Body weight may be one of the most sensitive topics a physician can discuss with a patient. Weight can affect how people feel about themselves and how others treat them. Unfortunately, weight bias (when negative assumptions, beliefs, and judgments are made about people based on their body size) and weight stigma (the attribution of negative personal or behavioral qualities based on weight) have become more common with the increased prevalence of obesity.
Weight bias and weight stigma stem from the belief that a person’s weight (and health) is solely under their control, making weight management a personal responsibility. Obesity, however, is a complicated, multifactorial disease, and there is a wealth of evidence that genetic, environmental and cultural factors affect body size. People do not have complete control over their weight and claiming that they do can result in negative psychological and physiological consequences.
Stigma-based messaging is an ineffective way to encourage people with obesity to change their diet and lifestyle; in fact, weight stigma has a measurable negative effect on health. People who experience weight discrimination are reported to have higher levels of stress hormones and inflammatory markers, higher long-term cardiometabolic risk, and increased mortality. Weight stigma is associated with poor mental health and increased risk of depression, anxiety, social isolation, low self-esteem, substance use, binge eating, emotional overeating, and unhealthy weight control behaviors. Those who experience high levels of weight stigma report higher exercise avoidance, lower levels of physical activity, and increased sedentary behaviors, making it more difficult to improve overall health.
Weight bias from healthcare providers can have a particularly deleterious effect on the health of individuals with obesity. Patients with obesity who detect weight bias in the clinic are less likely to seek care, including screenings and preventive care. When they do seek treatment, these patients tend to have worse outcomes, partly due to delayed diagnoses. Additionally, studies have shown that clinicians spend less time and are less likely to provide health education and health-related resources to patients with obesity.
Five steps health care providers can take to combat weight bias and improve the quality of care for patients with obesity:
- Try not to judge patients based on their weight. To identify and confront potential biases you may not even be aware of, check out online resources for healthcare providers, such as the Rudd Center’s self-assessment resources or Harvard University’s Implicit Association Test (IAT).
- Ask your patients if they are willing to discuss their weight and give them the power to say no. If patients faced discrimination in the healthcare setting in the past, it might take some time for them to rebuild trust.
- If your patient is willing to discuss their weight, talk with them about their struggles and acknowledge that lifestyle change can be difficult. This type of conversation may challenge your assumptions about people with obesity. It is important to keep in mind, for instance, that dieting is often ineffective, and many people with excess weight have tried dieting unsuccessfully. Also, be aware that language can be stigmatizing. Compassionate, patient-first language (such as patients with obesity rather than obese patients) can go a long way to earning your patients' trust and helping them feel that their condition does not define them.
- Assess whether your patient is ready to make changes and be willing to accept any hesitancy. If a patient indicates that they are prepared for change, give clear advice, including measurable and attainable goals. Offer encouragement by reminding patients that a small amount of weight loss can have significant health benefits. Schedule a follow-up to assess progress. If a referral to a counselor or nutritionist may be helpful, share these options.
- Finally, consider the physical environment of the clinic. Seats without armrests, more oversized chairs, wide sturdy exam tables, high-capacity scales in private locations, and appropriately sized equipment (such as vaginal speculum, blood pressure cuffs, and gowns) can help to alleviate the stress that people with larger body sizes may feel during the clinical encounter, improve how patients feel about their visit and make the experience more positive overall.
Body weight is a sensitive topic for many people. But obesity is a serious disease that should be discussed, approached, and treated like any other — without bias. Addressing weight bias in the clinical setting is a much-needed step toward treating obesity and its host of serious complications and may improve patient outcomes by helping people with obesity feel more at ease talking with their healthcare providers about their weight and taking constructive steps to treat their condition.
For more information on strategies for addressing this condition in the clinic, see the DynaMed topic on Weight Bias.
