Weight Stigmatization among Physical Therapy Students and Registered Physical Therapists

Abstract

Introduction: Weight stigmatization is reflected in anti-fat attitudes and stereotypical perceptions of people who are overweight; it has been demonstrated to be prevalent in many segments of society across multiple countries. Studies examining the prevalence of weight stigmatization use different research tools, which can hinder inter-study comparisons. There is also evidence indicating weight stigmatization among registered physical therapists, although its magnitude differs between studies. Limited information exists regarding the attitudes and beliefs of physical therapy (PT) students toward individuals with obesity. Examining weight stigmatization among PT students is particularly important for developing appropriate educational interventions that may influence the professional lives of future physical therapists. Objective: This study aims to characterize and compare the stigmatizing attitudes and beliefs of PT students and certified physical therapists regarding people with obesity in Israel. Its secondary objective is to translate three weight stigmatization questionnaires into Hebrew and determine their psychometric properties. Methods: A cross-sectional, anonymous, and computerized self-report survey was completed by 285 certified physical therapists (average age 39.6 ± 10.1 years) and 115 PT students (average age 26.4 ± 4.9 years). The study used three validated weight stigma questionnaires employed in earlier studies to determine different aspects of weight stigmatization: the Fat Phobia Scale (short form; FPS), Anti-Fat Attitudes (AFA) questionnaire, and Beliefs about Obese People (BAOP). These questionnaires were translated into Hebrew and their psychometric properties ascertained. Results: Similar to the original English versions, the translated versions of the three question-naires demonstrated good internal consistency (Cronbach's α values of FPS = 0.77; AFA = 0.75; BOAP = 0.59). The three questionnaires showed a low correlation. No significant difference was noted in the FPS and AFA scores between groups, reflecting that both demonstrated average weight stigmatization (FBS in both groups: average score of 3.6 out of 5; AFA therapists: 3.3 ± 1.2, students: 3.0 ± 1.2 out of 9). However, significant between-group differences were observed for BOAP, which examines beliefs regarding individuals' control over their weight (therapists: 16.4 ± 5.6, students: 18.0 ± 5.7 out of 48; p < 0.01). Conclusion: Student and certified physical therapists demonstrate average levels of weight stigmatization, as reflected in the FPS and AFA scores. Nevertheless, compared to certified physical therapists, physical therapist students believe more strongly that obesity cannot be controlled by the individual. The students' beliefs could affect their clinical judgment and behavior as health care professionals in the future. Therefore, anti-fat attitudes and stereotypical perceptions should be addressed and remediated early using educational interventions during the study period.

Weight bias among health care professionals: A systematic review and meta‐analysis

“…Studies were published between 1989 and 2020, with one study (50) included from gray literature. Seven studies (39,51‐56) examined the extent of weight bias in a multidisciplinary group of HCPs, twelve studies (21,42,49,50,57‐64) examined weight bias in nurses, twelve studies (20,35,38,41,43,65‐71) in physicians/medical doctors, five studies (22,40,72‐74) in dietitians, three studies (23,75,76) in physiotherapists/physical therapists, and one study in psychologists (24) and physician assistants (77). Seven studies (20,21,53,64,66,71,73) examined implicit weight bias measured by the Weight Implicit Association Test, and the remaining studies examined explicit weight bias using 26 different methods.…”

Obesity bias and stigma, attitudes and beliefs among entry-level physiotherapy students in the Republic of Ireland: a cross sectional study

“…Like students in Asia [16], most of the physiotherapy students in this study were aware of multiple causes of obesity, but they overwhelmingly believed that obesity was due to behavioural factors that could be controlled by the individual. They almost universally agreed that physical inactivity, followed by overeating and poor nutrition were the most important causes of obesity.…”

“…A recent systematic review exploring weight stigmatisation in physiotherapy reported explicit weight stigma in six of the seven included studies, with the majority of physiotherapists describing people with increased weight as 'noncompliant' and 'unmotivated' [14]. Yet, in terms of beliefs about obesity, most physiotherapists agree that obesity is a legitimate health issue and that physiotherapy can play a central role in its management through exercise interventions, mobility training and cardiorespiratory programmes for associated impairments [15,16].…”

“…The main focus of the study, however, was knowledge and health related risk associated with obesity. A recent study conducted in Asia compared weight stigmatisation between practising physiotherapists and physiotherapy students and found both groups demonstrated average levels of stigmatisation with students believing more strongly that obesity can be controlled by the individual [16].…”

Do Registered Dietitians, Nutrition Students, and Laypeople Perceive Individuals with Obesity Differently?

“…Placing blame for weight gain solely on the individual conflicts with the World Obesity Federation's classification of obesity as a disease that requires collaborative action by health professionals, policy-makers, and industry [25,26]. Substantial evidence has demonstrated that healthcare professionals, including physicians, nurses, medical students, physical therapists, exercise professionals, and nutrition professionals, hold stereotypes and negative attitudes toward patients with obesity [10,[27][28][29].…”