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  • Australian Study: Physiotherapists Demonstrate 'Weight Stigma'

    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.


    • I have been a PT for 43 years...as far as I can tell, PT is still tied into the Western Medical Mind...or at least many are...Weight is tied to many things; most overweight or obese people, who are treated with the traditional medical model are not treated holistically...the weight leads to this or that, scare tactics. Weight is a complex issue that needs a thoughtful approach that looks at the whole person, and does not seek to shame them, or to scare them. They are already afraid, and ashamed. I have many therapists with this bias. I hope studies like this one can open some eyes and some hearts...it is clear, at least in America, that weight is a huge issue which is getting bigger and bigger, and understanding this problem, and ways to help, is critical. Understanding the difference between nutrition and drug and food industry advice is critical. Understanding underlying brain chemistry, and ways to promote healthier lifestyles is critical. And understanding that, in this country, many rural people grocery shop in gas stations, and have no sidewalks, and may be a long way from access to organic, healthy food. They absorb ads from the food industry hawking very unhealthy processed food... They eat at restaurants that lack any semblance of healthy food. We, as physical therapists, need to wake up to all of these factors, and stand up to the government entities, such as the Department of Agriculture, or the FDA, and denounce practices that put people in the loop of diabetes, chronic inflammatory diseases, etc. We need to be encouragers of health, not discouragers of the unhealthy...

      Posted by Nancy Witt on 8/11/2014 7:20 PM

    • Stigma vs patients is not only at this level. I have seen it also with other kind of patients. patients with mental health, sexual preference etc. As therapists our job is to treat,educate with better life styles, and attempt at improving someones medical and general status. But it is not our job to judge and express preconceived attitudes towards our patients. It becomes unethical If so and one is not in the good profession. You may have a preference in a clientele but the care you provide should be equal and ethical for all patients.

      Posted by Marie on 8/11/2014 10:02 PM

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