physiotherapists demonstrated the highest stigma when it came to an attitude that individuals who are overweight lack willpower.
Responses to the case studies also pointed to implicit stigma, though authors write that "there was minimal indication in the clinical parameters tested … that patients in different BMI categories would be treated differently."
Still, they write, 59% of responses mentioned weight management as part of a treatment or referral strategy, and within that subset, researchers identified common thematic threads that they believe "indicated implicit weight stigma: "use of negative language when describing patients, a "focus on weight management to the detriment of other important considerations," the assumption that weight is "individually controllable," the preference for directive or prescriptive—rather than collaborative—responses, and a failure to recognize the complexity of weight management.
"The most common responses were simplistic, implicitly negative, and prescriptive advice," authors write. "It was rare for responses to indicate a more complex consideration of weight or explicitly negative/stereotyping attitudes. These findings align with literature about other health professionals."
Though the study is focused on Australian physiotherapists, Lisa Culver, PT, DPT, MBA, APTA senior specialist in clinical practice, believes that the findings underscore an important point for the profession in general. “It's clear from many studies that overweight and obesity stem from much more than diet and exercise," she said. "There are many contextual factors at work here beyond just the individual, and it is important that physical therapists and physical therapist assistants have a positive impact as motivators and advocates for change for our patients and clients."
"This research begins a critical conversation about physiotherapists and weight stigma," authors write. "There may be value in physiotherapists reflecting on their own attitudes towards patients who are overweight."
APTA offers several resources that emphasize the importance of collaborative approaches to behavior change in patients and clients in many areas, including weight. Offerings on the behavior change webpage include podcasts, measures, and guidance on how to facilitate the change process.
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.
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