Compare HAES® and other physiotherapists’ understandings of, and clinical practices relating to, weight stigma, including how it manifests and practices which disrupt it.
We completed a narrative inquiry study informed by a public advisory board with lived experience of weight stigma in health care. We generated data using a story completion method followed by 70–90 minute semi-structured interviews with a purposive sample of 11 physiotherapists from Australia, Canada, and the USA. Sampling emphasized a mix of physiotherapists practicing Health At Every Size® and those without anti-weight stigma training. Multiple interview techniques emphasized the telling and interpreting of stories. The primary analysis approach was socionarratology (Frank, 2010).
Participants ranged from those explicitly espousing anti-fatness and pro-thinness beliefs as a basis for physiotherapy practice to those who have taken up sophisticated ways to disrupt it. The latter developed a critical consciousness about weight, weight stigma, and ‘diet culture’ mainly on their own, outside of the profession. At the core of this development was learning to trouble the common story in their societies and in physiotherapy: that weight is a simple reflection of lifestyle and willpower. Instead, they reframed the trouble as that of navigating weight stigma, as it manifests internally, interpersonally, and structurally. Those with a critical consciousness of weight stigma used the narrative features of luck and ‘a journey’ to describe their transformation into their present self, aided by mentors from other backgrounds, their own experiences of recovery from disordered eating and exercise behaviors, and/or engaging with HAES® and trauma-informed care sources. They repeatedly returned to the idea of patients’ experiences and feelings, describing patients as whole, complex characters facing high stakes situations, where their needs are often unrecognized and unmet.
Physiotherapists demonstrating a critical consciousness of weight stigma and practice had to learn to work against the grain of what they were formerly taught, both in physiotherapy education and more broadly. Future research should address how weight stigmatization is reproduced and/or disrupted in physiotherapy education, and ethnographic studies of physiotherapy sites can inform dialogue about weight-inclusive practices within the profession.
If physiotherapy seeks to be an inclusive, health-enhancing profession, learning to disrupt stigmatization on the basis of bodily fatness should not depend on luck. A concerted effort is needed to disrupt anti-fatness and pro-thinness as it manifests in education and practice.
narrative inquiry
equitable care
