Weight Bias in Health Care

Uploaded by YaleUniversity on 27.01.2009

Doctor: "Well,
what do we have here?"
Mother: "He burned his hand on a stove."
Doctor: "Did you warn him not to touch a hot stove?"
Mother "Of course I did!" Doctor: "Well,
I'm afraid we can't help him. Clearly,
he did this to himself."
That's absurd, isn't it?
That a doctor would compromise care for a patient because he did it to himself.
But unfortunately overweight and obese people are the victims of this kind of
irrational weight prejudice almost everyday.
Whether it's in the
form of negative attitudes, societal stigma,
or unfair treatment.
My name is Emme, and as the first plus size supermodel trust me, I know what it's like to be
judged based on my size.
And that's why I'm here today, to raise your awareness of exactly what weight bias is,
how it shows up in medical practices,
and who its victims, sources and consequences are. I'm hopeful that by the
time that we come to the end of this brief journey, you'll be inspired to
make subtle but critical changes in your own medical practice and perhaps
even adjust your own perceptions in treatment of your overweight and obese patients.
Weight stigma is bias and discrimination discrimination aimed at overweight
people based
on a series of social attitudes that people develop that can start very early
in life that assume that there's something wrong with overweight people
and that they should be punished for their condition.
Patient: "Hi, could you help me?"
Receptionist: "Do you have an appointment?" Patient: "Yes, I made it
a year ago." Receptionist: "Name?" Patient: "Cole."
Receptionist: "Natasha?"
"You can take a seat."
"Over a year ago? She must really hate coming to the doctor."
One important area were wight bias is expressed is in medical care.
Overweight people are very often reluctant to go get medical care,
preventive services in particular, because of
biased attitudes they feel that they're going to encounter at the hands of
health care professionals. There've been studies with physicians with medical
students, with nurses, with dietitians, with psychologist and with other health care
showing quite negative attitudes and feelings that there's something wrong
with the overweight person
that their weight condition is their fault and that because they haven't lost
weight there's something seriously lacking in their personality
Child Patient: "Mom, mom. That lady's huge."
Mother: "Shhh."

Weight bias can be as hurtful and difficult to counter as a racial
and yet there's no anti-discrimination laws to protect people who are
Weight bias is so prevalent in our society that most people don't even
stop to question it.
As a result, overweight individuals confront negative stereotypes and
prejudice often on a daily basis
It's important to recognize just how common this problem is in the United States.
We recently examined a nationally representative sample of American adults
and found out the prevalence of weight discrimination is comparable to racial
discrimination, and is in fact more common than racial discrimination among women.
We also found that the prevalence of weight discrimination is more common than
discrimination due to ethnicity, religion, sexual orientation or physical disability.
It's important to consider that statistically six out of ten patients in
your waiting room
are already overweight or obese,
and that number is rapidly on the rise. And most of you know that obesity has
doubled in the past twenty years in both children and adults,
and frighteningly,
it's tripled in teens. One in five children is overweight
and overweight children tend to become overweight adults.
Thirty percent of adults are obese
and we're right on track for this trend to continue.
Whether or not you want to deal with this the obesity epidemic is increasingly
going to impact your practice and as these numbers continue to grow anything
you can do to make your overweight and obese patients feel more comfortable
and accepted
will translate into an improved working environment and a more successful practice
and most importantly,
better health outcomes for your patients.
Receptionist: "Miss Cole,"
"The nurse will take you in."
The stigma of obesity is so strong, that even health-care professionals
specializing in the treatment of obesity
hold negative attitudes towards the obese and
infer that these people have blameworthy behavior
Nurse: "Step on the scale please."
Patient: "I'd rather not".
Nurse: "We have to weigh you." Patient: "It's the same as last time."
Nurse: "We need it for our medical records."

Nurse: "Two hundred and sixty pounds."
"What, are you five four?"
"You've gained weight since last year."
"It looks like your diet isn't working."
"Please move into the examination room. The doctor will be right with you."
Nurse: "How hard is it to push yourself away from the table?"
Receptionist: "I know, and get off the couch."
"Nothin' to it, but to do it." Nurse: "You have to work hard to get that overweight."
Physicians limit their interactions with obese patients, are ambivalent about
treatment roles and are reluctant to perform certain screenings.
Studies have revealed that nurses too view obese patients as lazy, over-
indulgent, non-compliant and less successful than their average weight
Nurses self-reported alarming statistics. One study found that in a third to half of
the nurses surveyed admitted
feeling uncomfortable caring for obese patients.
Many would prefer not to touch obese patients.
A quarter of them agree that obese patients repulse them and fully a
third we prefer not to care for obese patients at all.
And these are their caregivers.
Nurse: "This thing isn't big enough for you."
Nurse: "Here, change into this."
Nurse (out the door): "Does anyone know where the extra large blood pressure cuff is?"
Weight bias could affect an individual's health in many ways.
just being a victim of discrimination could affect your health but then you
add to that the fact that people don't get care as they should because of the biased
attitudes they expect to encounter.
It creates a real problem.
health care providers are not immune to wait bias and unfortunately many overweight
and obese patients report negative experiences from multiple
groups of providers.
As an example, we surveyed over twenty four hundred overweight and obese adults and
we asked them to tell us about the different sources of weight bias in their
What we found is that physicians are the second most common source of weight bias
Fully sixty nine percent of people reported weight bias from physicians,
Forty six percent from nurses, thirty seven percent from dietitians and twenty one
percent for mental health professionals. So this really is a common experience
for many individuals in the health-care environment.
Let's take a look
at the impact
of all of this to see why this is such a critical
and urgent issue.
Well there are a range of negative consequences of weight bias for both
emotional and physical health.
For example we know that individuals who experience weight bias are more
vulnerable to depression, low self-esteem, poor body image and even suicidal
We also know that individuals who experience weight bias are more likely to
engage in unhealthy eating behaviors like binge eating and avoiding physical
activity, both of which may ultimately only reinforce weight gain and additional
It's not a leap to conclude that when patients experience bias
their preventative care is compromised.
So what's the solution? What can you do?
The solutions are so simple.
Treat your overweight and obesity patience with the same courtesy you
treat all of your other patients.
Receptionist: "Mrs. Cole, how are you today? Patient: "Good, thank you." Receptionist: "Good, are you here for your 10:30 appointment?" Patient: "I sure am."
Receptionist: "Great, just take a seat. The doctor will see you shortly." Patient: "Thank you."
There are a number of things that
health professionals and medical offices can do to combat weight bias.
The first is just to take a look at the physical environment of the office. So
for example, making sure that in the waiting room there's room for people to
move around, that there are chairs that are large enough to
accommodate all patients.
And it's important to even look at the reading material in the office because
things like,
you know, fashion magazines
that have a lot of very stereotypical images of women and exaggerated images
of, you know, female beauty can sometimes be disturbing to patients feeling like
they're constantly surrounded by those images.
Another thing the medical professionals can do is make sure that the place where
they weigh patients is private, so we recommend that the scale is often a
separate section of the office, it's not visible to other people.
And another thing that helps a lot is to actually ask the patient if they would
like to be weighed. It's a way of showing respect for the patient's decision
whether or not they feel that that's important for them to do during that
Nurse: "Hello,
would you like to be weighed today?"
Patient: "No, there haven't been any significant changes."
Nurse: "Fair enough.
There's a gown right there and I'll be right back to take your blood pressure." Patient: "Great."
Provide larger sized gowns,
larger, sturdier examination tables.
Provide larger blood pressure cuffs to your patients who require a larger size.
It's very important for health care providers to increase awareness about
their own attitudes and assumptions based on weight
and providers can ask themselves questions like, Do i make assumptions
based on weight regarding a person's character or intelligence or success or
Am I comfortable working with patients of all sizes?
Do i get appropriate feedback to encourage healthful behavior change?
Am I sensitive to the needs and concerns of obese individuals?
Do I treat the individual or only the condition?
Another important aspect of reducing weight bias to really understand the
complexity of obesity.
People think that for someone who's overweight all they need to lose weight
is some self control and trying harder to eat less and exercise more.
If that only worked we wouldn't have the problem that we have today. The causes of
obesity are very complex. It is a combination of genetic factors,
environmental factors, psychological factors and it's important to recognize
that so that when we look at someone and we see whatever their body weight is we
don't make assumptions about their behaviors based on that information.
It's important for providers to recognize that patients may have had
negative experiences with weight bias from previous providers so when they come
into the office for the first time providers need to be aware of these issues.
We often hear from patients that when they go into the doctor for a problem
such as an ear ache that the doctor frequently will blame the issue on their
body weight even though it has nothing to do with the presenting problem.
Many patients have tried to lose weight repeatedly in the past but have been
And so when a patient comes into the office for the first time, telling a patient
that they need to lose weight
is something that the patient has probably heard many times before and
it's not necessarily the most helpful advice to give.
One thing that providers can do is to really emphasize behavior changes rather
than just a number on the scale. We want to be setting goals for patients
that are realistic and achievable.
So things like can they increase their consumption of fruits and vegetables,
reduce intake of soda,
walk more frequently during the day,
very tangible strategies and goals that patients can work on to improve their health.
It's also important for providers to recognize that relatively small weight
losses can have
important improvements for overall health and so even if an individual
is able to lose five or ten percent of their body weight,
that can have very important implications for their overall health.
They may be able to get off certain medications or lower their blood pressure, and
communicating this to patients can be very empowering as they try to make behavior
If weight loss was easy, we would not have the current obesity epidemic that we have
so it's very important for providers to acknowledge how difficult this is
and to provide support.
Patients are in three times more likely to address diet and lifestyle changes
if their doctor constructively and sensitively called their way to their
Yet less than half of physicians actually do.
Doctor: "Well, Mrs. Cole, all your vitals look great,
it sounds like you're doing great.
Would you mind if we talked about your weight?" Patient: "Sure.
I know I could eat better, get more exercise."
Doctor: "I'm glad to hear you're thinking about ways to improve your health
but it's important to remember that body weight is only partly determined by diet
and exercise.
Still, we can all stand to make lifestyle improvements.
Let's talk about what you're doing now and how effective that is." Patient: "Okay."
The medical community offers great opportunities to help address the issue of weight bias,
because with positive attitudes, people will get better care but not only that but
it'll be modeling for the world about how overweight people should be
treated what weight is. It shows that weight is an issue that needs to be
dealt with in medical settings in a straightforward, positive, constructive
And as people see this then they see that weight isn't an issue
where there should be tremendous prejudice and stigma
directed at individuals, rather it should be a straightforward medical condition just
like anything else.
In spite of millions of dollars spent every year on weight loss efforts,
long-term results in America
point to the fact that they are obviously other factors that play beyond
intention and commitment.
Yet the increasing prevalence of obesity in our society has oddly not reduced
weight bias. With more and more people overweight, one might think
tolerance would increase,
but it hasn't.
At the Rudd Center, we work hard to eliminate the problem of weight bias.
We believe that there's a strong social injustice occurring here,
that hundreds of millions of people around the world are deeply affected by
this and it just doesn't need to occur. Race bias doesn't need to occur, gender
bias doesn't need to occur and weight bias doesn't need to occur.
Thank you for taking the time to watch this educational video on weight
For more information please visit the Rudd Center for Food Policy and Obesity
at yaleruddcenter.org.