Introduction

Obesity is a significant chronic disease affecting millions globally. Obesity is linked to a variety of comorbidities, including cardiovascular disease, diabetes, hyperlipidemia, obstructive sleep apnea, and certain cancers (Purnell, 2023). In addition to these health ramifications, obesity also underscores the issue of weight bias that is pervasive in healthcare. This article will explore the intersection of weight bias and obesity in healthcare, including implications for nursing practice.

Weight Bias in Healthcare

Weight bias in healthcare exists in both implicit and explicit forms. Implicit weight bias can affect the quality of care received and overall healthcare outcomes in individuals with a higher body weight or who are obese. Explicit bias can include presumptions about a person’s lifestyle choices, motivations, and abilities (Carels et al., 2024). Healthcare providers, including nurses, may exhibit weight bias, which can lead to stigmatization and, in some cases, discrimination. Up to 80% of people in developed countries in the world will be overweight or obese by the year 2030. This indicates that soon, most people participating in healthcare systems in these parts of the world will be overweight or obese. Without intervention, weight bias may continue to contribute to the worsening of obesity for years to come (Lawrence et al., 2021).

Internalized Weight Bias

Internalized weight bias is a part of the broader issue of weight stigma. People may assimilate negative stereotypes, beliefs, and attitudes about body weight and size into their own self-concepts. Overweight or obese people seeking care may also have internalized feelings of shame or judgment from prior encounters with the healthcare system, which may negatively impact their health (Seymour et al., 2018). Over time, these encounters can lead to distrust and a lack of engagement in their care. These experiences may prevent individuals who are overweight or obese, and who are likely to develop or further worsen comorbidities from seeking care (Lawrence et al., 2021).

Impacts of Weight Bias on Care

Weight bias has several impacts on care, including lower quality of care. Healthcare providers may assume that a person’s healthcare issues are only because of their weight and may overlook other potential underlying health conditions. As a result, people may also experience reduced access to care because their potential underlying conditions are not explored. This can delay diagnostic testing or referral for their underlying condition (Sobczak & Leoniuk, 2021). According to Lawrence et al. (2021), individuals may avoid treatment when they do not feel healthcare providers are attentive to their health concerns or spend enough time listening to them during their appointments. Individuals from marginalized backgrounds may have compounded biases, which leads to worsening health outcomes and increased health disparities. People may also experience psychological concerns, including anxiety, depression, and substance use disorders because of weight bias (Kennedy et al., 2022).

The Impact of Nursing

Nurses can play a role in addressing obesity and mitigating bias in healthcare settings. Providing nurses with education and training on the complexities of obesity, including the metabolic, genetic, and social factors, can lay the groundwork for understanding this complex chronic disease (Kennedy et al., 2022). Evidence suggests that healthcare providers who receive training on weight bias provide more supportive attitudes and behaviors toward patients with obesity (Baska et al., 2024). Motivational interviewing, which encompasses effectively beginning conversations about a person’s weight with their consent and identifying a person’s challenges and goals, is another tool to better care for this population. Developing cultural competencies related to cultural differences in attitudes toward obesity and health can improve communication and build trust. Through the development of this knowledge, it allows for more individualized care. Collaboration with interdisciplinary team members such as dietitians, mental health professionals, and physical therapists can develop comprehensive treatment plans. Nurses can also help address social determinants of health, including food insecurity, transportation, and access to care barriers that can affect health and well-being (Kennedy et al., 2022). Finally, nurses have the unique opportunity to advocate politically for patients at the local, state, and national levels, including policies promoting holistic and equitable care for all patients.

Conclusion

Obesity is a complex health issue, and bias and stigma continue to impact overweight and obese people across the world. Nurses and other healthcare professionals, can be a part of the change, recognize and address their biases, and provide equitable and quality care for patients who are overweight or obese. By fostering an environment of learning, cultural competency, empathy, and advocacy, nurses can contribute to reducing stigma and improving health outcomes for individuals who are overweight and obese. Addressing the weight biases present in healthcare systems and the internalized stigma experienced by patients is essential for creating a more inclusive healthcare environment.

References

Baska, A., ´Swider, K., Zgliczy´nski, W. S., Kłoda, K., Mastalerz-Migas, A., & Babicki, M. (2024). Is Obesity a Cause for Shame? Weight Bias and Stigma among Physicians, Dietitians, and Other Healthcare Professionals in Poland—A Cross-Sectional Study. Nutrients, 16(7), 999. https://doi.org/10.3390/nu16070999

Carels, R. A., Byrd, R., Mansour, L., Metzler, A. L., & Jansen, E. (2024). The role of weight stigma and internalized weight bias in health care avoidance and mistrust. Stigma and Health. https://doi.org/10.1037/sah0000578

Kennedy, A. B., Taylor, S. S., Lavie, C. J., & Blair, S. N. (2022). Ending the Stigma: Improving Care for Patients Who Are Overweight or Obese. Family Practice Management, 29(2), 21–25.

Lawrence, B. J., Kerr, D., Pollard, C. M., Theophilus, M., Alexander, E., Haywood, D., & O’Connor, M. (2021). Weight bias among health care professionals: A systematic review and meta-analysis. Obesity, 29(11), 1802–1812. https://doi.org/10.1002/oby.23266

Purnell, J. Q. (2023). What is Obesity? Gastroenterology Clinics of North America, 52(2), 261–275. https://doi.org/10.1016/j.gtc.2023.03.001

Seymour, J., Barnes, J. L., Schumacher, J., & Vollmer, R. L. (2018). A Qualitative Exploration of Weight Bias and Quality of Health Care Among Health Care Professionals Using Hypothetical Patient Scenarios. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 55, 004695801877417. https://doi.org/10.1177/0046958018774171

Sobczak, K., & Leoniuk, K. (2021). Attitudes of Medical Professionals Towards Discrimination of Patients with Obesity. Risk Management and Healthcare Policy, Volume 14, 4169–4175. https://doi.org/10.2147/RMHP.S317808