Clinicians' Corner

4 Tips for Addressing Anti-Fat Bias as a Clinician

People in larger bodies face discrimination due to their weight across all settings of life, from school to the workplace to a physician’s office.  In fact, it appears that weight discrimination is as prevalent as racial discrimination, particularly for women.  This discrimination can come from institutional policies, such as a Body Mass Index (BMI) cut-off to receiving a workplace benefit, or from other individuals, in the form of name-calling, for example.  Recent research tells us that not only are these experiences associated with psychological distress; they’re also linked to many of the behaviors we see among individuals with eating disorders, including binge eating and skipping meals.  We also know that people with certain eating disorders, particularly binge-eating disorder, are likely to be in larger bodies.  Therefore, it’s likely that many of the patients we see in an eating disorder treatment setting have experienced weight discrimination at some point in their lives.  Possibly even when seeking help for disordered eating: healthcare providers, dieticians, and yes, even therapists who specialize in eating disorders have demonstrated implicit and explicit weight bias in studies on the topic (PS: for more from us on mental health clinicians and weight stigma, click here).

It’s no surprise that experiencing weight bias can negatively impact a patient’s relationship with their clinician, and it’s likely that the same could be true between a patient and their therapist.  So in order to be our most effective selves as treatment providers, what’s a clinician to do? 

Here are four ways to address your own weight bias:

  1. Raise your awareness: Start by taking the Implicit Association Test (IAT) for weight bias, a quick, online test that measures beliefs and attitudes about weight that exist outside your awareness.  Next, learn more about how implicit bias can impact our behavior.  Implicit bias is sneaky and its effects on your behavior are automatic.  Acknowledging and accepting its existence and effects are crucial first steps towards making changes.
  2. Learn about weight: Most Americans believe that weight status is influenced by diet and exercise alone, and that losing weight is a matter of willpower.  These types of beliefs likely support weight bias, as they blame the individual for weight status.  In fact, weight appears to be much more complex than calories-in, calories-out (think genetics and your environment, for starters).  Simply learning more about our current understanding of weight can reduce your explicit and implicit biases, and make you a valuable addition to the conversation when weight comes up.  If you’re looking for ways to approach this with patients who believe that total control of their weight is possible, check here for some tips.
  3. Cultivate your mindfulness skills:  Talking about weight and a patient’s experience of discrimination can bring up uncomfortable feelings, due in part to our own set of beliefs or judgements about weight.  But avoiding these sticky topics can interfere with treatment effectiveness: after all, internalized weight bias among patients in larger bodies is likely tied to eating disorder symptoms.  Mindfulness practice, and in particular, lovingkindness meditation, can reduce stress in challenging situations, increase compassion for others and even lower the likelihood that implicit bias is activated in the first place.
  4. Look to others: Role models are important in shaping our implicit and explicit weight biases.  If you’re still in training, look for supervisors that emulate the kind of attitudes you’re hoping to develop about weight.  Further in your career?  Check out fat positive resources (here or here, for starters) to find colleagues you can look up to.  Ready to be that colleague for others?  Model the use of non-stigmatizing language in consultation and address weight discrimination non-judgmentally when it arises in your workplace.

The bottom line on weight bias?  Let’s acknowledge its existence, build awareness of its impact and work to address it personally, for the benefit of our patients. 

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