Exploring weight bias,fatphobia,and diversity training among collegiate athletic coaches

Abstract

Many fields have called for a shift from a weight-normative to a weight-inclusive approach. However, there is still a paucity of research investigating such a shift within college athletic coaching. This quantitative study investigated weight bias, fatphobia, and diversity training among collegiate athletic coaches (n = 68). A cross-sectional survey design using random convenience sampling was used and findings revealed the prevalence of weight bias and fatphobia among coaches, with many endorsing harmful weight normative beliefs that can exacerbate negative mental health outcomes, such as disordered eating, among student athletes. The results also indicated a significant lack of diversity training related to size and body composition, highlighting a crucial gap in coaches’ preparation to foster a weight-inclusive environment that supports athletes’ mental and physical well-being. This research is a call for athletic departments to adopt weight-inclusive coaching practices, ensuring that athletes of all sizes can thrive in a supportive environment. Recommendations and resources for inclusive coaching practices are also provided.

Keywords

Body composition inclusivity mental health sizeism student-athletes well-being

Introduction

Research shows that participating in collegiate sports fosters positive traits, such as self-confidence, social support, time management, and discipline. However, the simultaneous pursuit of academic and athletic goals places student athletes at potential risk for negative mental health consequences.¹ These risks include conflicting identities, injuries, disordered eating, and substance use.² These issues can be exacerbated if student athletes are training and playing in environments in which their athletic coaches participate in weight stigma or harbor fatphobic beliefs, this includes coaches discriminating against or having negative attitudes toward individuals based on their body size or weight.³

Some coaches may avoid discussing topics related to body image or nutrition with their athletes due to fears of triggering negative emotional responses, such as disordered eating behaviors or body dissatisfaction. This hesitancy, while well-intentioned, can contribute to a lack of open communication about health and well-being, perpetuating misunderstandings and unhealthy behaviors among athletes.^4–7

The culture within different sports can also contribute to these risks, as each sport normalizes specific behaviors that may impact body image. For instance, sports that emphasize endurance or aesthetic performance, such as track, gymnastics, and dance, may promote leanness as an ideal, potentially encouraging restrictive eating and overtraining.⁸ In contrast, sports like football or weightlifting may emphasize muscle gain, which can lead to different pressures related to body composition.⁹ Coaches and athletics staff must understand the harmful impacts of these implicit or explicit biases, and pursue continuing education on inclusive coaching practices when working with student athletes.¹⁰

This study investigated collegiate athletic coaches’ training, attitudes, and opinions about size diversity within their sport. The goal is to enhance inclusive coaching practices and support advocacy efforts for coach training. The manuscript serves as a call to action for collegiate athletic departments to foster and incorporate active discussions on size diversity, sizeism, fatphobia, and inclusive coaching practices. Readers can expect a review of the literature, explanation of research methods, presentation of results, a comprehensive discussion, recommendations for practitioners, and limitations of the study.

Literature review

College athletes face unique mental health challenges that differ from those of their non-athlete peers. They often experience stress from balancing academic responsibilities, athletic performance pressures, and personal life demands.^11,12 Factors like competition, injuries, and performance anxiety are common stressors, often exacerbated by the stigma surrounding mental health in sports, which may discourage seeking help. The NCAA found that athletes report higher levels of mental exhaustion, anxiety, and depression compared to pre-pandemic rates. Additionally, barriers such as perceived expectations, financial pressures, and team dynamics contribute to mental health struggles among college athlete.^13,14

The competitive nature of sports exposes the body to public examinations, thereby increasing concerns about food, body weight, and appearance.⁷ The emphasis on body composition, along with the idea of “slim to win,” has psychological and health consequences for student athletes, such as anxiety, depression, low self-esteem, and an increased risk of disordered eating.^15,16 Research indicates that both male and female athletes are susceptible to disordered eating patterns, with sociocultural pressures and sport-specific ideals exacerbating this risk.^17,18 Body weight, along with gender, race, and sexuality, is part of the intersectionality of an athlete's cultural identity and should be respected and honored.¹⁹

The medicalized model of weight has predominantly influenced cultural and scientific discussions surrounding weight loss and health.²⁰ This model prioritizes body mass index (BMI) as a general health measure. Carefully managed weight and slim bodies are seen as healthy, desirable, and preferred.^3,21 In sports, they are often perceived as necessary for better performance.⁵ Weight-inclusive models challenge this, critiquing the limitations of BMI as a measure of health, emphasizing that it fails to account for variations in muscle mass, bone density, and other health factors.^22,23 These models aim to separate BMI from health status, reduce weight stigma, and foster sustainable, personalized practices, such as pleasurable exercise and nutrient-rich diets.³ Despite the availability of weight-inclusive models, the “slim-to-win” mentality continues to permeate various sports cultures, reinforcing harmful practices like self-starvation and extreme dieting among athletes.¹⁸ Emphasizing performance over appearance can help mitigate body image concerns, particularly for female athletes in aesthetic sports.⁶ Some coaches in women's gymnastics have started to adopt more holistic models, emphasizing energy levels over thinness and accommodating the development of older athletes.²⁴ Alternatively, social milieus that prioritize controlled weight and slimness aim to advance a weight-normative model, encouraging sizeism and fatphobia.

The personal development of student athletes is influenced by many different stakeholders, including coaches and nutritionists.²⁵ Coaches are expected to educate and guide student athletes to accomplish their goals while maintaining their health and well-being. However, many coaches often prioritize and value “desirable body composition” over health.²⁶ When sharing information, many coaches communicate sizeist and fatphobic beliefs, setting body weight targets that can encourage restrictive diets and overtraining.²⁶ In women's artistic gymnastics, the persistence of the “pixie-style” coaching model has been criticized for promoting harmful practices like extreme dieting, corporal punishment, and forced training despite injuries.²⁴ Body shaming by coaches, whether intentional or inadvertent, has been identified as a factor that contributes to athletes’ social physique anxiety, disordered eating, and body dissatisfaction.²⁷ This behavior, although sometimes framed as “body sensitivity,” can still have shaming consequences for athletes, particularly during transitional life stages, such as adolescence.⁶ These behaviors, often linked to playing time and favorable feedback from coaching staff, can perpetuate harmful stereotypes and have adverse effects on athlete mental health.¹⁶ Despite receiving sports training education, coaches typically focus on tactics rather than holistic approaches that consider athletes’ mental well-being.²⁸ Coaches working with elite athletes may face additional pressures to achieve specific body ideals, while those working with amateur athletes might emphasize overall health and development.

Many student athletes encounter weight-related expectations and face anti-fat attitudes from their coaches.¹⁶ Coaches’ implicit and explicit biases regarding weight and size can impact sociocultural competencies and harm athletes’ body image, contributing to negative mental health outcomes.^5,29 A study on female athletes found that sports with a focus on leanness increase the risk of developing eating disorders, while male athletes often encounter pressures to achieve a “fat-free” body for success.^17,27 Youth athletes, particularly in elite sports schools, frame food as performance-oriented, linking it to nutritional supplements and emphasizing the quick consumption of calories for training optimization.³⁰ Participating in holistic, inclusive training is essential to promote body positivity and better identify athletes at risk.²⁸ Athlete-centered coaching aligns with weight-inclusive models, focusing on skill development, empowerment, and growth.³¹ This holistic approach allows athletes to achieve their best physical and mental potential while minimizing stigma and promoting health.

Methods

This quantitative study sought to investigate collegiate athletic coaches’ training, attitudes, and opinions regarding weight bias and size diversity. Therefore, a cross-sectional survey design using random convenience sampling was used. This method of sampling was deployed based on accessibility and athletic coaches were recruited through existing collegiate networks and institutions.

Procedures

This study was reviewed by the University of North Florida's Institutional Review Board (IRB) and was declared exempt (IRB#: FY2024-20). The researchers complied with all federal, state, and local laws and institutional policies and procedures applicable to this research. After obtaining IRB approval, prospective participants were invited to participate in the study in several ways. First, the research team gathered contact information for prospective participants from a list of public and private National Association of Intercollegiate Athletes (NAIA) and National Collegiate Athletic Association (NCAA) Division I, II, and III schools, and university websites. Subsequently, emails with recruitment materials were sent to the identified coaches. The eligibility criteria included athletic coaches aged 18 years or older who coach in the NCAA or NAIA divisions within the United States.

If prospective participants met the study requirements and chose to participate, they were instructed to select the link in the recruitment email that automatically redirected them to a Qualtrics survey. The Qualtrics survey began with an informed consent form. If the prospective participants provided informed consent to participate in the study, they completed a questionnaire composed of 36 questions used to gather data regarding each participant's demographic information, sports they coach, size-related opinion questions, and diversity training (Table 1).

Table 1.

Structure and composition of survey.

Section	Number of Question	Example Questions	Scale Type	Answer Options
Informed Consent	1	By clicking yes below, I agree to participate…	Self-developed	Yes/No
Demographics	11	"What is your gender?”, “What is your age?”, “How long have you been in a collegiate athletic coaching position?”, “What collegiate sports have you coached in the last 3 years?"	Self-developed	Multiple choice, Check all that apply, Open-ended
Opinions on Size and Health	6	“Weight is a valid proxy for health.”, “Weight loss is maintainable for the majority of the population."	Adopted from existing literature (Boggs et al., 2023)	4-point Likert scale (Strongly Disagree to Strongly Agree)
Fat-Phobia Scale- Short Form	14	Adjective pairs like “lazy - industrious”, “attractive - unattractive”.	Fat Phobia Scale- Short Form	Semantic differential 5-point scale
Coaching Practices	3	"Have you integrated mental health in your coaching practice?”, “Have you heard of the weight inclusive model?”	Self-developed	Yes/No,
Opt-In Additional Resources	1	… you will be given the opportunity to provide your email address to receive resources and information about weight inclusive materials related to health and size that can inform your coaching…	Self-developed	Opt-In option

A total of 1000 coaches were invited to participate in the study. Seventy-four participants started the survey and only 68 finished the survey, with a response rate of 6.8%. Power analysis shows that with the current sample size, we have 80% power to detect an effect size of 0.138 or larger at the 0.05 significance level. The sample size for this study (n = 68) was sufficient to detect an effect size of 0.48 or larger with a power of at least 0.80, using a two-sided test and a 5% Type I error rate.

Measures

Demographic and training information

The eleven-item demographic questionnaire included gender, sexual orientation, age, race/ethnicity, level of education, employment length, geological location of the institution, institution type, division or association of athletic programs, and types of sports and genders coached. The participants were also asked questions regarding their training and implementation of size diversity and mental health. An example includes: In the last three years, have you taken a coaching course with learning objectives that included size, sizeism, and fatphobia as components of inclusion? In the past three years, have you integrated mental health into your coaching practice?.

Weight-related opinion questions and fat phobia scale-short form

This section included a six-item questionnaire that gathered information about the participants’ opinions. Sample statements include: Weight is a valid proxy for health, and body weight is controllable and should be controlled for better health. Each statement was rated on a 4-point Likert-type scale ranging from 1 (strongly disagree) to 4 (strongly agree).³² This section also included the Fat Phobia Scale-Short Form. The Fat Phobia Scale-Short Form is a 14-item assessment tool used to measure fatphobia.³³ The scale lists 14 pairs of adjectives often used to describe fatalities. Participants were asked to view the adjectives and place a marker closest to the adjective that best described their feelings and beliefs. Sample adjectives included Lazy and Industrious, Good Self-Control and Poor Self-Control, Fast and Slow, Weak and Strong, and Active and Inactive. The adjectives are listed parallel to one another on a 5-item numbered Likert scale. A higher score indicated more fat phobia, whereas a lower score indicated less fat phobia. The Fat Phobia Scale-Short Form demonstrates excellent psychometric properties, is reliable (Cronbach's alpha = 0.87), and has construct validity.³³

Analysis

Descriptive statistics were used to characterize the study sample and survey findings. Statistical analyses were conducted using STATA version 14.2. Kruskal-Wallis and Pearson's χ2 tests were used to assess continuous and categorical variables, respectively. Bivariate analysis employing Ordinary Least Squares regression examined the associations between the fatphobia composite scores and selected participant characteristics. All statistical tests were two-sided, and the results included parameter estimates (regression coefficients) and p values. Statistical significance was defined as P < 0.05.

Results

This study included a total of 68 participants. Among them, 32 (47.06%) self-identified as male and 36 (52.94%) as female. The majority of respondents identified themselves as heterosexual or straight (83.83%), while 16.18% did not. The sample was predominantly Caucasian or White (80.88%), followed by African-American or Black (11.76%), Asian (5.88%), Latinx or Hispanic (5.88%), Native Hawaiian or Pacific Islander (4.41%), Biracial or Multiracial (2.94%), and Native American (1.47%). Regarding educational attainment, the majority held a master's degree (58.82%) or bachelor's degree (36.76%), and a small number held either a high school degree or GED (1.47%), an associate degree (1.47%), or a doctorate (1.47%). The mean age of the participants was 41.25 years (SD = 12.6), and the mean coaching experience, measured by the number of years in a coaching position, was 14.35 years (SD = 10.43), indicating a mature and experienced cohort. Descriptive statistics are presented in Table 2.

Table 2.

Participant demographic information, n = 68.

	Frequency	Percent
Gender
Male	32	47.06
Female	36	52.94
Heterosexual or Straight
No	11	16.18
Yes	57	83.83
Race/Ethnicity
Asian	4	5.88
African-American or Black	8	11.76
Biracial or Multiracial	2	2.94
Caucasian or White	55	80.88
Latinx or Hispanic	4	5.88
Native American	1	1.47
Native Hawaiian or Pacific Islander	3	4.41
Level of Education
High School Degree or GED	1	1.47
Associate Degree	1	1.47
Bachelor's Degree	25	36.76
Master's Degree	40	58.82
Doctorate Degree	1	1.47
	Mean	SD
Age	41.25	12.60
Years Coaching Experience	14.35	10.43

Table 3 shows the distribution of higher education institutions and their associated divisions. The largest proportion of colleges was located in the South (47.06%), followed by the Midwest (29.41%), West (20.59%), and Northeast (2.94%). Most institutions were private (59.09%), whereas 40.91% were public. In terms of serving specific populations, 1.47% were Hispanic-serving institutions, 2.94% were Historically Black Colleges or Universities, and 1.47% represented other diverse populations. Regarding athletic division or association, the coaches were predominantly from NCAA Division I schools (39.71%), followed by NCAA Division II (33.82%), NAIA (25%), and NCAA Division III (1.47%).

Table 3.

Institution demographic information, n = 68.

	Frequency	Percent
Region
Northeast	2	2.94
Midwest	20	29.41
South	32	47.06
West	14	29.59
Institution type
Private	39	59.09
Public	27	40.91
Other
Hispanic Serving	1	1.47
Historically Black	2	2.94
Other-Diverse Population	1	1.47
Division or Association
NAIA	17	25.00
NCAA-D1	27	39.71
NCAA-D2	23	33.82
NCAA-D3	1	1.47

Table 4 shows the distribution of the sports coached by the participants. The sample of coaches represented a variety of sports, with the largest groups being volleyball (22.06%) and soccer (16.18%), followed by basketball (13.24%), track and field (10.29%), and golf (8.82%). Other sports coaches included was cheerleading (5.88%), cross-country (5.88%), tennis (4.41%), hockey (2.94%), swimming (2.94%), baseball (1.47%), football (1.47%), lacrosse (1.47%), acrobatics (1.47%), esports (1.47%), rowing (1.47%), and stunting (1.47%). In terms of the gender of those who play the sport, 72.06% of coaches worked with women's teams, 33.82% with men's teams, and 17.65% with coed teams.

Table 4.

Participant sport demographics, n = 68.

	Frequency	Percent
Sport
Baseball	1	1.47
Basketball	9	13.24
Cheerleading	4	5.88
Football	1	1.47
Golf	6	8.82
Hockey	2	2.94
Lacrosse	1	1.47
Soccer	11	16.18
Swimming	2	2.94
Tennis	3	4.41
Track and Field	7	10.29
Volleyball	15	22.06
Acrobatics	1	1.47
Cross Country	4	5.88
Esports	1	1.47
Rowing	1	1.47
Stunt	1	1.47
Gender of Sport
Coed	12	17.65
Men	23	33.82
Women	49	72.06

The survey responses revealed varied attitudes towards sizeism and weight bias in sports, these results are displayed in Table 5. Regarding the importance of being mindful of sizeism, 31 (45.59%) agreed and 22 (32.35%) strongly agreed, while 9 (13.24%) disagreed and 6 (8.82%) strongly disagreed. When asked if weight was a valid proxy for health, 34 (50.00%) agreed, 8 (11.76%) strongly agreed, 21 (30.88%) disagreed, and 5 (7.35%) strongly disagreed. The belief that weight and disease are causally related was endorsed by 49 (72.06%) agreeing and 6 (8.82%) strongly agreeing, with 12 (17.65%) disagreeing and 1 (1.47%) strongly disagreeing. Regarding the controllability of body weight for better health, 47 (69.12%) agreed, 7 (10.29%) strongly agreed, and 14 (20.59%) disagreed. Opinions on the maintainability of weight loss showed that 40 (58.82%) agreed, 5 (7.35%) strongly agreed, 20 (29.41%) disagreed, and 3 (4.41%) strongly disagreed. Finally, when considering weight loss as a practical and positive treatment goal for athletes, 21 (30.88%) agreed and 5 (7.35%) strongly agreed, while 33 (48.53%) disagreed and 9 (13.24%) strongly disagreed. The results of the Fat Phobia Scale-Short Form were also calculated (Table 6). The total fat phobia composite score was 3.39, with a maximum score of 5 and a standard deviation of 0.44. A higher score indicates more fat phobia, while a lower score indicates less fat phobia.

Table 5.

Participant opinion of weight-related statements, n = 68.

	Strongly Disagree	Disagree	Agree	Strongly Agree
In your opinion:
In the sport's you coach, it is important for you to be mindful of sizeism when working athletes (e.g., team meetings, practice, setting goals).	6 (8.82%)	9 (13.24%)	31 (45.59%)	22 (32.35%)
Weight is a valid proxy for health.	5 (7.35&)	21 (30.88%)	34 (50.00%)	8 (11.76%)
Weight and disease are causally related.	1 (1.47%)	12 (17.65%)	49 (72.06%)	6 (8.82%)
Body weight is controllable and should be controlled for better health.	0 (0.00%)	14 (20.59%)	47 (69.12%)	7 (10.29%)
Weight loss is maintainable for the majority of the population.	3 (4.41%)	20 (29.41%)	40 (58.82%)	5 (7.35%)
Weight loss is a practical and positive treatment goal for athletes	9 (13.24%)	33 (48.53%)	21 (30.88%)	5 (7.35%)

Table 6.

Descriptive statistics for the fat phobia scale-short form.

Fat Phobia Scale-Short Form	Mean (SD)
Industrious - Lazy	3.15 (0.89)
Has will power - No will power	3.19 (0.95)
Attractive - Unattractive*	3.24 (0.79)
Good self-control - Poor self-control*	3.44 (0.85)
Fast - Slow*	3.69 (0.85)
Having endurance - Having no endurance*	3.50 (0.86)
Active - Inactive*	3.49 (0.87)
Strong - Weak	2.78 (0.86)
Self-sacrificing - Self-indulgent	3.43 (0.76)
Dislikes food - Likes food*	3.76 (0.76)
Shapely – Shapeless	3.44 (0.68)
Undereats - Overeats*	2.29 (0.69)
Secure – Insecure	3.34 (0.77)
High self-esteem - Low self-esteem	3.35 (0.73)

*Reverse coded. The range of scores is 1–5. High scores = more “fat phobia”. Low scores = less “fat phobia”.

The survey also explored the education and integration of sizeism and mental health in coaching practices; the results are presented in Table 7. In the past three years, 47 out of 55 respondents (85.45%) reported that they had integrated mental health into their coaching practices, while eight (14.55%) did not. When asked if they had taken a coaching course with learning objectives that included size, sizeism, and/or fatphobia as a component of diversity in the last three years, 49 out of 54 respondents (90.74%) had not, whereas 5 (9.26%) had. Additionally, 51 coaches (92.73%) were unfamiliar with weight-inclusive models, and only 4 (7.27%) had heard of it.

Table 7.

Participants education and integration of sizeism and mental health.

	Frequency	Percent
In the past 3 years, have you integrated mental health in your coaching practice? n = 55
No	8	14.55
Yes	47	85.45
In the last 3 years, have you ever taken a coaching course with learning objectives that included size, sizeism, and or fatphobia as components of inclusion? n = 54
No	49	90.74
Yes	5	9.26
Have you heard of the weight inclusive model?
No	51	92.73
Yes	4	7.27

Finally, bivariate analyses explored various factors influencing fatphobia among 68 college athletic coaches; these results are displayed in Table 8. Gender did not significantly influence fatphobic attitudes (p = 0.301), although male coaches showed a slightly positive coefficient compared to female coaches. Age demonstrated a statistically significant positive relationship with fatphobia (coefficient = 0.01, p = 0.002), indicating that older coaches tend to exhibit higher levels of fatphobia. Coaches identified as white showed significantly higher levels of fatphobia (coefficient = 0.30, p = 0.028) than other racial or ethnic groups surveyed. Coaching experience was also statistically significant, indicating that coaches with more experience had higher fatphobia scores (coefficient = 0.01, p = 0.014). Cheerleading (coefficient = −0.63, p = 0.004) and tennis (coefficient = −0.68, p = 0.007) coaches displayed notably lower levels of fatphobia than coaches of other sports did. Soccer coaches displayed higher levels of fatphobia (coefficient = 0.43, p = 0.002). Finally, believing that weight was a valid proxy for health was associated with higher fatphobia (coefficient = 0.47, p = 0.026). The integration of mental health into coaching practice and awareness of the weight-inclusive model did not show significant associations with fatphobia (p = 0.728 and p = 0.15, respectively).

Table 8.

Bivariate analyses of participant characteristics and fatphobia, n = 68.

	Fatphobia
	Coefficient	Standard Error	P-Value
Gender (Ref: Female)
Male	0.11	0.11	0.301
Sexual Orientation (Ref: Other)
Heterosexual or Straight	0.23	0.14	0.107
Age	0.01	0.00	0.002
Race/Ethnicity
White	0.29	0.13	0.028
African-American or Black	−0.22	0.16	0.183
Asian	−0.10	0.23	0.655
Hispanic	−0.03	0.23	0.910
Native American	−0.80	0.43	0.067
Native Hawaiian	0.07	0.26	0.794
Biracial or multiracial	−0.19	0.31	0.547
Highest Degree (Ref: High School/GED)
Associate	0.00	0.63	1.000
Bachelor's	0.27	0.45	0.550
Master's	0.19	0.45	0.675
Doctorate	0.64	0.63	0.309
Coaching Experience	0.01	0.00	0.014
Region (Ref: Northeast)
Midwest	−0.34	0.33	0.298
South	−0.39	0.32	0.226
West	−0.32	0.33	0.346
Institution Type (Reg: Private)
Public	0.04	0.11	0.689
Sport Division (Ref: NAIA)
NCAA-D1	−0.02	0.14	0.866
NCAA-D2	0.07	0.14	0.637
NCAA-D3	0.08	0.46	0.862
Type of Sport
Baseball	−0.80	0.43	0.067
Basketball	−0.06	0.16	0.694
Cheerleading	−0.63	0.21	0.004
Football	0.57	0.44	0.194
Golf	−0.09	0.19	0.651
Hockey	−0.08	0.32	0.800
Lacrosse	−0.22	0.44	0.614
Soccer	0.43	0.13	0.002
Swimming	0.03	0.32	0.924
Tennis	−0.68	0.25	0.007
Track and Field	0.15	0.17	0.386
Volleyball	0.13	0.13	0.303
Acrobatics	−0.59	0.44	0.184
Cross Country	0.35	0.22	0.116
Esports	0.07	0.44	0.882
Rowing	−0.44	0.44	0.319
Stunt	0.14	0.44	0.755
Sport Gender
Coed	−0.22	0.14	0.118
Male	−0.01	0.11	0.933
Female	0.12	0.12	0.319
Weight Related Opinions (Ref: Strongly Disagree)
In your opinion, in the sport's you coach, it is important for you to be mindful of sizeism when working athletes (e.g., team meetings, practice, setting goals).
Disagree	−0.12	0.22	0.595
Agree	0.07	0.19	0.724
Strongly Agree	−0.25	0.19	0.210
In your opinion, weight is a valid proxy for health.
Disagree	0.41	0.21	0.057
Agree	0.47	0.21	0.026
Strongly Agree	0.37	0.24	0.132
In your opinion, weight and disease are causally related.
Disagree	−0.01	0.46	0.990
Agree	0.10	0.45	0.821
Strongly Agree	0.06	0.48	0.902
In your opinion, body weight is controllable and should be controlled for better health. (Ref: Disagree)
Agree	0.19	0.13	0.145
Strongly Agree	0.29	0.20	0.152
In your opinion, weight loss is maintainable for the majority of the population.
Disagree	−0.17	0.27	0.540
Agree	−0.04	0.26	0.887
Strongly Agree	0.09	0.32	0.790
In your opinion, weight loss is a practical and positive treatment goal for athletes.
Disagree	0.19	0.16	0.251
Agree	0.30	0.17	0.081
Strongly Agree	−0.05	0.24	0.823
Integrated Mental Health in Coaching Practice (Ref: No)	−0.06	0.17	0.728
Attended Inclusive Coaching Course (Ref: No)	0.37	0.21	0.089
Knowledge of Inclusive Models (Ref: No)	−0.34	0.23	0.150

Discussion

The primary purpose of this study was to explore collegiate athletic coaches’ training, attitudes, and opinions on weight bias and size diversity. Our goal was to advocate for a weight-inclusive approach (WIA) in sports training education and athlete-centered coaching. The results of this study should be read with due consideration of the fact that the analysis was conducted with a small, relatively non-diverse convenience sample. Findings from this quantitative cross-sectional study indicated that very few (9.2%) participants had taken a course with learning objectives that included size as a component of diversity. Participants also reported agreement with the harmful tenets of the weight-normative approach (WNA). More than 80% of participants agreed that weight and disease are causally related, 79.41% agreed that body weight is controllable and should be controlled for better health, 61.76% agreed that weight is a valid proxy for health, and 66.17% agreed that weight loss is maintainable for the majority of the population.

Weight-normative approaches in athletic coaching can pose significant risks, including promoting unhealthy weight control behaviors, fostering negative body image, and leading to disordered eating patterns among athletes.^5,29 These approaches prioritize weight and body shape over performance, causing psychological distress and undermining athletes’ confidence and overall well-being. Additionally, focusing solely on weight and body shape can detract from the importance of skills, training, and proper nutrition, ultimately hindering athletic development and performance.^3,34

In comparison to other research on fat phobia among youth sport coaches, the current study's findings align closely. For example, Winter et al. (2024) found a mean score of 3.44 on the Fat Phobia Scale-Short Form among middle and high school coaches, which was slightly lower than the average score of 3.52 in the general U.S. adult population but still within the moderate range of weight bias.¹⁶ These results emphasize that weight bias is not only present among collegiate coaches but is also observed across different levels of sports coaching.¹⁶ The total fat phobia composite score in the present study was 3.39, indicating moderate fatphobic beliefs among participants.

Notably, the results indicated higher levels of fatphobia among white coaches and among those who reported being late in their careers. This finding aligns with previous research suggesting that intersections of ethnicity, age, and gender can shape attitudes toward body size and fatphobia. For example, studies have found that individuals from different racial or ethnic backgrounds may experience varying degrees of weight-related stigma due to cultural attitudes toward body shape and size.^35,36 The current findings are incongruent with past research that showed coach tenure was unrelated to body image attitudes.^37,38 However, research has shown that male coaches exhibit high levels of weight bias, potentially influenced by gendered perceptions of athletes’ bodies and performance expectations.¹⁵ These intersecting factors suggest that addressing fatphobia in coaching requires a nuanced approach that considers cultural, generational, and gender-based dynamics. This perspective emphasizes that fatphobia is not solely an issue of individual attitudes but is shaped by broader sociocultural systems and professional environments. Targeted training programs could benefit from exploring these intersections to tailor interventions that are sensitive to coaches’ diverse backgrounds and experiences.

Again, these results generally indicate that coaches may harbor dangerous tenets of WNA, wherein they appraise and value their athletes’ body, shape, and size over their physical health. However, it is crucial to recognize that these biases are not solely the result of individual shortcomings but are perpetuated by broader organizational and cultural systems that reinforce weight-centric ideals. These implicit and explicit weight biases can promote stereotypes and weight discrimination, whereas integrating a WIA could decrease student athletes’ fear of discrimination based on their body size and discourage the promotion of “slim to win”.^15,16 Additionally, adopting a WIA could help dismantle harmful stereotypes and disprove outdated notions that weight and disease are causally related and that encouraging weight loss and focusing on size can be physically and mentally harmful.²⁰

Recommendations for practice

With few participants attending diversity training, the associated risks are often overlooked. This gap is not just an individual coach's oversight but reflects broader structural issues in coach education. Weight diversity modules are largely absent from curricula, both in the U.S. and Europe, indicating a systemic failure to prioritize this content.¹⁶ Addressing this deficiency requires institutional commitment to incorporate weight diversity into training, rather than relying solely on coaches’ personal initiatives.

Athletic coaches must embrace weight inclusivity and demonstrate such in their interactions with student athletes. However, it is important to acknowledge that some coaches may avoid initiating conversations about body shape or weight due to fears of triggering disordered eating behaviors or negative body image. This well-intentioned caution can lead to a form of inaction, where coaches choose not to address issues even when intervention might be necessary. While this approach aims to prevent harm, it can inadvertently perpetuate misunderstandings about health and body size among athletes, who may benefit from informed, supportive discussions led by trained professionals. Addressing these fears through targeted education can empower coaches to engage more confidently in these sensitive conversations, ensuring that interventions are both effective and considerate of athletes’ mental health needs.^4–7

Coaches are also discouraged from commenting on an athlete's weight and body composition and are encouraged to avoid comparing athletes’ bodies. Coaches are advised to rely on professionals such as nutritionists, counselors, or sports psychologists to address individual concerns and receive appropriate information rather than sharing misinformation or advice rooted in fatphobic beliefs. Coaches are also encouraged to stay abreast of research-based information about mental health and size diversity. Within their teams, coaches can (a) foster an environment where athletes of all body sizes feel accepted, (b) use language that emphasizes health and performance rather than weight and appearance, and (c) promote mental health resources, such as counseling centers and sports psychologists. Additional resources include websites, podcasts, and educational materials such as (a) Health at Every Size, (b) weight-inclusive nutrition and dietetics, (c) NEDA Coach and Athletic Trainer Toolkit, and (d) Body Kindness.

Finally, coaches are encouraged to attend trainings related to body diversity, inclusive language, and mental health. Starting in November of 2025, The National Collegiate Athletic Association (NCAA) will require Division I schools to provide mental health services and support to student-athletes. This regulation is a step in the right direction for a holistic student-athlete model. Such policy-level initiatives demonstrate a shift toward addressing the structural factors that contribute to weight bias in coaching, emphasizing the need for sustained efforts at institutional and organizational levels. These initiatives will provide coaches with opportunities and resources to expand their multicultural awareness and implement updated practices, such as WIA.

Limitations

While the present study contributes to the limited literature on weight bias, fatphobia, and diversity training among collegiate athletic coaches, it has some limitations. First, and as mentioned earlier, although the research team made a concerted effort to recruit a diverse sample from all states and sports, the response rate was low, and most participants were white, cisgender, and heterosexual. The low response rate suggests that the results from this sample should be interpreted with caution. The sample may not be fully representative of the population, and the estimates may be less precise than desired. Additionally, the data were collected from volunteer participants; therefore, self-selection bias may have been present in the findings. Specifically, the title of the survey may have contributed to the self-selection bias. It is also possible that the language used in the survey questions may have influenced participants’ responses. For instance, although participants may have received training related to body weight and shape, the explicit language used in the research questions might not have aligned with their experiences, potentially leading to underreporting or misinterpretation of their perspectives. Also, the recruitment survey was a combination of validated and non-validated questions aimed at assessing weight bias, fatphobia, and diversity training. Finally, the order and nature of the questions within the survey might have primed coaches for response bias.

Recommendations for research

Based on the limitations of this study, recommendations for future research include expanding and replicating the study with a larger sample. Toward this end, it may be helpful to target specific sports or conduct qualitative studies within sports wherein coaches reported high (soccer) and low (cheer and tennis) fatphobic beliefs. The results also indicated that older- and late-career coaches reported higher levels of fatphobic beliefs. Future researchers could better understand these findings by targeting and exploring this intersection. It is also recommended that future research explore weight bias among other collegiate athletic staff, such as physical therapists, athletic trainers, administrative staff, nutritionists, and sports psychologists. Expanding this research could create a shift in collegiate athletics and society to uncover harmful practices and foster inclusive practices to deconstruct stereotypes and discrimination. Finally, future researchers should examine how weight bias affects student athletes who are already vulnerable to disordered eating and other health issues.

Conclusion

This study highlights the critical need for athletic coaches to adopt a weight-inclusive approach (WIA) to combat pervasive weight bias and promote size diversity among collegiate athletes. The alarming prevalence of fatphobia and adherence to weight-normative approaches among participants underscores the significant risks posed to athlete well-being, performance, and mental health. By prioritizing educational initiatives that emphasize body positivity, mental health resources, and inclusive coaching practices, we can foster an environment in which all athletes feel valued, regardless of size. The upcoming NCAA requirement for mental health services signifies progress; however, coaches must embrace continuous training in diversity and weight inclusivity to ensure a supportive and equitable athletic landscape. A commitment to WIA not only enhances the holistic development of athletes but also challenges outdated misconceptions regarding weight and health, ultimately enriching the sporting experience for all.

Footnotes

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Kassie R Terrell

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