A Systematic Review of Weight Bias in the Human Services Professions

Background and Purpose:  While weight bias has been increasingly studied in various contexts ----including in medicine, academia, and society at large-- since the turn of the century, the role of weight bias in human services has gone relatively unstudied and ignored.  This presents a significant gap in knowledge about weight bias, and a risk to obese clients of practitioners who hold unconscious biases.  Previous studies of weight bias find that it is common, though personal and demographic characteristics can significantly affect levels of bias. Four hypotheses are stated:  (1) women will be more biased than men; (2) younger practitioners will be more biased than older practitioners; (3) practitioners with lower BMIs will be more biased than those with higher BMIs; and (4) White practitioners will be more biased than non-White practitioners. 

Methods:  A systematic review of weight bias in the human services was conducted in order to better understand the role of weight bias in psychology, psychiatry, counseling, and social work.  Studies used a variety of measures on diverse samples drawn from all of the aforementioned populations.  A search was conducted in social work, medical, and other databases for studies that consider the role of weight bias, stigma, or phobia in the human services in psychology, psychiatry, counseling, therapy, and social work.  Initially only three of 1184 articles found met the criteria, which was expanded to a total of eight articles by reviewing references. 

Findings:  The review sample included 1726 participants who were 86% White and 25% male.     Age ranged from 19 to 84, mean age ranged from 24.7 to 44.7. Various sample characteristics were considered, including clinician and client gender, clinician age, clinician BMI, and clinician race.   Hypothesis (1) that women are more biased than men was generally supported.  Hypothesis (2) that younger practitioners are more biased than older practitioners led to mixed results.  Two studies found that younger practitioners are more biased, three found that older practitioners are more biased, and one found no relationship.  Hypothesis (3) that practitioners with lower BMIs were more biased than those with higher BMIs led to mixed results.  Social workers with high BMIs were less biased; eating disorder practitioners with higher BMIs were less biased though those trying to lose weight were more biased.  Hypothesis (4) that White practitioners are more biased was not generally supported. 

Conclusion and Implications:  Weight bias exists in social work and related practices, though further study is needed in this relatively neglected field.  Gender, age, BMI, race, and other factors may all have an effect on individual beliefs and biases.  As with other biases, practitioners must be mindful of their beliefs about weight and consider how these affect practice with service users of all shapes and sizes.  Most existing study of weight bias in the human services has been limited to conscious bias, the testing of which is subject to social desirability, especially in a field whose values are so antithetical to bias.  Further study of this subject using unconscious bias testing is also warranted.