Specialists in treating eating disorders not immune to fat bias, study suggests

People who specialize in treating eating disorders can carry some of the same anti-fat attitudes and “fat phobia” towards obese people as the rest of society, new research suggests.

In what is being described as the first look at weight bias specifically among psychologists, therapists, social workers and other mental health professionals specializing in eating disorders, Yale University researchers found a considerable percentage believe obese patients have poor self-control, no willpower, and are self-indulgent, unattractive and insecure.

The majority had heard or witnessed other professionals in their field making derogatory comments about obese patients. Nearly half believe obese patients lack the motivation to lose weight.

“Similar to other health disciplines, professionals treating eating disorders are not immune to weight bias,” the researchers write in the International Journal of Eating Disorders. Other studies have found that doctors, nurses and medical students often view obese patients as “lazy,” “stupid” and “worthless,” and that doctors report less respect for their patients the bigger their body mass.

Obese people who feel stigmatized or shamed about their weight are more likely to suffer depression, low self-esteem, anxiety, poor body image and thoughts of suicide. They’re also more likely to binge eat and engage in other disordered eating habits. “Turning to food is sometimes a coping strategy. This just kind of reinforces the cycle,” said author Rebecca Puhl, deputy director of the Rudd Center for Food Policy & Obesity at Yale University in  New Haven, Conn.

“These professionals are likely working with many patients who are struggling with weight and eating difficulties,” Puhl said. “This is such an opportunity for professionals to provide sensitive, compassionate care in ways that can really empower their patients. But instead, what we’re seeing is that these patients are vulnerable to feeling shamed and stigmatized.”

In Canada, more than one in four adults are obese, according to the Public Health Agency of Canada.

For their study, Puhl’s team surveyed 329 mental health specialists. Participants completed anonymous, online questionnaires about their feelings towards treating obese patients. They also completed the “Fat Phobia Scale,” which measures attitudes about obese people using different adjectives.

The vast majority — 94 per cent — agreed that it’s important to treat obese patients with compassion and respect, and most felt confident to provide care for obese people.

However, 56 per cent also reported that they had witnessed colleagues making negative comments about obese patients; 35 per cent agreed that people in their field “feel uncomfortable caring for obese patients.”

Thirty-three per cent agreed that obese people have poor self-control; 16 per cent said they have no willpower; 24 per cent said obese people are unattractive; and 50 per cent said they are insecure. About half,  49 per cent, believed that obese patients lack motivation to change their diet and only 24 per cent believed obese patients can maintain weight loss.

“It’s clearly alarming that people working in the field of eating disorders apparently have this kind of bias because they are amongst the health professionals that people really look to for help,” said Dr. Arya Sharma, professor of medicine and chair of obesity research and management at the University of Alberta in Edmonton.

The eating disorders community has traditionally focused on anorexia, “the other extreme end of the spectrum,” he said.

“They might see the anorexia side of things as being the more acute problem, the problem that requires more attention or care than people suffering from (being) overweight or obesity.”

Many of the therapists in the Yale study were treating a broad range of eating disorders, Puhl said, including binge-eating disorder.

Other experts said the findings should be interpreted with caution. “Yes, there is some bias. But these professionals actually show less weight bias than other health professionals, which I think is a positive outcome,” said Dr. David Lau, a professor of medicine at the University of Calgary.