Mental health professionals treating eating disorders are not immune to weight bias

Some mental health practitioners who treat patients with eating disorders may have their own weight biases that could negatively affect their patients, according to a study by the Yale Rudd Center for Food Policy & Obesity. Although previous research has documented weight bias among other healthcare providers, this is the first to examine it specifically among mental health specialists. The study is published online in the International Journal of Eating Disorders.

Researchers surveyed 329 mental health specialists, asking about their weight biases, views about the causes of obesity, attitudes about treating obese patients, perceptions of treatment compliance of obese patients, and observations of weight bias among other practitioners.

Although the vast majority agreed that it is important to treat obese patients with compassion and respect, and felt confident about their own ability to provide quality care to these individuals, a substantial number said they had observed negative biases among other mental health practitioners. Among the findings:

• 56% reported that they heard or witnessed other professionals in their field making negative comments about obese patients;
• 42% believed that practitioners who treat eating disorders often have negative stereotypes about obese patients;
• 35% reported that their colleagues have negative attitudes toward obese patients and feel uncomfortable caring for them.

In addition, participants expressed pessimism with respect to treatment outcomes of obese patients, despite the confidence they expressed in their ability to treat them:

• Only 36% believe that obese patients comply with treatment recommendations;
• 24% are confident that obese patients can maintain weight loss.

Further, considerable numbers of mental health professionals expressed attitudes that may reflect their own inherent bias toward obese patients. Among the beliefs expressed in the study:

• 33% say that obese individuals have poor self-control; 16% that they have no willpower; and 15% that they are self-indulgent;
• 24% believe obese patients are unattractive; 38% that they are inactive; and 50% that they are insecure.

The authors assert that if obese patients feel stigmatized they may be reluctant to seek care, may cancel or delay appointments, or may postpone seeking important mental health services.

“The relationship that therapists develop with their patients is a critical part of health care delivery and treatment,” said lead author, Rebecca Puhl, deputy director of the Rudd Center. “Efforts are needed to bring attention to the issue of weight bias and its negative consequences for individuals with obesity, as well as initiating stigma reduction efforts in training and clinical practice.”

The paper was co-authored by Janet Latner, associate professor of psychology, University of Hawaii; Kelly King, former Rudd Center research associate; and Joerg Luedicke, Rudd Center statistical consultant.