Confronting Weight Stigma in Primary Care: 10 Reports on the Problem & Strategies to Fix It
Weight bias or stigma in healthcare settings, whether explicit or implicit, may keep patients from getting care. Find a review of the recent literature in this slide show.
While persons with obesity are at increased risk for serious medical complications, they often face the additional issue of weight stigma, one that frequently carries over from general society into the healthcare setting.
Health care professionals (HCPs) often are unaware of their own personal bias against persons with obesity placing in jeopardy the ability to establish and maintain an effective therapeutic relationship.
Many recent studies and reports describe various aspects of the weight stigma problem in healthcare, and many offer strategies to reduce or eliminate it.
Scroll through the slides below for concise summaries of 10 articles you may want to bookmark.
Weight stigma is widespread. In 2020, an international consensus statement on obesity stigma reported a 19% to 42% prevalence of weight discrimination among adults with obesity. Rates were higher for those with higher body-mass index and women. About 40% to 50% of US adults with overweight and obesity experience internalized weight bias, about 20% of them at high levels. Weight stigma has been documented in multiple societal domains, including healthcare settings. Nature Medicine.
Common myths fuel stigma. Obesity stigma is fueled by misconceptions: Body weight = calories in – calories out (there are additional factors), Obesity is primarily caused by voluntary overeating and a sedentary lifestyle (causation is more nuanced), Obesity is a lifestyle choice (typically recognized as a health problem), Obesity is a condition, not a disease (definition should be based on objective evidence), Severe obesity is reversible by eating less and exercising more (not supported by evidence). Nature Medicine.
Problems in primary care. An analysis of weight bias and patients’ engagement with primary care services identified 10 negative themes: disrespectful treatment, lack of training, ambivalence, attribution of all health issues to excess weight, assumptions about weight gain, barriers to health care utilization, expectation of differential health care treatment, low trust and poor communication, avoidance or delay of health services, and seeking medical advice from multiple HCPs. Nature Medicine.
Weight bias begins in medical school. Weight bias among healthcare professionals results in weak physician-patient rapport, low patient trust in physicians, and avoidance of healthcare, study authors stated. To decrease weight bias in first-year medical students, they conducted a 1-session, curriculum-based intervention founded on the elaboration likelihood model (ELM). Their results supported use of the ELM and controlling for social desirability in weight bias interventions. Clinical Obesity.
Discrimination hinders treatment. In a recent study of medical professionals, most (68.5%) reported that negative attitudes toward patients with obesity is commonplace. Inappropriate behaviors included mocking the patient’s appearance (96.6%), looks of disgust and repulsion (96.2%), lack of reaction to offensive remarks (92.0%), and scaring a patient with the necessity to lose weight (57.7%). Limited access to dedicated medical equipment was cited as a discriminatory systemic limitation. Journal of Risk Management and Healthcare Policy.
Weight bias and poor communication put up barriers to bariatric surgery. Weight stigma and bias and suboptimal communication between patients and providers may serve as barriers to utilization of bariatric surgery for clinically severe obesity. A recent article reviewed the existing literature and described shared medical decision-making as a potential strategy to promote appropriate conversations between patients and providers. Surgery for Obesity and Related Diseases.
Does weight bias increase ED wait times? In a study of obesity bias in an ED setting, persons with obesity did not experience longer wait times than patients of normal weight. In fact, median door-to-room and door-to-provider times for adults with class 3 obesity were significantly shorter than those for patients in the normal weight category. Percentage differences for both men and women translated to slightly shorter wait times of 0.4 to 1.2 min. American Journal of Emergency Medicine.
Attitude adjustment strategies. Attempts to reduce obesity stigma in the primary care setting include strategies for improving provider attitudes: increase empathy through perspective-taking exercises, alter perceived norms regarding negative attitudes and stereotypes, seek instruction and practice in emotion regulation techniques, examine explicit beliefs and stereotypes and complete an assessment of implicit attitudes, and learn more about the various contributors to weight gain and loss. Obesity Reviews.
Put out the welcome mat. Weight stigma may be reduced by providing a less threatening environment. Strategies include shifting focus from body weight to screening for conditions for which obesity is a risk factor. Encourage feasible behaviors that will improve health and well-being, adopt patient-centered communication strategies, provide chairs and medical equipment that are usable by patients of all sizes, and convey a sense of identity safety by providing evidence that diversity is valued. Obesity Reviews.
Weight management screening tool. The EOSS-2 Risk Tool, a new screening tool based on the Edmonton Obesity Staging System, may be clinically useful for activating weight management discussions in general practice. Regarding obesity stigma, GPs reported that the tool helped them initiate health-based and nonjudgmental conversations with their patients. GPs and patients reported that the tool helped focus on self-management of weight-related complications. PLoS One.
