Addressing weight bias in medicine

You happen to be among the two-thirds of Americans with overweight and obesity (defined as a body mass index of 25 or greater), and you are just thrilled to go to your next doctor’s appointment, right? Wrong! Unfortunately, if you have a diagnosis of overweight or obesity, you might find the doctor’s office to be the least inviting place to be.

Maybe you find that there are no chairs to accommodate you in the waiting room. When the medical staff takes your blood pressure, you might find that they struggle to find the right size cuff. You might feel as though you are weighed in a disrespectful fashion. Or maybe, when you bring up a medical issue with your doctor that is of significant concern, your doctor states that if you just “got your weight under control,” that this and all other issues would no longer be problematic. And finally, as you prepare to depart, your doctor tells you once more: “If you eat less and exercise more, you will lose weight.”

Health consequences of weight bias

Weight bias is pervasive in medicine, as communicated in a recent article in the Journal of the American Medical Association. The prevalence of weight bias in medicine may stem, at least in part, from minimal education about obesity in undergraduate and graduate medical education. And there is even less education about weight bias and stigma and its impact on the health of individuals who struggle with obesity.

Obesity is a complex disease that cannot be minimized to the “calories in/calories out” mantra that has become commonplace. Factors that can contribute to weight might include biological issues such as genetics and hormonal changes that come with aging; developmental issues such as parental obesity; psychological issues including depression or history of trauma; or environmental factors, such as large portion sizes. And these are just a few of a myriad of possible contributors.

Yet explicit and implicit bias towards people with obesity truly impacts their health. In an article in Clinical Diabetes, researchers summarized evidence of the health consequences of weight bias to people with obesity. These consequences included:

• changes in eating and physical activity, such as unhealthy eating behaviors, binge eating disorder, and lower motivation for exercise
• physiological reactions including increased blood pressure, blood sugar, and levels of the stress hormone cortisol
• reduced engagement with health care services, including less trust of health care providers and poor adherence to treatment
• effects on psychological health and distress, including depression, anxiety, substance abuse, and suicidal tendency
• long-term health effects including more advanced and poorly controlled chronic disease, and low health-related quality of life.

Learn to advocate for yourself

One of the first steps you can take to begin to undo weight bias and stigma is to use “people first language” when discussing your overweight and obesity, as I noted in a recent paper on the topic. You should never refer to yourself as an “obese person” or “morbid,” as these terms are stigmatizing. Obesity is a disease: you are not an “obese person”; rather, you have the disease of obesity.

Also, we don’t use the term “morbid” to describe any other disease. Yet, we are quick to use the word “morbid” when we refer to people with a significant amount of excess weight. Instead, one should state, more appropriately, “I have severe obesity.”

But using the proper language is just one small part of tackling weight bias in medicine. Here are some other practical steps you can take:

• Take the Harvard Implicit Association Test (IAT) for weight to discern if you have weight bias toward individuals with obesity. Often persons who have obesity have a similar amount of weight bias as those who do not have obesity.
• Learn about obesity as a disease. You might find that there is a great deal you don’t know. For example, did you know that the bacteria in the gut of lean individuals often differs from those who have obesity, and that this difference may explain some of the weight struggles for some individuals?
• Learn more about weight bias by using resources such as those at the Rudd Center for Food Policy and Obesity.
• Speak with your physician and their office staff if you experience bias in the office setting. They may be unaware of ways in which they are contributing to the problem.
• Find a group, such as the Obesity Action Coalition, to help elevate the message about weight bias and its harmful impact on health.

Doctors and people with obesity alike must make strides to reduce weight bias and stigma, for the sake of all our health.

Follow me on Twitter @fstanfordmd

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