Learning to disrupt weight stigma in physiotherapy: a constructivist narrative inquiry

Abstract

Weight stigma is pervasive in healthcare and is often reinforced through weight-centric approaches that pathologize fatness and position body weight as a primary indicator of health. Within physiotherapy, weight stigma has largely been conceptualized as a matter of individual attitudes or bias, with little attention paid to the interpretive processes through which weight-centered practices are normalized or challenged within clinical reasoning. In this study, I explored how physiotherapists make meaning of weight within clinical encounters. Guided by a constructivist paradigm and Frank’s (2010) socio-narratology, I did a qualitative narrative study using data from the Storying Physiotherapy project. Eleven physiotherapists, including four aligned with Health at Every Size® (HAES®), participated in semi-structured interviews. In the interviews, the participants responded to fictional clinical stories provided to them prior and they shared stories from their practice. I analyzed the data using dialogical narrative analysis, attending particularly to Frank’s concepts of Trouble and Character. Findings revealed that while participants often preferred similar stories, they differed in their interpretation of weight and if/how they recognized weight-centered practices as stigmatizing. I argue that weight stigma in physiotherapy is embedded not only in individual attitudes, but also in dominant understandings of bodies, health, responsibility, and “good” care. My study demonstrates how narrative approaches can surface the moral and professional assumptions shaping physiotherapy practice and support more reflective, weight-inclusive care.