"It's so Internalized, and It's so Personal": MSW Students' Experiences Increasing Critical Consciousness on Weight Stigma

Background and Purpose: Research indicates that weight stigma is prevalent and impacts various domains of life including education, employment, interpersonal relationships, medical care, and mental health care. Individuals that experience weight stigma are more likely to have worse mental health outcomes, including increased anxiety, depression, disordered eating, poor body image, substance use, and suicidality. Despite research indicating that weight stigma exists among mental health professionals, body size and weight-based discrimination is not often addressed in social work curriculums. This study examined student experiences of a 10-week MSW course about weight stigma, its connection to other forms of discrimination, and weight-inclusive clinical care. This qualitative study examined MSW students’ perspectives on the course and their experiences developing critical consciousness around weight stigma.

Methods: All students who had completed the course (n=30) were invited for study participation. 20 students (16 cisgender women, 4 gender diverse; 90% white; 60% LGBTQ+; 65% non-disabled) completed semi-structured interviews informed by narrative inquiry and phenomenological approaches. Participants also had the option of submitting classroom assignments for research team review. Interviews were audio-recorded, transcribed, and validated. Interviews and assignments were de-identified and thematically coded to identify common themes (Braun & Clarke, 2006) using Dedoose software.

Results: We identified five themes regarding unlearning weight stigma: 1) Connecting empirical weight science literature to ethical practice, 2) Self-reflexivity as difficult, impactful, and unfinished, 3) Learning through vulnerable, contained, reparative community, 4) Life-integrated learning modalities as transformative, and 5) Photovoice as a tool for critical consciousness. Regarding didactic approaches, students emphasized the importance of integrating and critiquing research examining the complex correlations between weight and health. Regarding self-reflexivity, students highlighted how unlearning weight stigma was a deeply personal and ongoing process. Regarding environment, students highlighted the importance of (and potential for harms in) learning communities, emphasizing the necessity of skillful facilitation to manage microaggressions. Regarding learning modalities, students valued assignments that integrated real-life experiences, such as Photovoice, social media curation, and personal narratives. Wholistically, participants discussed the ongoing, transformative, and counter-cultural nature of critical consciousness development around weight stigma. A primary challenge included translating weight-inclusive perspectives to personal, social, and clinical settings where diet culture is central to understandings of health.

Conclusion and Implications: Results suggest that didactic, reflexive educational approaches similar to this one may increase critical consciousness around weight stigma for MSW students. When learning about deeply ingrained sources of societal oppression, students may benefit from life-integrated learning modalities and communal reflexivity, in addition to more traditional didactic approaches. Universally, students endorsed the importance of learning about weight stigma as an integral piece of an intersectional social justice lens and suggested that weight stigma content be more widely integrated into MSW curricula. Further research is needed to assess the effectiveness of similar educational approaches in impacting explicit and implicit weight stigma in healthcare students and professionals.