PhD Profile: Jenny Setchell Explores Weight Stigma in Rehabilitation

Weight a minute: do some physical therapists demonstrate an obesity stigma? Do their beliefs affect their treatment of patients?

For postdoctoral Fellow Jenny Setchell, something wasn’t sitting right. A physical therapy colleague had just commented about not wanting to touch a patient because he was obese.

“This was unsettling, and I challenged my colleague on this discriminatory comment. But afterwards, it got me thinking about stigma in relation to weight, and how we as physiotherapists are approaching patients with obesity” says Setchell. “I wanted to explore how physios are demonstrating weight stigma, and how this affects their interactions with patients.”

Scale that has "You are more important than this number" written on itFast-forward four years, and she has done just that.

Back in 2012, Setchell embarked on her PhD thesis, conducting research that is particularly relevant in today’s society, as rates of obesity increase in North America, as well as her native Australia. Her work explored four key areas: physical therapists’ attitudes towards obesity, the experiences of obese patients, the way physical therapists think and talk about weight, and ideas on how we can alter the stigmatization of obesity within clinical practice.

Her research, which was based in Queensland, found that physical therapists are indeed demonstrating weight stigma, defined as “negative attitudes towards people who are overweight or obese, and frequently stereotyping people as lazy, sloppy, less intelligent and unattractive”.

Setchell points out that obesity stigma had been recognized and Two women doing a water fitness classstudied in many other medical professions; however no one had ever looked at the relationship between physical therapists and weight stigma. She also notes that often people are not even aware that they harbour these sorts of false judgements, as stigmas are deeply ingrained and pervasive in societal messages.

Her studies found that patients often spoke of experiencing these stigmas, describing how they felt uncomfortable with their physical therapist, or the physical therapy environment. When exploring how physical therapists think and speak around obesity, she discovered that often they were not aware of the complexity of body weight. This included having little awareness of weight stigma, lacking understanding of how to consider the causes of obesity beyond diet and exercise, and a lack of theoretical resources to take into account the socio-political factors intertwined with obesity. Physical therapists also exhibited a tendency to focus on weight-related issues with their patients, to the detriment of other (perhaps more relevant) treatments, and expressed difficulty physically working with obese patients.

“Many of the physios I spoke to said that they found it challenging to work with obese patients. Physiotherapists said this was because these patients were less capable of certain movements, or certain muscles or joints were difficult to access due to their weight. However, it is unlikely that practitioners would describe working with, say, a pregnant woman as ‘more difficult’, even though treating a pregnant woman can present similar challenges. Calling obese patients ‘difficult’ is an example of the subtle, yet problematic, stigma around weight” says Setchell. “What was wonderful, however, was that talking with physios, they really cared about stigma as an issue. They cared that this is a problem. This stigma does not come from ill-intent.”

Perhaps the most significant aspect of Setchell’s work surrounds how we can change these biases to provide better physical therapy care for all patients, regardless of size. She worked with her study cohort using critical reflexivity to find strategies to reduce stigma both in physical therapists themselves and their treatment of patients.

Among other things, her work suggests that improved understanding and education around the complexity of weight loss, increased sensitivity when speaking to patients about their size, and tactics such as refraining from weight-related conversations while a patient is changing, can significantly improve physical therapists’ treatment of obese patients.

Picture of Jenny SetchellHaving recently completed this thesis, Setchell has chosen to continue her critical physical therapy research as postdoctoral fellow to Department of Physical Therapy Professor Dr. Barbara Gibson at the Bloorview Research Institute and University of Toronto.

“There are some really interesting physiotherapy thinkers here. Many members of this department are exploring areas that aren’t commonly looked at in physiotherapy” says Setchell. “It’s brilliantly unusual.”


To learn about work similar to Jenny Setchell’s (above right), please visit the Critical Physiotherapy Network.