Comments on “Examining Weight Stigmatization toward Obese Individuals among Nutrition and Dietetic Students Using the Attribution Theory” by Kusuma et al.

Dear Editor, As a dietitian and dietetics faculty member, I read the article by Lintang Kusuma et al.[1] who examined weight bias among dietetics and nutrition students with great interest. However, I would like to take this opportunity to provide commentary regarding methodological concerns and societal shifts that are critical to the interpretation of the study’s results. The first and foremost is the concern regarding how scores on the 14-item Fat Phobia Scale were used to categorize students as having high levels of “fat phobia.” Despite evidence establishing a much higher cutoff value,[2,3] a score of 2.5 on the 5-point Scale appears to have been arbitrarily selected as the cutoff for “high-fat phobia.” Bacon et al.[2] developed the 14-item version of the Fat Phobia Scale and viewed 3.6 as a score reflective of the average level of “fat phobia” and a score of 4.4 or greater as an indicator of a high degree of fat phobia. Similarly, Puhl et al.[3] reported an average score of 3.7 on the 14-item scale. A cutoff value of 2.5 appears to be inexplicably low and as such has likely resulted in the misclassification of students as “fat phobic.” Second, Puhl et al.[3] did not find a significant difference in Fat Phobia Scale scores for dietetic student ratings of obese individuals versus ratings for nonobese individuals. This failure to detect weight bias using the Fat Phobia Scale raises concerns regarding the predictive validity of the scale. Indeed, 65% of the students in the study by Lintang Kusuma et al.[1] scored <2.5 on the Fat Phobia Scale. By all accounts, there was likely a low level of weight stigma among the students even given the very low cutoff value. Yet, no discussion of the Fat Phobia Scale’s limitations or interpretation of the scale scores was included in the article. Finally, although the authors did not specify the time frame for data collection, public records indicate that data collection most likely occurred at some point before the fall of 2015 at which time the academic units described in the paper were restructured and renamed. Furthermore, the references citing weight bias among dietetics students are extremely outdated and fail to reflect current educational practices as well as the increasing student and professional interest in a weight neutral approach to nutrition care.[4,5] These stated concerns are of momentous importance in interpreting the paper’s results. A failure to consider these concerns may lead to an inaccurate conclusion regarding the degree to which fat phobia and weight bias are a concern among students in dietetics education programs. Ultimately, such a misguided conclusion perpetuates stereotypes and may divert attention and resources away from more pressing educational issues. Financial support and sponsorship Nil. Conflicts of interest Nil.