Monday, August 16, 2010

Weight Bias Among Dietetics Students

Puhl R, Wharton C, Heuer C. Weight bias among dietetics students: implications for treatment practices. J Am Diet Assoc. 2009 Mar;109(3):438-44.

Rudd Center for Food Policy and Obesity, Yale University, 309 Edwards, New Haven, CT 06520, USA.


BACKGROUND: Several studies have examined attitudes about obesity among food and nutrition professionals, yielding mixed results, and no experimental research has tested the impact of dietitians' attitudes on their treatment practices or health evaluations with obese patients.

OBJECTIVE: This study investigated attitudes of dietetics students toward obese persons and tested whether a patient's body weight influences students' treatment decisions and health evaluations within a randomized experiment.

DESIGN: Between the months of September and December 2007, a convenience sample of 182 dietetics undergraduate students (92% women; mean age 23.1+/-5.4 years) from colleges throughout the United States completed online self-report surveys to assess weight bias (using the Fat Phobia Scale). Participants were also randomly assigned to read one of four mock health profiles of patients who varied only by weight-related characteristics (eg, obese or average weight) and sex (male or female), and asked to make judgments about the patient's health status and participation in treatment.

STATISTICAL ANALYSES PERFORMED: To compare group data, multiple analysis of variance was used to test for an effect of the patient's body mass index on participants' health evaluations and their perceptions of patients in each of the four experimental conditions. Correlations were calculated between mean fat phobia scores and perceptions of patients.

RESULTS: Participants in all conditions expressed a moderate amount of fat phobia (mean=3.7), and students rated obese patients as being less likely to comply with treatment recommendations compared with nonobese patients (P less than 0.05).

Results from multivariate analysis of variance tests showed students also evaluated obese patients' diet quality and health status to be poorer than nonobese patients, despite equivalent nutritional and health information across weight categories for each sex in patient profiles.

In contrast, obese and nonobese patients were rated to be similarly motivated, receptive, and successful in treatment.

CONCLUSION: Implications of these findings for education and intervention in dietetics training are discussed, with emphasis on increasing awareness of weight bias in existing dietetics curricula.

PMID: 19248859

*Comments?  Personal experiences with fat-phobic dieticians? Or size-friendly dieticians?


Cassandra said...

I was working as a medical assistant in a family clinic that included an office for a nutritionist. The clinic owner started up a weight loss program shortly after I began working there, mostly selling powdered shakes and supplement bars while pimping out every expensive service she could manage. She held a meeting with all the providers to say that she would be referring her patients to as many of them as possible - mental health, basic physicals, skin care, cosmetic procedures and of course, the nutritionist. The nutritionist politely declined her advertisement services as she morally disagreed with what she was selling, but would not turn off any patients she did see to the weight loss program. Her lease was terminated and was told she had two weeks to get out. Wonderful lady, very intelligent, very caring. By the way, I was also fired from the clinic for being unsupportive (I was neutral) of the weight loss program even though I worked with the nurse-midwives and urgent care. They love herd mentality there.

darah said...

Ugh. This so brings up memories from when we went on WIC when I was pregnant with my first child. Everyone there treated me so well, were somewhat relieved that I was educated about my own body, etc, except the dietitian. She was awful. She told me I needed to restrict my calories during my pregnancy and gain at the most 10-15 lbs. I'm sure you can imagine her looking me up and down as she says this. She made me feel horrible for having even gotten pregnant in the first place because of my weight.

Luckily I'd been to my midwife the day before where we'd had a much more realistic discussion about my weight and overall health. She told me at that appointment that if it was something I was going to stress out about that she'd rather me just weigh myself at home and report any anomalies or red flags to her.

Dietitians are in such a position to positively impact women and their relationship to food and their bodies. Let's hope it's happening somewhere!

Anonymous said...

She was probably worried about gestational diabetes, since the risk of getting it goes higher with bmi.

But she probably should have told you to only gain about 11- 20 pounds during your pregnancy. Since dieting while pregnant is bad for baby.

Well-Rounded Mama said...

How about if she provided actual NUTRITIONAL guidance instead of trying to make someone meet a rather arbitrary weight guideline?

Care providers can absolutely share what the suggested weight gain guidelines are. But I can't stand it when they emphasize weight gain guidelines over actual NUTRITION, and especially when they suggest manipulating caloric intake in order to meet arbitrary guidelines.

What's more important...that an expecting mother get good nutrition for her baby, or that she meet a random weight guideline whose standards keep changing over time? Meeting the guidelines is NOT a good surrogate for healthy nutrition.

I've written about this issue many times on the blog, dissecting the new wt gain guidelines and their pros and cons, and what evidence supports and doesn't support them. Click on the "prenatal weight gain" category to read them.