How Clinicians Perpetuate Weight Stigma

“There is not a single patient with significant obesity who has not experienced weight bias, whether it’s comments from doctors or nurses, the way waiting rooms are set up, or privacy issues. Weight bias is ubiquitous in society as a whole.” JAMA 2019

Quick facts!

Weight bias is incredibly common, and its prevalence has increased by approximately 66% over the past decade.

Victims of weight stigma report that family members and physicians are the most common sources of weight stigma.

  • As shown in the following table, a survey of over 2600 patients with overweight/obesity reported high rates of experiencing stigma from healthcare providers: 69% from doctors, 46% from nurses, 37% from dietitians and nutritionists, and 21% from mental health professionals. 
Source: Puhl RM, Brownell KD. Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity (Silver Spring). 2006 Oct;14(10):1802-15.

Weight stigma can trigger physiological and behavioral changes linked to poor metabolic health and increased weight gain, including 

  • increased eating
  • decreased self-regulation
  • increased cortisol levels
  • avoidance of exercise
Source: Puhl RM, Phelan SM, Nadglowski J, Kyle TK. Overcoming Weight Bias in the Management of Patients With Diabetes and Obesity. Clin Diabetes. 2016 Jan;34(1):44-50.

Weight stigma among clinicians

Research shows that healthcare providers, when talking to patients with overweight/obesity, tend to 

Weight stigma in healthcare settings leads patients with obesity to delay or avoid healthcare services for many reasons: 

  • receiving unsolicited advice about weight loss 
  • not wanting to get weighed 
  • feeling embarrassed about their weight 
  • fear of exposing their bodies 
  • inadequate hospital equipment such as small gowns, exam tables, chairs, and BP cuffs 

Our language matters!

It’s important for clinicians to realize the perceived effect that weight-related language has on patients:

  • Generally most desirable and least stigmatizing terms: weight, unhealthy weight, high BMI
  • Generally least desirable and most stigmatizing terms: morbidly obese, fat, obese, chubby, heavy
Source: Puhl R, Peterson JL, Luedicke J. Motivating or stigmatizing? Public perceptions of weight-related language used by health providers. Int J Obes (Lond). 2013 Apr;37(4):612-9.

A 2013 Pediatrics study showed that children of parents who used “weight-centered” language were more likely to diet frequently, binge eat, and develop eating disorders. In contrast, parents who focused on healthy eating had a protective effect on each of these issues. 

What can we do as clinicians to decrease weight stigma?

Recognize that standard medical advice for weight loss (“eat less, exercise more”) perpetuates stigmatization.

Incorporate the principles of Health at Every Size:

  1. Weight inclusivity
  2. Health enhancement 
  3. ​Respectful care 
  4. ​Eating for well-being 
  5. ​Life-enhancing movement

Use weight-neutral language.

Respect patients’ healthcare priorities by treating the problem at hand and avoid offering unsolicited weight loss advice.

Provide the most appropriate equipment for each patient without commenting on it (e.g., BP cuffs, scales, gowns, etc.)

Ask yourself if your healthcare setting accommodates people of all sizes (e.g., armless chairs, appropriate exam tables, etc.)

Further reading/listening! 

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