The impact of client weight and ethnicity on counselors' evaluation of eating disorder symptoms: A vignette study



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The purpose of this study was to examine the potential impact of client weight and ethnicity on counselors’ recognition and appraisal of eating disorder symptoms. Previous research has demonstrated weight-based bias in healthcare practitioners, including individual therapists. In addition, previous research has illustrated that racial and ethnic stereotypes may contribute to misdiagnosis/underdiagnosis of disordered eating in women of color. This study randomly assigned participants to one of six different vignette conditions. The vignettes varied only by the weight (low, high) and ethnicity (White, Black, Hispanic) of the client they describe. All vignettes featured a young woman who engages in restrictive eating behaviors and over-exercising, and who has lost 25% of her body weight over a short period of time. Participants were asked to label and rate the severity of her presenting problem, as well as rate the frequency and severity of the client’s symptoms. It was hypothesized that participants would rate the client’s eating disordered behaviors as less severe when the client is not significantly underweight, despite the presence of drastic, medically unsafe weight loss. Demographic information of participants was collected in order to identify any potential relationship between demographic factors and patterns of decision-making. Results indicated that the weight of the client in the vignette appeared to influence participants’ clinical evaluation of the client. Participants were more likely to recommend a medical follow-up when the client was lower weight. Participants’ responses on an Anorexia symptom subscale indicated that they rated the behaviors as more frequent in the lower weight condition, and their rating of the overall severity of her presenting problem was higher in the lower weight condition. No differences were observed based on race, or on interaction of race and weight. Implications for theory, research, and practice are discussed.



atypical anorexia nervosa, eating disorders, weight bias, weight stigma, racial bias