The prevalence and practice impact of weight bias among New Zealand registered dietitians

Abstract

This study explored demographics and three characteristics of registered dietitians-optimism, perfectionism, and weight bias and whether they affect three components of dietetics practice-dietetics assessment, dietetics recommendations, and dietitian's perception of the client's success. Methods: A self-administered questionnaire was completed by 92 registered dietitians and student dietitians in New Zealand to assess explicit weight bias.[Correction added on 27 January 2023, after first online publication: in the preceding sentence, '109 registered dietitians' has been updated to '92 registered dietitians'.] Participants were randomised to receive a case study for a condition unrelated to weight accompanied by a photo of a woman with either a smaller or a larger body. Participants then assessed the client based on data provided, provided recommendations, and rated their perception of the client.Results: Mean (±SD) scores indicated mild fatphobia (2.63±0.39) in participating dietitians. Dietitians presented with the photo of a larger client assessed the client to have lower health and were more likely to provide unsolicited weight management recommendations. Additionally, dietitians rated the larger client as less receptive and motivated, and less likely to understand the recommendations adequately, with a lower ability to comply with and maintain these recommendations. Conclusions: Dietitians and student dietitians in New Zealand may practise in a manner that could be perceived as influenced by negative implicit weight bias, despite the explicit fatphobia scale scores assessing only mild fatphobia.Further research examining the extent of the problem in New Zealand, how it impacts client outcomes, and possible solutions are required.

Is individual competency enough? Challenges for the dietetics profession to be leaders in nutrition

“…Similarly to our Reconciliation Action Group authors, Roy et al, 8 in their work on weight bias amongst dietitians, challenge long‐standing biases of which the profession may have been accused. Professionals may not like measuring practice that may highlight inadequacies or areas for improvement.…”

“Whatever I said didn’t register with her”: medical fatphobia and interactional and relational disconnect in healthcare encounters

“…Healthcare practitioners frequently spend less time with overweight patients (Phelan et al, 2015) and are often reported to be rude and disrespectful or even verbally abusive (Ananthakumar et al, 2020). In these shorter consultations, practitioners are also likely to disproportionately focus on weight at the expense of the actual reason for the patients' visit (Roy et al, 2023) and may 'weaponize' weight shame and stigma, albeit ineffectively, to encourage weight loss (Williams and Annandale, 2020).…”

Prompting lifestyle interventions to promote weight loss is safe, effective and patient-centred: No

“…30 Recent research with NZ dietitians shows negative implicit weight bias in their clinical management of patients. 31 Fatphobia in medicine is difficult for health providers to navigate, and there is limited support or training. General practitioners (GPs) in NZ experience disempowerment regarding their ability to 'treat' obesity in their patients.…”