Philip Samantha R, Standen Erin C, Schueler Jordan, Fields Sherecce A, Phelan Sean M
Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States.
Front Psychiatry. 2025 Jul 15;16:1596625. doi: 10.3389/fpsyt.2025.1596625. eCollection 2025.
Weight bias is a pervasive form of prejudice, most deeply and directly harming individuals in larger bodies. Although the mental health field strives to promote the delivery of equitable, culturally sensitive care, the prevalence and nature of weight bias in therapeutic contexts are not well understood. This scoping review examines how weight bias manifests within mental health settings and its impacts on client care and outcomes, exploring the issue from both client and provider lenses.
A total of 43 studies meeting search criteria were identified from a systematic search process.
Findings indicate that mental health professionals (MHPs) hold negative stereotypes toward larger-bodied individuals. Although MHPs were less likely to report having negative attitudes, they reported a high prevalence of weight bias in their colleagues. Studies using experimental designs demonstrated that providers' clinical judgment and decision-making were impacted by client body size, generally showing that higher-weight clients were perceived to have lower global functioning, greater pathology, and more negative attributes than lower-weight clients. When the client was described with restrictive eating disorder symptomatology, however, MHPs rated higher-weight clients as less severe and recommended less intensive treatment compared to lower-weight clients. Qualitative studies from client samples revealed experiences of weight stigma during treatment, including MHPs' expressions of implicit and explicit weight bias, assumptions and misattributions based on the clients' weight, unsolicited (direct or subtle) weight loss advice, and differential treatment based on size. Experiences of weight bias were harmful to the client's therapeutic progress and undermined their trust in their provider and the mental health system at large.
The body of evidence suggests that weight bias is a serious and significant barrier to the provision of equitable mental health treatment and mental health equity.
体重偏见是一种普遍存在的偏见形式，对体型较大的个体造成的伤害最为深刻和直接。尽管心理健康领域致力于促进提供公平、具有文化敏感性的护理，但治疗环境中体重偏见的普遍性和性质尚未得到充分了解。本范围综述从服务对象和提供者两个角度探讨体重偏见在心理健康环境中的表现形式及其对服务对象护理和治疗结果的影响。
通过系统检索过程，共识别出43项符合检索标准的研究。
研究结果表明，心理健康专业人员（MHPs）对体型较大的个体持有负面刻板印象。尽管心理健康专业人员不太可能报告自己有负面态度，但他们报告称同事中体重偏见的发生率很高。采用实验设计的研究表明，服务对象的体型会影响提供者的临床判断和决策，总体而言，与体重较轻的服务对象相比，体重较重的服务对象被认为整体功能较低、病态程度更高且具有更多负面特征。然而，当服务对象被描述有饮食失调症状时，与体重较轻的服务对象相比，心理健康专业人员认为体重较重的服务对象症状较轻，并建议给予强度较低的治疗。来自服务对象样本的定性研究揭示了治疗期间体重污名化的经历，包括心理健康专业人员隐性和显性的体重偏见表达、基于服务对象体重的假设和错误归因、主动提供的（直接或微妙的）减肥建议以及基于体型的区别对待。体重偏见的经历对服务对象的治疗进展有害，并破坏了他们对提供者以及整个心理健康系统的信任。
现有证据表明，体重偏见是提供公平心理健康治疗和心理健康公平性的严重且重大的障碍。
