The authors of a new study say no earlier research had examined weight stigma among health professionals in Spain. They now have, with numbers that can be checked, because the paper and its data are open.
The study, by David Sánchez-Carracedo, Albert Fornieles-Deu, Dimitra Anastasiadou and Stuart W. Flint, was published in PLOS One on 18 June 2026 (21(6): e0351868, open access). It is a cross-sectional online survey of 922 health professionals. Its central finding is not that individual clinicians are unkind. It is that the professionals who believe body weight is mostly a matter of personal commitment also score higher on two standard measures of anti-fat attitudes.
Who answered, and when
The survey link was sent by ten Spanish professional societies to their members, among them societies for obesity research, diabetes, endocrinology, paediatrics, internal medicine and obesity surgery. The authors call it a non-probabilistic convenience sample. Because the societies forwarded the link, the team does not know how many people received it, so no response rate exists. Data were collected between early July and 21 October 2020, which is nearly six years before publication.
Of the 922 respondents, 74.1 percent were women, the mean age was 43.7 years, and the mean BMI was 23.7. Paediatricians were the largest group at 36.4 percent, about 85 percent worked in the public sector, and about 89 percent said they care for patients with higher body weight. Almost 30 percent of the respondents were themselves living with overweight or obesity. Weight and height were self-reported.
Two scales and eight questions
Attitudes were measured with two established instruments. The Dislike subscale of the Anti-Fat Attitudes questionnaire has seven items on a scale from 1 to 7. The short form of the Fat Phobia Scale asks respondents to place people with higher body weight between 14 pairs of opposite adjectives, such as “has willpower” and “no willpower”, on a scale from 1 to 5.
The results look different depending on the scale. The mean Fat Phobia score was 3.53 (standard deviation 0.44), above the scale midpoint of 3; the authors compare it with 3.40 in an earlier multinational study of health professionals. The mean Dislike score was 2.09 (standard deviation 0.88), which on a 1 to 7 scale is well below the midpoint. The authors summarise both as negative attitudes. A careful reading is narrower: stereotypes were clearly present, open dislike was low on average.
Beliefs about causes and treatment came from eight questions taken from the ASK study, a multinational survey of health professionals. These questions are not a validated scale, and the authors say so. The Spanish version of the Fat Phobia Scale was adapted from a Mexican version and has not been formally validated in Spain.
The beliefs behind the scores
Among the 922 respondents:
- 38.1 percent attributed overeating mainly to causes located in the person: food addiction, gluttony or emotional eating. The most common single answer, chosen by 36.1 percent, was a malfunction of the body’s appetite and satiety regulation.
- 65.6 percent said obesity could be entirely prevented by an individual’s commitment to a healthy lifestyle, and 58.9 percent said it could be cured that way.
- 57.3 percent named a lack of motivation or self-discipline as the main reason people find it hard to lose weight.
- 32.8 percent explained a failure to lose weight in a lifestyle programme with poor compliance due to lack of motivation, and 35.4 percent explained weight regain with the person’s diet and lifestyle choices.
Respondents who held these beliefs scored higher on the stigma measures, on at least one of the two scales in each case. One question showed no such link: what respondents thought was the most effective treatment for severe obesity was not associated with their stigma scores. This article does not evaluate any treatment, and the study’s own point is about attribution, not about which intervention works.
Who scored higher
Health professionals with underweight or normal weight scored higher than those with obesity on both scales. On the Fat Phobia Scale, respondents aged 35 or younger scored higher than those aged 55 or older. Specialties differed on the Fat Phobia Scale, but the pairwise comparisons between specialties were not statistically significant, so no ranking of professions can be read from the study.
One result cannot be reported at all. The abstract says working in the private sector was associated with higher Dislike scores, while the results section says the public sector scored significantly higher. The two statements contradict each other, and we do not repeat either.
What the study cannot say
It measures what professionals say they believe, not what they do in a consultation. The paper’s suggestion that these attitudes may contribute to inappropriate care and unfair treatment is a hypothesis, supported by earlier research the authors cite, not a finding of this survey. No patient was asked anything.
The design is cross-sectional, so the link between belief and stigma score shows association, not cause. The sample is self-selected and comes from societies with an interest in obesity, the authors consider it possible that people with a particular interest in the topic were more likely to take part. The 2020 data predate Spanish guidance on non-stigmatising care that the authors cite as new. The eight belief questions are unvalidated, and in the survey’s scoring, answering “yes” to lifestyle prevention and cure of obesity is treated as the incorrect answer. That judgement comes from the ASK study’s authors, not from anything measured in Spain.
Why it still matters
For people who avoid medical appointments because of past experience, the useful information is not a league table of professions. It is the mechanism the study tests: when a clinician attributes weight mainly to willpower, that attribution travels with higher scores on two stigma scales. Respondents living with obesity scored lower than those with normal weight, and the study cannot say why.
The data for the study are public on the Open Science Framework (osf.io/xrbaf), so anyone can check the tables against this summary. Germany, the United Kingdom and the United States are not covered by these numbers, and nothing here should be read as a rate for any country other than Spain, in 2020, among members of the societies that took part.
This is a report on the design and findings of one study, not medical advice, and it recommends no treatment.
Source: Sánchez-Carracedo D, Fornieles-Deu A, Anastasiadou D, Flint SW. “Stigmatizing attitudes and misconceptions about obesity among Spanish healthcare professionals.” PLOS One 2026;21(6):e0351868, doi.org/10.1371/journal.pone.0351868. Full text read on 29 September 2026. Chart: Fatosphere Editorial.