Attitude could affect care patients might get, experts warn
Just 2 percent of those training to be dietitians have positive or neutral attitudes toward people who are obese, and the rest are moderately biased against their prospective patients, a new study has found.
“Essentially, this shows that future dieticians are not immune to weight bias, and there are negative attitudes toward obese patients that may have a negative impact on the quality of care,” said Rebecca Puhl, the study’s lead author and the director of research and stigma initiatives at Yale University’s Rudd Center for Food Policy and Obesity.
Most of the almost 200 dietetic students who participated in the study had pejorative views about the attractiveness, self-control, overeating, insecurity and self-esteem of people who are obese. They also rated obese patients as being less likely than non-obese patients to comply with treatment recommendations. The findings were published in the March issue of the Journal of the American Dietetic Association.
But the students aren’t alone in their beliefs and share the biases with other health-care providers, Puhl said, adding that other studies have shown that many health professionals have negative perceptions about very overweight patients. Patients have reported “very many examples of providers who really make very stereotypical comments that suggest that they are making assumptions about a patient’s character, intelligence or abilities because of their weight,” she said.
Other signs of professional insensitivity, Puhl said, include weighing obese patients on freight scales because scales in a doctor’s office don’t accommodate their weight and not having blood pressure cuffs big enough for a heavy patient.
She said that the attitudes expressed by the dietetic students in the study show a lack of appreciation for how difficult it is to lose weight and for the biological factors involved. Also, the message that obesity results from a lack of self control ignores mounting scientific evidence that it’s difficult to lose weight and keep it off for a sustained period of time, she said.
“Most people, when they walk into an office, have already tried to lose weight and, more likely, they’ve lost weight and regained the weight,” Puhl said. “I think a better understanding and appreciation of the complexities and difficulties of weight loss are needed to reduce the stigma.”
The 182 students who completed the study were from 14 universities and had been enrolled in an undergraduate dietetics program for about two years. With an average age of 23, 92 percent were women, and 85 percent were white.
The researchers asked the students to respond to questions about a normal-weight male and female and an obese male and female. The people they were asked about shared the same health characteristics except for weight.
Dr. Nicholas H.E. Mezitis, an assistant professor of clinical medicine and nutrition at Columbia University College of Physicians and Surgeons, said that the findings might be misleading because of the small number of minority students and the predominance of white females among the participants. “If you get into ethnic communities, such as a black population, they all have different views,” he said. In some groups, he explained, being thin might not be seen as desirable.
“We also have to bear in mind that a lot of what these students are reading in magazines and such are taking them to the other extreme,” Mezitis said. “What’s desirable is very thin, and … these [obese] patients are way on the other extreme.”
Lona Sandon, a spokeswoman for the American Dietetic Association, added that students’ mentors need to provide positive role modeling. “If mentors reflect weight bias, then students are likely to do the same,” she said. “In addition, one’s own attitudes about body image may influence attitudes towards other’s weight.”
The study recommends adding stigma reduction to the standard curriculum for dietetics programs.