Weight stigmatisation in physiotherapy: a systematic review

Background: Physiotherapists play an integral role in the provision of health care to individuals who are overweight or obese. An understanding of weight stigma is therefore important in ensuring best practice. Despite these considerations, no previous systematic reviews have investigated weight stigma in physiotherapy. Objectives: To determine if (i) physiotherapists demonstrate weight stigma through explicit or implicit means and (ii) how weight stigma is perceived by physiotherapy patients. Methods: Database searches were conducted to identify quantitative and qualitative studies published between January 1960 and September 2015. Two reviewers independently performed data extraction and assessments of methodological quality. Outcome measures included explicit attitudes, implicit attitudes and beliefs about obesity held by physiotherapists, as well as patient perceptions of obesity management. Results: Seven high-quality studies were included in the review. Six studies demonstrated the existence of explicit weight stigma, with a majority of physiotherapists describing people with increased weight as ‘noncompliant’ and ‘unmotivated’. One study demonstrated the existence of implicit weight stigma, but this did not appear to influence treatment approaches. Four studies found stigmatising beliefs about weight among physiotherapists, and one study found that physiotherapy patients believed both physical environments and paternalistic communication styles propagated weight stigmatisation. Conclusions: Explicit weight stigmatisation is common in physiotherapy and is often perceived by patients, who may feel unmotivated or ignored as a result. While implicit stigmatisation also occurs, it is unclear if this influences physiotherapy management. Future research is required to assist in the development of appropriate preventative strategies.