Pears and Scales

A Simple Cure for Weight Stigma

Writing in the Washington Post, dietitian Rebecca Scritchfield has a simple cure for weight stigma in healthcare. Stop weighing heavier patients, she says. Healthcare might improve.

To make her point, she tells the story of Bernie Salazar. He was an “at-home” winner of The Biggest Loser. Visiting with a relatively new doctor, he felt shame and defeat when the doctor suggested bariatric surgery:

Why would my doctor recommend a highly invasive, irreversible surgery without knowing my recent labs or discussing my habits? He didn’t ask if I was concerned about my weight or if was open to discussing weight loss at all.

Disrespect

The core problem here is disrespect. Bernie is right. The first step in a conversation about weight and health is to ask. Without offering any judgement, a provider should first ask, can we talk about this? Where the conversation goes is up to the patient. Otherwise it goes off the rails and becomes an unwelcome, shaming lecture.

Obesity expert Scott Kahan of George Washington University offers perspective:

Weight stigma is certainly rampant in healthcare. Banning weighing in doctors offices, while a provacative headline, is not a solution.

Scales don’t shame people. People shame people. It’s usually inadvertent. We would do better to teach trainees and practitioners about obesity and obesity care, so that they understand why and how the examples in the article can happen. Then, they can learn how to approach patients in a more helpful way.

Understanding obesity, as Kahan suggests, is essential. Too many patients and providers believe that body weight, and thus obesity, is a simple matter of choice. But in fact, it’s the product of physiology. Patients can have a bit of influence, but not total control. In that regard, it’s no different from other aspects of physiology.

Focusing on Health First

Weight is important, objective information for a competent medical assessment. But like any other clinical measure, it shouldn’t be a preoccupation. Health is the whole point. Professor Michelle Cardel, a Registered Dietitian, offers further perspective:

I think weight can be a marker for things the provider may need to look into (e.g., significant unintentional weight loss can indicate cancer). Weighing at every visit, respectfully and with the patient’s consent, is an important part of medical history. However, I think how a provider approaches the topic has everything to do with how the patient will feel. I think it’s respectful and kind for a provider to ask their patient IF they want to discuss their weight.

Beyond her provocative headline, Scritchfield gets to the core of the issue. She says that doctors should collaborate with patients. They should focus on healthy habits with patients of every size.

We agree completely.

Click here for Scritchfield’s commentary and here for further perspective from a presentation by Arya Sharma.

Pears and Scales, photograph © Steve Walker / flickr

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June 22, 2018

8 Responses to “A Simple Cure for Weight Stigma”

  1. June 22, 2018 at 9:51 am, Angie Golden said:

    I agree with Scott, people blame not scales. However, at some point we as healthcare providers have to learn to treat obesity as a disease. We do not ask a patients permission to talk to them about their blood pressure when it is high and we don’t ask permission if the HgbA1C is 14. We do a history and physical and then talk about the disease the patient has and all the available options to treat it. Until we learn to approach obesity with that same respect – it is a disease and no offense towards a patient at all – but the disease doesn’t deserve the respect of NOT being discussed. Obesity has too many complications to not discuss WITH KINDNESS towards the patient with the disease all available evidenced based options. The patient deserves the respect to have the approach to the discussion be respectful with a full collaboration of options – just like I would with every other disease. But I don’t ask permission to talk about hypertension or diabetes – so I believe once we get past our bias in healthcare around obesity we will have the same respectful and non-blaming conversations with patients and THEN obesity will be considered a disease in healthcare settings.

  2. June 22, 2018 at 12:53 pm, Al Lewis said:

    If doctors shouldn’t weigh patients for the reasons you give, here’s a group that REALLY shouldn’t be weighing patients: employers. And yet they obsess with it.

    Here are some stories of the harms of being weighed by an employer’s wellness provider, triggering eating disorder relapses. https://theysaidwhat.net/2017/11/10/final-installment-3-more-stories-of-wellness-shame-and-harms/

  3. June 22, 2018 at 4:43 pm, Ted said:

    I absolutely agree with you, Al, that employers should not be weighing employees and handing them weight goals.

    If you read what I wrote carefully, you’ll find that I said weight is an important objective information for a competent medical assessment. But it shouldn’t be a preoccupation. And doctors should ask permission before diving into a discussion about weight and health.

    Obviously then, employers should not be coercing employees to submit to assessments of their weight.

  4. June 22, 2018 at 4:46 pm, Ted said:

    Good point, Angie. Unfortunately, we’re far from that. So you have many patients who walk in the door with a lifetime of trauma from blame and shame about about their weight. And their grateful for the respectful care you provide.

    Seldom do patients present with a lifetime of trauma about hypertension or diabetes.

  5. June 22, 2018 at 6:21 pm, Rebecca Scritchfield said:

    Thanks for finding my Washington Post story… of course, I didn’t suggest “banning” weighing clients… The headline is more of a rhetorical question, not nearly a solution to eradicate weight stigma since medicine is not the only place higher weight people face oppression.

    Weight centered assumptions about behaviors and health are problematic and the data on weight stigma in medicine and healthcare avoidance is cause for concern.

    So, why not look at it differently? Delay weighing new patients, ask for consent since it is an optional screening. As the doctor in the story said, unfortunately the burden to reduce stigma lies on the patient advocating for themselves…. so educating doctors to reduce the high percentage of weight stigma is key.

    The article comments are worth sifting through as well, some good stories and interesting insights for a few docs.

    Whom do you think is doing a model job at educating the negative health consequences of weight stigma and practically how doctors can change their behaviors toward patients to reduce weight stigma themselves?

  6. June 23, 2018 at 4:58 am, Ted said:

    Thanks for sharing your thoughts here, Rebecca. In answer to your question, the most effective educators I’ve seen are people who tell their own stories expect respectful care. Stigma persists because it is so deeply rooted that too many people have internalized the negativity they encounter every day. Another potent force has been the broad-based rejection of fat-shaming in popular media.

  7. June 25, 2018 at 9:43 pm, Anne Fletcher said:

    I have a real beef about the practice of weighing-in at each visit for every patient and how it’s done. First, it’s usually the first thing they do when you come in, suggesting that’s the most important thing about you. And it’s usually in a public space, not private. There’s no consistency about time of day or what you’re wearing. People who are very sensitive about their weight, thin or heavy, may not choose to be weighed at every visit.Some people regularly have many medical appointments and don’t need to be weighed at every visit. Patients need to know that they can choose NOT to be weighed and to be weighed with consistency (same time of day, same amount of clothing, etc.) privacy, and dignity.

  8. June 26, 2018 at 4:48 am, Ted said:

    I agree with you completely, Anne. Clinicians who actually care for people with obesity do exactly what you’re saying. Other clinicians should wise up.