Antifat Bias of OT and Physical Therapy Assistants

PURPOSE: Research suggests anti-fat prejudice rivals prejudice towards other stigmatized groups (O’Brien et al., 2010) with anti-fat bias described as the last socially acceptable forms of prejudice (Alperin et al., 2014). Healthcare professionals’ anti-fat bias results in substandard quality of care that contributes to health disparities (Brewis et al., 2018). Occupational and physical therapy assistants (OTA/PTA) are key stakeholders in rehabilitation practice; however, few studies have examined their attitudes towards fat people. Therefore, the aim of this study was to examine OTA/PTA implicit (unconscious) bias toward fat people, the relationship between implicit bias and OTA/PTA characteristics and beliefs, and how OTA/PTA bias compares to all other professions. (The word “fat” is utilized rather than other descriptors for the reasons detailed by Fikkan and Rothblum (2012): “we prefer to use the term ‘fat,’ as it is descriptive, whereas the term ‘overweight’ implies unfavorable comparison to a normative standard and ‘obese’ is a medical term with its own negative connotations” (p. 577). Furthermore, Vartanian (2010) found the language “obese people” produces stronger negative connotations than “fat people.”)

DESIGN: This was a quantitative study that used secondary data about anti-fat bias were obtained from Project Implicit (Xu et al., 2014), a free public website (https://implicit.harvard.edu/implicit/) where people from across the world can test their implicit prejudices, including against fat people. (As it was secondary data, IRB determined it was exempt from review.) Some people participate because they are interested in exploring their biases, others may participate for class or work assignments, and others for additional reasons.

METHOD: We analyzed secondary weight Implicit Association Test (IAT) data from 11,342 people, 50% of which were OTA/PTA. We used Greenwald et al.’s (2003) updated IAT scoring protocol to examine the weight IAT scores, and then a one-way t-test to examine distribution and spread of implicit attitudes. We also used linear regression models to compare attitudes to those from other professions, and to determine correlates of OTA/PTA anti-fat bias.

RESULTS: Findings revealed the overwhelming majority of OTA/PTA (82.4%) implicitly preferred thin people. OTA/PTA also had higher anti-fat bias than other professionals. Additionally, we found a number of demographic characteristics and beliefs about weight significantly correlated with anti-fat bias.

CONCLUSION: Implications of this study will discuss recommendations for OTA/PTA curriculum approaches for addressing anti-fat prejudice through a deeper understanding of how OTA/PTA anti-fat bias can contribute to inequitable healthcare and health outcomes for fat people.

IMPACT: Educators and health care administrators should recognize the impact anti-fat attitudes can have on the therapeutic relationship as well as how they might impact the rehabilitation outcomes and quality of life of clients who are fat.

References

Alperin, A., Hornsey, M. J., Hayward, L. E., Diedrichs, P. C., & Barlow, F. K. (2014). Applying the contact hypothesis to anti-fat attitudes: Contact with overweight people is related to how we interact with our bodies and those of others. Social Science & Medicine, 123, 37-44. https://doi.org/10.1016/j.socscimed.2014.10.051

Brewis, A., SturtzSreetharan, C., & Wutich, A. (2018). Obesity stigma as a globalizing health challenge. Globalization and health, 14(1), 20. https://doi.org/10.1186/s12992-018-0337-x

O’Brien, K. S., Puhl, R. M., Latner, J. D., Mir, A. S., & Hunter, J. A. (2010). Reducing anti-fat prejudice in preservice health students: a randomized trial. Obesity, 18(11), 2138-2144. https://doi.org/10.1038/oby.2010.79