How conceptualizing obesity as a disease affects beliefs about weight, and associated weight stigma and clinical decision-making in health care

Joanne A Rathbone; Tegan Cruwys; Jolanda Jetten; Kasia Banas; Lillian Smyth; Kristen Murray

doi:10.1111/bjhp.12625

How conceptualizing obesity as a disease affects beliefs about weight, and associated weight stigma and clinical decision-making in health care

Br J Health Psychol. 2023 May;28(2):291-305. doi: 10.1111/bjhp.12625. Epub 2022 Sep 26.

Authors

Joanne A Rathbone^{1

2}, Tegan Cruwys¹, Jolanda Jetten³, Kasia Banas^{2

4}, Lillian Smyth⁵, Kristen Murray¹

Affiliations

¹ Research School of Psychology, The Australian National University, Canberra, ACT, Australia.
² School of Medicine, Dentistry, & Nursing, University of Glasgow, Glasgow, UK.
³ School of Psychology, The University of Queensland, Brisbane, Australia.
⁴ Usher Institute, The University of Edinburgh, Edinburgh, UK.
⁵ Medical School, The Australian National University, Canberra, ACT, Australia.

PMID: 36164278
DOI: 10.1111/bjhp.12625

Abstract

Objectives: This study empirically investigated how conceptualizing obesity as a disease (i.e., pathologizing obesity) affects beliefs about weight, and weight stigma and discrimination among health professionals.

Design: An experiment that manipulated the pathologization of obesity was completed by a multi-nation sample of health professionals from Australia, UK, and USA (N = 365).

Methods: Participants were randomly assigned to one of two conditions where they were asked to conceptualize obesity as a disease or not a disease; then presented with a hypothetical medical profile of a patient with obesity who was seeking care for migraines. We measured biogenetic causal beliefs about obesity, endorsement of weight as a heuristic for health, negative obesity stereotypes, and treatment decisions.

Results: Participants in the disease (vs. non-disease) condition endorsed biogenetic causal beliefs more strongly and made more migraine-related treatment recommendations. No effect of the manipulation was found for the remaining outcomes. Biogenetic causal beliefs about obesity were associated with less weight stigma. Endorsing weight as a heuristic for health was associated with greater weight stigma and differential treatment recommendations focused more on the patient's weight and less on their migraines.

Conclusions: Pathologizing obesity may reinforce biogenetic explanations for obesity. Evidence demonstrates complex associations between weight-related beliefs and weight stigma and discrimination. Biogenetic causal beliefs were associated with less weight stigma, while endorsing weight as a heuristic for health was associated with greater weight stigma and differential treatment. Further research is needed to inform policies that can promote health without perpetuating weight-based rejection in health care.

Keywords: health care; health professionals; obesity as a disease; weight stigma; weight-based discrimination.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Clinical Decision-Making
Delivery of Health Care
Health Promotion
Humans
Migraine Disorders* / therapy
Obesity / therapy
Weight Prejudice*