The trouble with weight (stigma): From weight-centric to health-at-every-size physiotherapy
Bibliographic record
Abstract
Participants ranged from those explicitly espousing anti-fatness and pro-thinness beliefs as a basis for physiotherapy practice to those who have taken up sophisticated ways to disrupt it. The latter developed a critical consciousness about weight, weight stigma, and ‘diet culture’ mainly on their own, outside of the profession. At the core of this development was learning to trouble the common story in their societies and in physiotherapy: that weight is a simple reflection of lifestyle and willpower. Instead, they reframed the trouble as that of navigating weight stigma, as it manifests internally, interpersonally, and structurally. Those with a critical consciousness of weight stigma used the narrative features of luck and ‘a journey’ to describe their transformation into their present self, aided by mentors from other backgrounds, their own experiences of recovery from disordered eating and exercise behaviors, and/or engaging with HAES® and trauma-informed care sources. They repeatedly returned to the idea of patients’ experiences and feelings, describing patients as whole, complex characters facing high stakes situations, where their needs are often unrecognized and unmet. Compare HAES® and other physiotherapists’ understandings of, and clinical practices relating to, weight stigma, including how it manifests and practices which disrupt it. Physiotherapists demonstrating a critical consciousness of weight stigma and practice had to learn to work against the grain of what they were formerly taught, both in physiotherapy education and more broadly. Future research should address how weight stigmatization is reproduced and/or disrupted in physiotherapy education, and ethnographic studies of physiotherapy sites can inform dialogue about weight-inclusive practices within the profession. We completed a narrative inquiry study informed by a public advisory board with lived experience of weight stigma in health care. We generated data using a story completion method followed by 70–90 minute semi-structured interviews with a purposive sample of 11 physiotherapists from Australia, Canada, and the USA. Sampling emphasized a mix of physiotherapists practicing Health At Every Size® and those without anti-weight stigma training. Multiple interview techniques emphasized the telling and interpreting of stories. The primary analysis approach was socionarratology (Frank, 2010). If physiotherapy seeks to be an inclusive, health-enhancing profession, learning to disrupt stigmatization on the basis of bodily fatness should not depend on luck. A concerted effort is needed to disrupt anti-fatness and pro-thinness as it manifests in education and practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.016 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.016 | 0.026 |
| Scholarly communication | 0.007 | 0.008 |
| Open science | 0.001 | 0.017 |
| Research integrity | 0.003 | 0.009 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".