Weight bias among exercise and nutrition professionals: a systematic review

Abstract

Obesity affects approximately one-third of American adults. Recent evidence suggests that weight bias may be pervasive among both exercise and nutrition professionals working with adults who have obesity. However, the published literature on this topic is limited. This review aimed to (i) systematically review existing literature examining weight bias among exercise and nutrition professionals; (ii) discuss the implications of this evidence for exercise and nutrition professionals and their clients; (iii) address gaps and limitations of this literature; and (iv) identify future research directions. Of the 31 studies that met the criteria for this review, 20 examined weight bias among exercise professionals, of which 17 (85%) found evidence of weight bias among professionals practicing physical therapy (n = 4), physical education (n = 8) and personal/group fitness training (n = 5). Of 11 studies examining weight bias among nutrition professionals, eight (73%) found evidence of weight bias. These findings demonstrate fairly consistent evidence of weight bias among exercise and nutrition professionals. However, the majority of studies were cross-sectional (90%). Given that weight bias may compromise quality of care and potentially reinforce weight gain and associated negative health consequences in patients with obesity, it is imperative for future work to examine the causes and consequences of weight bias within exercise and nutrition professions using more rigorous study designs.

Clinical care for obesity: A preliminary survey of sixty‐eight countries

“…These responses describe an underlying attitude to obesity treatment held by health care professionals that emphasizes the need for behaviour change and personal commitment, and the corollary assumption that treatment failure is a lack of commitment. Patients may react to these assumptions negatively and cease to attend treatment sessions in turn confirming the professionals' biases …”

“…Patients may react to these assumptions negatively and cease to attend treatment sessions in turn confirming the professionals' biases. 11,12 For health professionals and some patients, classifying obesity as a disease may help overcome the assumption that obesity is an individual responsibility and that treatment failure reflects the lack of a personal commitment. Moves to have obesity formally accepted as a disease by governments, health professionals and health insurers were…”

Developing meaningful client‐dietitian relationships in the chronic disease context: An exploration of dietitians' perspectives

“…The finding that dietitians' values, beliefs and opinions and their health, can influence relationship development reflects the need to consider our own lens as dietitians: who we are, what we bring to the relationship and what impact it may have. Research suggests dietitians can show weight stigma towards clients, 28, 29 whilst a cross‐sectional study 30 surveyed dietitians about their management of obesity and found they experienced frustrations with clients' lack of motivation, commitment and compliance. Furthermore, Diversi et al 28 acknowledge the negative impact these emotions may have on client‐dietitian relationships.…”

Participants’ Perceptions of “C.H.A.M.P. Families”: A Parent-Focused Intervention Targeting Paediatric Overweight and Obesity

“…In addition to the importance of the group environment, participants emphasized that their experience in the program was enhanced by the rapport developed between themselves (including their children) and the Project Coordinator whom they described as likeable, engaging, and non-judgmental. Weight bias among primary care providers [89,90], as well as exercise and nutrition professionals [91], has been well-documented in the literature and has been shown to compromise patient outcomes and quality of care [92]. Furthermore, perceptions of judgment from health professionals can have a negative effect on weight loss [93].…”