Weight bias and stigma in healthcare: breaking down barriers for better care

‍Weight stigma is an unfortunately pervasive issue in healthcare and it can significantly impact the well-being and overall health of individuals.

Weight bias manifests in various ways, such as healthcare providers making assumptions about an individual’s health solely based on their weight or size, using judgmental language, and making assumptions with treatment plans. These biases can occur in routine check-ups, diagnostic procedures, and even in conversations about lifestyle choices. Weight bias (negative perceptions about someone based on their weight) leads to weight stigma (the discriminatory acts that people with higher weights experience).

Imagine going to a doctor appointment seeking care for knee pain. Weight bias starts in the waiting room where perhaps there are no chairs to comfortably accommodate you. In the exam room, the medical assistant insists on weighing you despite your stated preference to not be weighed, since it’s irrelevant to your chief complaint and you know that seeing a number on the scale could trigger your past history of disordered eating and intrusive thoughts. The medical assistant notes only that you refused to comply. Next, they aren’t able to take your blood pressure because they don’t have an appropriately-sized cuff. When the doctor comes into the room, instead of asking you questions about your knee pain or past activity levels, he immediately starts talking about weight loss. Even though you’ve stated that exercise has been painful due to knee issues, the doctor recommends that you “lose 20 lbs” and “eat healthy and exercise” and follow-up in six months.

Weight bias and stigma matter because they undermine the fundamental principles of healthcare, which include providing unbiased and patient-centered care. When healthcare providers judge patients based on their weight, it can lead to several negative consequences. It hampers the trust between patients and healthcare professionals, resulting in avoidance or delays in seeking necessary care. Weight stigma can also cause psychological distress, including decreased self-esteem, depression, and anxiety. It can even worsen physical health outcomes as individuals may experience delays in diagnosis or receive inadequate treatment due to assumptions about their health solely based on weight.

Weight bias can lead to misdiagnosis and delayed treatment of health conditions. Symptoms may be attributed to weight rather than investigated further, leading to potential mismanagement of underlying medical issues. Providers may assume weight-related conditions are the primary concern and overlook other health issues. Patients may feel judged, ashamed, or humiliated, leading to avoidance of medical care altogether. In one study, 53% of people with overweight and obesity reported to have received inappropriate comments from their doctor about their weight, and 24% of nurses said that they are “repulsed” by people with obesity.

In any setting, healthcare-related or otherwise, weight bias is often cloaked as concern for a person’s health. While there are connections between weight and health, it’s not the only factor to consider. Some body-positive experts counsel people to ask their providers how they would treat someone with a lower weight and then start there with their treatment for those in larger bodies. Attributing health issues solely to excess weight is an incomplete picture — health is more than just a number on a scale.

The popularity of new weight loss medications called GLP-1s, known by the brand names Ozempic, Mounjaro, and Wegovy, have shined a spotlight on the weight loss industry as a whole and the complicated science of weight management. There is a promising shift away from characterizing excess weight and obesity as personal failings to chronic medical conditions. The Obesity Medicine Association defines obesity as “a chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.” Effective, lasting treatment for obesity and excess weight must focus on more than just medication or “calories in/calories out.”

To create a more inclusive and respectful healthcare environment, providers and health advocates can focus on:

• Education. Healthcare professionals should receive training on weight bias, its impact, and strategies to provide unbiased care. Clinicians should start by exploring their own stigmatizing views they may hold, including whether they make different recommendations for patients based on body size.
• Language. Adopting non-stigmatizing language that focuses on health and the person rather than weight can foster a more positive patient-provider relationship. Emphasizing behavior changes rather than solely focusing on weight can also be beneficial.
• Cultivating safe spaces. Healthcare settings should be safe spaces where individuals can discuss health concerns without fear of judgment. Ironically, weight stigma actually leads to a decrease in health-seeking behaviors. Regardless of their BMI, people who face weight stigma are more likely to engage in disordered eating or unhealthy eating behaviors, such as binge eating. They are also more likely to avoid exercising and to report feeling uncomfortable exercising in public. Unfortunately it remains legal to discriminate against people because of their weight except in a couple states and a handful of cities. That essentially sends a message that this is a tolerable form of unfair treatment.
• Diverse body representation. Promoting diversity in healthcare marketing materials, imagery, and educational resources can combat weight bias and contribute to a more inclusive healthcare environment.

Reducing and eliminating weight bias is a collective effort. However, if you or a loved one experiences weight stigma, there are still ways to be an advocate:

• Speak up when you feel hurt, or hear disrespectful comments or jokes about weight. If you hear someone engaging in weight-based stereotypes or disrespectful language, let them know that their words are hurtful and harmful.
• Educate the people around you. There are many misconceptions around medical conditions like obesity and the causes of weight gain.
• Address your concerns with a healthcare provider, and seek a second opinion. If you’re concerned that your provider is judging you based on weight alone, ask them if that’s the case. If you have the ability to do so, seek care from another provider to get a second opinion on your health matter.
• Develop a strong support network. Surround yourself with supportive, compassionate people. You deserve friends and loved ones who will listen, sympathize, and lift your spirits through challenging times.

Weight stigma in healthcare perpetuates a cycle of negative health outcomes, decreased patient trust, and diminished well-being. By understanding and addressing weight stigma, we can foster a healthcare system that respects and supports the health of all individuals, irrespective of their size or weight. It is crucial for healthcare professionals, policymakers, and society as a whole to work together to eliminate weight stigma and create an environment where everyone receives equitable and compassionate care. Together, we can break down these barriers and pave the way for improved health outcomes and holistic well-being.