Physicians Urged to Address Weight Bias to Improve Patient Care

By DANIELLE DICENZO

Nearly two-thirds of the American population are overweight or have obesity.

According to an article published in Obesity, individuals who are struggling with weight issues also experience weight bias and are vulnerable to increased risks of depression, social rejection, anxiety, and suicide. Increasingly, people who are overweight or have obesity face discrimination in the workplace, barriers in education, stereotypes from the media, stigma in personal relationships, and bias from healthcare professionals.

 “It is critical for healthcare providers to be aware of this issue and take steps to prevent stigma associated with weight in their practice,” said Dr. W. Scott Butsch, vice chair of the MMS Committee on Nutrition and Physical Activity, and an obesity specialist at the Massachusetts General Hospital Weight Center.

The prevalence of weight discrimination in the U.S. has increased 66{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} over the past 10 years and is comparable to rates of racial discrimination, especially among women. A study of physicians found that more that 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of physicians viewed patients with obesity as “awkward, unattractive, ugly, and non-compliant.” These biases — both explicit and implicit — are hampering patients’ access to healthcare.

Research conducted by the Rudd Center for Food Policy and Obesity at the University of Connecticut has found that physicians spend less time and are less engaged in discussions with patients who are struggling with weight issues. Furthermore, the Rudd Center’s research reveals that physicians are reluctant to perform preventive screenings and to engage with patients who are overweight or have obesity.

According to a Boston Medical Center public-health review, attributing a person’s obesity to causes within his or her control continues to be a major source of stigmatization and discrimination.

Addressing lifestyle choices such as dieting and physical activity without acknowledging the genetic, metabolic, and other characteristics that are contributing factors to obesity can perpetuate weight bias.

“A growing body of scientific literature has supported that obesity is a complex disease that stems from the failure of normal weight and energy regulation. We know it’s more than a matter of ‘calories in and calories out,’ as there are multiple contributing factors to one’s weight gain and strong genetic and biological forces at play making it difficult to lose weight,” Butsch said.

UConn’s Rudd Center suggests four approaches physicians can take in order to address weight bias and to enhance patient experience in a clinical setting.

The first is to self-identify negative weight-based assumptions, stereotypes, or judgments and empathize with the lived experience of those who are overweight or obese. Second, alter weighing procedures, paying attention to negative comments or facial gestures which contribute to patient embarrassment and shame. Third, evaluate medical equipment, ensuring that appropriately sized gowns or blood-pressure cuffs, for example, are available. Finally, look at the overall office environment; remove reading materials that stigmatize weight, and be aware of size of chairs in the waiting room.

“Weight bias is somehow an acceptable form of discrimination. We need to change that,” Butsch said. “Physicians can work toward this and work toward improving patient outcomes by educating themselves, their staff, and their patients.”