Weight bias: Investigating the impact of an empathy-evoking intervention in reducing mental health professionals' anti-fat attitudes

Earlier research indicates that overweight and obese individuals face weight bias and discrimination in multiple domains, including healthcare settings. Evidence suggests that obese people are faced with anti-fat attitudes from healthcare providers, with common perceptions that they are lazy, stupid, worthless, lacking in self-control and willpower, non-compliant with treatment, unsuccessful, undisciplined, unintelligent and dishonest. There is further evidence indicating that weight bias in healthcare settings leads to poor quality of care. While research has found weight bias to be present in various societal domains, namely, educational and occupational settings, retail and healthcare, there has been limited investigation into weight bias among mental health professionals (MHPs). This study therefore examines, the degree of explicit and implicit weight bias among MHPs who have, or who are treating patients who are overweight and/or obese, the impact of an empathy-evoking intervention, and the behavioural outcomes and practice implications. Two hypotheses and five sub-hypotheses were offered in line with previous research: 1) participants would report negative explicit and implicit attitudes towards obesity; 2) the experimental group would report reduced anti-fat attitudes post-intervention; and 3a) overweight/obese participants would indicate anti-fat attitudes towards patients who are overweight/obese due to an absence of ‘in-group’ bias; 3b) younger participants would hold more negative anti-fat attitudes towards their patients who are overweight/obese; 3c-e) differences in anti-fat attitudes between ethnicity, gender and occupational approaches would be evident. 125 London-based MHPs between the ages of 25-69 years-old volunteered to participate. Participants working as either Psychologists, Psychotherapists, CBT Therapists or Counsellors, completed a demographics questionnaire, as well as the measures of explicit and implicit attitudes towards obesity. Study hypotheses were examined using Multivariate Analyses of Variance (MANOVA) on the pre-intervention for each independent variable (age, sex, ethnicity, BMI, occupation, working privately and working with patients who are overweight/obese), and on the discrepancy data (difference between the post- and pre-intervention data) against the intervention groups. A Multivariate Analysis of Covariance (MANCOVA) was conducted on the discrepancy data for each independent variable (covariates) with intervention group as fixed factor. Follow-up one-way ANOVAs were employed to examine attitudes in relation to the demographic characteristics, with post hoc tests or independent samples t-tests used where there was significance. Analysis on the overall pre-intervention data suggests that participants generally held negative explicit and implicit attitudes towards obesity. Differences based on sex, age, ethnicity, BMI, and occupation were evident, however it was only age and occupation at pre-intervention testing, and specifically ‘Young Adults’ and ‘Counsellors’, which were shown to hold statistically significant negative explicit attitudes toward their overweight and/or obese patients. Analysis on the overall post-intervention data suggests that participants generally maintained their negative explicit and implicit attitudes towards obesity, with the intervention video significantly affecting the experimental group participant’s attitudes from pre- to post intervention testing, however not in the direction anticipated. The anti-fat attitudes of those within the experimental group were shown to become more negative post-intervention. The study findings contribute to evidence that patients who are overweight and obese seeking mental healthcare are discriminated against and are subjected to weight biases in such settings. These findings provide insight for not just Counselling Psychologists, but for all practitioners working within mental healthcare who may be unaware of the existence of any explicit and/or implicit weight biases, the difficulty in modifying these biases, and the implications of these attitudes on the various therapeutic dynamics within their practice.