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Obesity discrimination in healthcare

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Obesity discrimination in healthcare, or weight bias, refers to a wide range of discriminatory and harmful attitudes toward people deemed to be overweight. It can include beliefs such as those that heavier people are usually unhealthy, that having excess weight is easy to modify and is usually a person’s “fault,” and that heavier people must always be trying to lose weight if they care about their health.

Research has consistently shown that healthcare professionals are biased against people deemed as having overweight or obesity. This causes them to behave in discriminatory ways, such as blaming serious health issues on weight and, therefore, inadvertently ignoring other possible causes.

Many healthcare professionals’ attitudes about obesity have little scientific backing. Although research does show a correlation between having obesity and certain health risk factors, not everyone with obesity is unhealthy. In fact, one 2015 study suggested that many adults with obesity are healthy and that 2–50% are “metabolically normal,” indicating a low risk of cardiovascular and other conditions.

Prioritizing weight above all other health issues can damage the mental and physical health of people deemed to have obesity. It may even contribute to rising rates of obesity.

Keep reading to learn more about obesity discrimination in healthcare, including information about why it exists, some statistics, and the negative effects of this stigma.

Concerns about an “obesity epidemic” have inspired many healthcare professionals to discuss weight concerns with their patients.

However, weight is just one of many factors affecting health. Also, the link between weight and health does not run in one direction. A person’s health can affect their weight, just as their weight can affect their health. Beliefs about people who carry excess weight often ignore this fact.

One 2015 paper suggested that healthcare professionals report viewing people with overweight or obesity as lazy, as weak-willed, or as lacking self-control. Rather than treating obesity as a health condition, they may treat it as a personality trait, judging a person as less compliant and more unhygienic based on their weight.

A 2016 study involving nurse practitioners found that healthcare professionals made sweeping judgments about heavier patients. Nurses reported that overweight people or those with obesity were not as good or successful as people carrying less weight, were unfit for marriage, and were messy, dirty, and unhealthy.

According to the 2015 paper above, these biases may cause people with overweight or obesity to report lower quality care. Healthcare professionals may offer a less patient-centered approach and make treatment recommendations based on stereotypes, not the person’s actual needs.

Doctors may also overestimate the extent to which a person can control their weight, choosing to attribute weight to a lack of discipline rather than a complex interaction between genes, the environment, stress, overall health, and personal choices.

Weight bias is becoming more common in healthcare. One 2016 paper suggested that weight bias increased by 66% during the previous decade.

Some healthcare professionals may believe that having frequent shaming discussions about weight may encourage weight loss. The data suggest otherwise. Shame is stressful, and it may undermine weight loss or even cause a person to gain weight.

A 2014 study looked at weight gain among women and the messages they received from people they trusted about their weight. Women with a higher level of weight concern were more likely to gain weight when they heard shaming or judgmental comments, while weight acceptance was associated with less weight gain and sometimes with weight loss.

A 2016 paper highlighted studies showing widespread bias and discrimination. Those studies reported the following statistics:

  • Around 53% of women with obesity report hearing inappropriate comments about their weight from healthcare professionals.
  • Approximately 79% of people with excess weight or obesity report eating more to cope with weight discrimination.
  • About 52% of women say that their weight has been a barrier to receiving appropriate healthcare. Concerns about weight are also associated with delaying or avoiding preventative care.
  • Roughly 40% of healthcare professionals admit to having negative reactions to patients with obesity.

Weight stigma is a collection of attitudes and actions related to weight bias. Weight bias refers to the notion that people viewed as having overweight or obesity are “inferior” or otherwise worthy of derision.

Weight stigma persists throughout society. For example, employers may refuse to hire someone based on their weight. Bullying people based on their weight is also common in many settings.

These experiences can directly affect a person’s mental and physical health, necessitating quality care from compassionate healthcare professionals. However, weight stigma is also pervasive in health settings.

Some other examples of weight stigma include the following.

Holding negative beliefs about people based on their weight

For example, a healthcare professional might think that a person with obesity is unhealthy or less successful.

Falsely attributing health problems to weight

A 2019 article highlighted the obituary of Ellen Maud Bennet. Her doctors repeatedly attributed her increasingly severe symptoms to her weight, suggesting a diet as treatment. She died of advanced stage cancer just a few days after a doctor finally diagnosed the correct condition.

Misunderstanding the causes of obesity

Obesity is a complex condition, and individual choices are just one factor. Overall health, stress, and similar factors also play a role.

Losing weight is extremely difficult. In fact, one 2015 study found that women with obesity have just a 0.8% chance of achieving a moderate weight.

Believing that shame works

People with overweight or obesity usually know that they are heavier than their doctors want them to be. There is no evidence to suggest that reminding them of this fact causes them to lose weight.

Believing that weight is the most important factor in health

Lighter people can be unhealthy, and heavier people can be healthy. Moreover, attempts to lose weight — such as disordered eating or crash dieting — can undermine health.

A 2016 study found that unfit light people were about twice as likely to develop diabetes as fit people who are overweight.

Weight bias does not help people become healthier. It can actually exacerbate health issues. Some examples of the negative effects of weight bias include:

  • Disordered eating: Weight bias is linked to disordered eating, such that people who internalize weight bias and shame are more likely to develop unhealthy eating habits. This can, in turn, cause serious health issues.
  • Avoiding preventive care: People who have experienced weight bias in health settings or who worry that they might are more likely to avoid seeking preventive care and other screenings.
  • Gaining weight: Weight stigma may actually contribute to the obesity epidemic by worsening overall health, leading to stress eating and causing people to avoid seeking medical attention.
  • Having negative healthcare experiences: Negative healthcare experiences can be traumatic and demoralizing, causing people to feel angry, unheard, or bad about themselves. These experiences can intensify the feelings of rejection and bullying a person might experience based on their weight.

Obesity can affect health, but it is not the only, nor the most important, factor when it comes to living in good health.

It is also important to note that people with obesity can be healthy, and focusing on size or weight as a primary determinant of health ignores many other health factors.

Regardless of their weight or health practices, all people need access to quality, compassionate healthcare professionals who will not guilt, shame, or judge them. Without this access, people can experience serious health consequences.

Obesity discrimination in healthcare is a problem. It does not reduce obesity. It is more likely to contribute to poor health.

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