Academic journal article Journal of Marital and Family Therapy

Marriage and Family Therapy Trainees Reports of Explicit Weight Bias

Academic journal article Journal of Marital and Family Therapy

Marriage and Family Therapy Trainees Reports of Explicit Weight Bias

Article excerpt

The concerns that clients present in therapy are often dually focused on health and relational factors. As such, it is likely that marriage and family therapists (MFTs) will work with individuals embedded in families who are struggling with their weight and dietary and physical activity behaviors (weight-related behaviors). Training and use of theories specific to restrictive eating disorders (i.e., anorexia nervosa) are common in MFT practice, yet working with clients, who may be overweight, and their families on weight-related behaviors has not been recognized as an area to formally develop clinicians' competence. Principle I of the American Association for Marriage and Family Therapy (AAMFT) Code of Ethics states that MFTs should provide services to persons without discrimination and should respect those who are seeking services (American Association for Marriage & Family Therapy, 2012). While MFT programs emphasize diversity and sensitivity training for vulnerable and oppressed populations to prevent further injustices from occurring in the therapy room (Blumer, Green, Knowles, & Williams, 2012; Seedall, Holtrop, & Parra-Cardona, 2014), trainings focused on how to engage clients who are overweight and to prevent possible weight bias from occurring are rare. The purpose of this study was to examine the prevalence of weight bias in a sample of MFT student/trainees, and concluded with methods for incorporating weight bias training in MFT programs.

Weight bias includes the negative attitudes, stereotypes, and overt (explicit) or covert (implicit) actions and expressions that affect our interpersonal relationships and interactions (Puhl & Brownell, 2007). These biases are harmful although are rarely called into question and often can lead to discrimination and rejection because of an individual's body size (Puhl & Heuer, 2009). Evidence of weight bias and subsequent weight discrimination can be observed in many different sectors including health care, education, and other processes such as adoption, jury selection, and in obtaining housing loans (Puhl & Heuer, 2009). Weight bias has been documented among physicians (Campbell, Engel, Timperio, Cooper, & Crawford, 2000), medical students (Phelan et al., 2014; Wigton & McGaghie, 2001), dieticians (Berryman, Dubale, Manchester, & Mittelstaedt, 2006), and nurses (Hoppe & Ogden, 1997). In one study examining the prevalence of weight bias among medical students, 74% of the students sampled exhibited implicit weight bias and 67% of students exhibited explicit weight bias; the predictors of weight bias included having lower body mass index (BMI), and identifying as male and non-Black (Phelan et al., 2014). Researchers have also noted a general concern for health professionals who specialize in obesity treatment, valuing a "pro-thin and antifat" ideal body type (Schwartz, Chambliss, Brownell, Blair, & Billington, 2003).

Mental health professionals are not immune from exhibiting implicit or explicit weight bias in their encounters with clients. Two studies have examined the prevalence of weight bias among psychologists who were given case examples of identical patient situations except for their body weight. Psychologists more frequently assigned negative attributes to clients who are overweight (Davis-Coelho, Waltz, & Davis-Coelho, 2000), and attributed more severe psychological symptoms and more pathology to clients who were obese, regardless of the identical presenting situations (Hassel, Amici, Thurston, & Gorsuch, 2001).

Despite the incidence of weight bias among mental and healthcare professions, the problem has not gone unrecognized. Some weight bias and body awareness curriculums have been developed (Lawrence, Hazlett, & Abel, 2012; Puhl & Brownell, 2007). The Yale Rudd Center for Food Policy and Obesity has developed a toolkit for healthcare providers titled, "Preventing Weight Bias, Helping without Harming in Clinical Practice. …

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