Obesity has historically been regarded as a moral failing, and people with obesity describe being seen as deficient, lazy, and/or undeserving of respect, lacking willpower and self-discipline, and gluttonous. Such negative judgments about obesity persist not only in society at large but also in healthcare settings.
These views contribute to weight bias (negative ideologies associated with obesity), which can lead to weight stigma (discriminatory acts and ideologies targeted toward individuals because of their weight and size). Furthermore, research has also suggested an association between weight stigma and increased food intake, such as eating without being hungry, emotional eating, binge eating, and long-term weight gain.
Kathleen Robinson, MD, PhD, assistant professor of internal medicine-endocrinology and metabolism, Iowa Carver College of Medicine, Iowa City, Iowa, and her colleagues surveyed 395 individuals who were asked about their experiences related to weight stigma and healthcare. “We found ongoing tension between the framing of weight as solely a result of personal responsibility vs weight as a multifactorial condition with an array of uncontrollable aspects,” Robinson reported. “And we found healthcare providers made assumptions about patients based on body size, such as what they were eating or whether they were exercising, and didn’t necessary ask about or acknowledge the patient’s previous experiences with losing weight or what their actual lifestyle was.” Advice given was often “trite and dismissive,” rather than addressing the patient’s specific needs and history. Weight stigma can result in physicians dismissing patients’ non–weight-related concerns, refusing care, or attributing health problems to obesity without considering other causes.
Weight bias and stigma in medicine therefore remain a systemic barrier to healthcare, but the medical community is working to address the problem, and there are practical steps physicians can take to make their practices weight inclusive. Physicians should focus on helping patients set and work on behavioural goals rather than on losing weight. Instead of focusing on weight, it is better to focus on actionable items, such as food substitutions, filling the plate with vegetables, or increasing movement. Measuring and discussing a patient’s weight may not always be necessary at every appointment.
Another alternative model is ‘Health at Every Size’, which supports size acceptance to end weight discrimination and to lessen the cultural obsession with weight loss and thinness. It promotes balanced eating, life-enhancing physical activity, and respect for the diversity of body shapes and sizes.
Physicians also can address weight stigma by making sure they have equipment that accommodates patients of all sizes. Experts recommend ensuring that blood pressure cuffs and patient gowns are large enough for patients with overweight and obesity and opting for patient chairs without arms. Examination tables, scales, MRI machines, and similar equipment should be able to accommodate individuals of all sizes and weights. Additional tips include having a split lavatory seat and properly mounted grab bars to help the patient get up more easily, floor-mounted toilets and well-supported toilet bowls, urine specimen collector cups with handles, extra-long phlebotomy needles and tourniquets, and a large vaginal speculum.
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