WEIGHT STIGMATISATION IN PHYSICAL THERAPY: A SYSTEMATIC REVIEW

Cavaleri R.¹, Short T.¹, Karunaratne S.¹, Chipchase L.¹

¹Western Sydney University, School of Science and Health, Sydney, Australia

Background: Obesity is now recognised as a multifaceted chronic health condition. Despite this, weight stigmatisation continues to pervade education, employment and the media. Such stigmatisation is known to impact the health and well-being of individuals who are overweight and obese. Increasing attention is therefore being given to weight stigmatisation in healthcare settings. Physical therapists play an integral role in the provision of health care to individuals who are overweight or obese. This includes not only direct weight management, but also interventions targeting weight-related comorbidities. Weight stigmatisation in physical therapy may consequently impede patient progress and lead to sub-optimal health care delivery. Despite these considerations, no systematic reviews have investigated the prevalence or impact of weight stigmatisation in physical therapy.

Purpose: To review the available research regarding
i) weight stigmatisation among physical therapists and
ii) the ways in which weight stigma is perceived by physical therapy patients.

Methods: Database searches identified quantitative and qualitative studies published before 2016. Two reviewers independently performed data extraction and assessments of methodological quality. Outcome measures included explicit attitudes, implicit attitudes, and patient perceptions of obesity management. Explicit stigma was defined as a conscious process measured through self-report questionnaires, while implicit stigma was defined as an unconscious process measured by eliciting automatic responses from participants without their awareness. The evidence was synthesised descriptively and papers were appraised using the Hawker checklist for disparate data.

Results: Seven high quality studies were included. Explicit weight stigmatisation was a common finding, with the majority of physical therapists across the six studies in this area describing people with increased weight in general as ‘noncompliant’ and ‘unmotivated’. ‘Physical inactivity’ and ‘overeating’ were perceived to be the main causes of high body weight, with little acknowledgement of broader contextual influences. One study explored implicit weight stigma, demonstrating that this too is common in physical therapy practice, but that it may not influence treatment decisions. The single study that explored patient perceptions of weight stigma found that patients believed physical environments (including narrow plinths and posters of ‘healthy’ people) and paternalistic communication styles propagate weight stigmatisation in physical therapy practices.

Conclusion(s): Both explicit and implicit weight stigmatisation are common in physical therapy. While this stigmatisation may not directly influence treatment choices, it is often perceived by patients, who may feel unmotivated or ignored as a result. The atmosphere and environment of a physical therapy practice itself may also lead to discomfort or embarrassment among individuals who are overweight.

Implications: Many physical therapists do not fully appreciate the multifaceted nature of weight gain. Individuals who are overweight or obese often perceive weight stigmatisation from physical therapists who adopt didactic or paternalistic communication styles. Focusing upon developing rapport, rather than weight education, may therefore be more beneficial during the early phases of a weight management program. Use of wider plinths, equipment with higher recommendations for maximum weight, and fewer posters portraying thin individuals as ‘healthy’ may reduce perceptions of weight stigmatisation. Future research into weight stigmatisation is required in order to assist in the development of appropriate preventative strategies.

Funding acknowledgements: None.

Topic: Professional issues

Ethics approval: Ethical approval was not required for this systematic review.

All authors, affiliations and abstracts have been published as submitted.