Puhl R, Wharton C, Heuer C. Weight bias among dietetics students: implications for treatment practices. J Am Diet Assoc. 2009 Mar;109(3):438-44.
Rudd Center for Food Policy and Obesity, Yale University, 309 Edwards, New Haven, CT 06520, USA.
BACKGROUND: Several studies have examined attitudes about obesity among food and nutrition professionals, yielding mixed results, and no experimental research has tested the impact of dietitians' attitudes on their treatment practices or health evaluations with obese patients.
OBJECTIVE: This study investigated attitudes of dietetics students toward obese persons and tested whether a patient's body weight influences students' treatment decisions and health evaluations within a randomized experiment.
DESIGN: Between the months of September and December 2007, a convenience sample of 182 dietetics undergraduate students (92% women; mean age 23.1+/-5.4 years) from colleges throughout the United States completed online self-report surveys to assess weight bias (using the Fat Phobia Scale). Participants were also randomly assigned to read one of four mock health profiles of patients who varied only by weight-related characteristics (eg, obese or average weight) and sex (male or female), and asked to make judgments about the patient's health status and participation in treatment.
STATISTICAL ANALYSES PERFORMED: To compare group data, multiple analysis of variance was used to test for an effect of the patient's body mass index on participants' health evaluations and their perceptions of patients in each of the four experimental conditions. Correlations were calculated between mean fat phobia scores and perceptions of patients.
RESULTS: Participants in all conditions expressed a moderate amount of fat phobia (mean=3.7), and students rated obese patients as being less likely to comply with treatment recommendations compared with nonobese patients (P less than 0.05).
Results from multivariate analysis of variance tests showed students also evaluated obese patients' diet quality and health status to be poorer than nonobese patients, despite equivalent nutritional and health information across weight categories for each sex in patient profiles.
In contrast, obese and nonobese patients were rated to be similarly motivated, receptive, and successful in treatment.
CONCLUSION: Implications of these findings for education and intervention in dietetics training are discussed, with emphasis on increasing awareness of weight bias in existing dietetics curricula.
*Comments? Personal experiences with fat-phobic dieticians? Or size-friendly dieticians?