Helen is a 37 year old woman coming in for her first psychotherapy session today. She has been feeling anxious, down, and irritable for quite some time. Recently, this has begun to get in the way of work and her relationship with her husband. Sometimes when she feels overwhelmed, Helen will head to the pantry and grab a handful of cookies to comfort or distract herself; in these moments, she’s careful to make sure that her husband can’t see what she is doing. In the past year, Helen has gained weight and she was recently made aware by her physician that her body mass index has moved from the lower end of the overweight range towards the cusp of obesity. She has put off starting psychotherapy for months, worrying, “What if my therapist doesn’t like me or doesn’t want to work with me because of my weight? Will she think I’m unmotivated or lazy?”
Helen’s fears are not unfounded. Many people experience weight bias in their day-to-day lives– catcalls while walking down the street, well-meaning family members who make insensitive comments, snide remarks overheard in the break room at work. Unfortunately, even mental health professionals—psychologists, psychiatrists, counselors, and social workers alike—can sometimes unintentionally do or say things that negatively impact the care of our higher weight patients.
How does weight stigma impact individuals seeking mental health services?
- Research shows that people may be less likely to go to the doctor and get the help they need if they think their doctor will stigmatize them for their weight.
- When someone is teased or mistreated because of their weight (wherever it falls on the weight spectrum), they become more vulnerable to developing mental health issues like anxiety and depression. Experiencing weight stigma can put someone at risk for worsened mood and anxiety, unhealthy dieting, binge eating, and other symptoms of eating disorders.
- Obese patients are often the targets of offensive humor and negative attitudes by health-care providers and even eating disorder specialists.
These stats are discouraging at first blush, especially when we clinicians try so hard to stay attuned to our patients’ needs, empathic towards their concerns, and mindful of our own reactions to them. But, there is good news for both clinicians and patients alike. First, the vast majority of mental health workers believe that their overweight and obese clients are deserving of compassion, respect, and appropriate treatment. Second, there are things that clinicians can do to reduce any weight biases they might harbor, and there are ways to interact with higher weight individuals that can improve their experience in treatment.
What can mental health clinicians do to more effectively help higher weight patients?
- Become aware of your weight biases by asking yourself: “What automatic judgments do I make about patients based upon their weight?” and “What impact might these judgments have on my ability to care for my patient?” There are a number of helpful tools for this kind of self-assessment available through the Rudd Center for Food Policy and Obesity.
- Keep yourself and your patients focused on all possible markers of health, not just the number on the scale. What strategies might improve sleep? Would relaxation techniques help with regulating stress and blood pressure? If the patient describes cycles of binge eating, eating in response to distressing emotions, or crash dieting, create goals that address changing these behaviors (regardless of what does or does not change about weight) while exploring potential connections between emotions and eating.
- Ask about the impact of weight bias in individuals’ lives. Acknowledge that these experiences are real, really upsetting and unfair, and all-too-common. Work on challenging maladaptive thoughts that might have resulted from such experiences (such as, “I keep struggling with my weight because I’m weak.”). Don’t forget to ask about internalized weight bias (one’s own negative beliefs about what weight might mean about oneself).
Helen has taken a brave step in seeking out treatment, despite her reservations about how she might be negatively judged by her therapist. If her therapist can put Helen’s fears to rest, treatment is more likely to effectively target her symptoms.
For more information about how to reduce weight bias in clinical practice, check out the Rudd Center for Food Policy and Obesity’s Toolkit for Preventing Weight Bias: Helping without Harming in Clinical Practice.