According to the CDC, over 42% of American adults suffer with clinical obesity. Many seek treatment for obesity-related comorbidities only to find themselves on the receiving end of weight bias. Alberga and colleagues define weight bias as a prejudicial or negative belief about an individual based on their weight or size.

Patients with obesity routinely seek out healthcare professionals to reduce their weight only to encounter providers who are ill-equipped to address their needs adequately, respectfully, or empathetically—physicians, nurse practitioners, and nurses have all shown bias toward patients with obesity. This bias not only deters high-risk patients from seeking care, but serves as a barrier to quality care that can have devastating and lasting effects. Patients who experience weight bias develop mistrust toward the healthcare system, with many avoiding follow-up care and delaying preventative health screenings, which can lead to poorer health outcomes.

Attitudes about weight among health professionals are disturbing. Surveys show many physicians believe that patients with obesity are lazy and unattractive. In a study of a large cohort of medical students, Durkin found that 74% exhibited implicit weight bias, and 67% endorsed explicit weight bias. These biases were actually higher toward individuals with obesity than racial minorities, gays, lesbians, and the poor. And a study by Ward-Smith and Peterson of 358 nurse practitioners (NPs) found that NPs perceived overweight and obese adults as untidy; respondents also felt the adults were not as healthy or as suitable for marriage as those not overweight. Clearly, a change in attitude is needed.

What you can do

Here’s what you can do to reduce weight bias. 

Educate yourself about obesity. Obesity is a multifocal, complex disease process. It’s a disease of adiposopathy, pathologic adipose tissue, hormones, and proinflammatory proteins that is caused by genetics, dysregulation of the gut microbiome, and environmental, psychological, social-cultural, and financial factors. Patients with obesity are at higher risk for diabetes mellitus, hypertension, metabolic disease, cancer, sleep apnea, depression, and COVID-19.

Address the patient not their disease. Use “person-first language”, for example, rather than saying, “ I have an obese patient”, state, “ I am treating a patient with obesity”.

Take the Harvard Implicit Association Test for weight . This test can help identify if you have bias toward individuals with obesity.

Consider the social determinants of health. Consider income inequality, food access, food quality, housing, transportation, education, and health literacy as contributing factors when encountering patients with obesity. 

Use suitable equipment. Weigh patients on scales that exceed weights of 350 lbs., use large blood pressure cuffs to obtain an accurate reading, and refrain from weighing patients in a public area.

Eradicate obesity bias

Obesity is a diagnosis—not a personal failing. Everyone, regardless of their role in healthcare, must do their part to reduce the harmful effects of weight bias. It’s the last socially acceptable practice that contributes to healthcare inequality and it’s time for it to be eradicated.

Removing bias promotes a multidisciplinary approach to the complex disease of obesity. Healthcare providers must take a holistic approach, including psychological, pharmacological, health education and personal training interventions. Our focus must be on a comprehensive, restorative, and functional health approach.

It’s time to put health back in healthcare and treat patients with obesity with the respect they deserve.

Stacy Winters is a primary care provider in Frederick, Maryland, who works in obesity medicine and is a PRN nurse resource on multiple units for Frederick Health. Winters is a certified health coach, runner, and triathlete. She moderates the podcast Health-Chats Stay Well.

References

Alberga AS, Edache IY, Forhan M, Russell-Mayhew S. Weight bias and health care utilization: A scoping review. Prim Health Res Dev. 2019;20:e116.

Centers for Disease Control Prevention. Adult facts. June 29, 2020. cdc.gov/obesity/data/adult.html

Cody Standford F. Addressing weight bias in medicine. April 3, 2019. health.harvard.edu/blog/addressing-weight-bias-in-medicine-2019040316319

De Lorenzo A, Gratteri, S, Gualtieri P, Cammarano A, Bertucci P, Di Renzo L. Why primary obesity is a disease. J Transl Med. 2019;17(1):169.

Durkin M. Doctor, your weight bias is showing. ACP Internist. February 2017. https://acpinternist.org/archives/2017/02/weight.htm

Fruh SM, Nadglowski J, Hall HR, Davis SL, Crook ED, Zlomke K. Obesity stigma and bias. J Nurse Pract.2016;12(7):425-32.

Lazarus E. What is obesity? 2020.  obesitymedicine.org/what-is-obesity/

Puhl RM, Phelan SM, Nadglowski J, Kyle TK. Overcoming weight bias in the management of patients with diabetes and obesity. Clin Diabetes. 2016;34(1):44-50.

Wadman M. Why obesity worsens COVID-19. Science. 2020;369(6509):1280-81.

Ward‐Smith P, Peterson JA. Development of an instrument to assess nurse practitioner attitudes and beliefs about obesity. J Am Assoc Nurse Pract. 2016;28(3):125-29.