Killing Us Gently with Implicit Weight Bias

We’re making progress. Right? Explicit fat shaming is no longer cool. But then again, we see implicit weight bias on the rise. It’s subtle. It often comes in healthcare – “for your own good.” Yesterday, it smacked us in the face when we read this from a distinguished bariatric surgery program explaining about a new procedure:

Like other weight loss programs, however, a commitment to a healthier lifestyle will help to ensure long-term success and permanent weight loss.

On one hand this is great advice. A commitment to a healthier lifestyle is always a good thing. But stop and think. Is it right to tell a patient that permanent weight loss depends upon their commitment to a healthy lifestyle?

Wrong on Two Counts

In a word, the answer is no. First of all, it’s wrong because whoever wrote these words is relying on a myth – the false belief that readiness to change is an important predictor of outcomes for any effort to lose weight. John Dixon et al pointed out this fallacy in a 2009 analysis of gastric band patients. Krista Casazza et al laid it to rest in the New England Journal of Medicine as an obesity myth in 2013.

Also, it’s wrong because there’s no such thing as permanent weight loss. As Professor Dixon explained to us:

Weight regain after weight loss in normal, physiological, and expected. You know only 100% of patients have weight regain after their NADIR weight in all weight loss programs.

So telling a patient that permanent weight loss depends on their commitment is a lie. But it’s also a setup for self-blame when some inevitable weight regain occurs.

Innocent, Implicit Bias

Recently, we had the privilege of presenting on the growing gap between explicit and implicit weight bias. Indeed, we’ve observed, and so have the folks from Harvard’s Project Implicit, that explicit weight bias is declining while implicit weight bias is actually growing.

And nowhere is implicit bias more appalling than in healthcare. Today tells the story of Edith Moore McGee whose surgeon demanded that she lose 50 pounds before he would repair a painful hernia. She’s still suffering in pain and trying to lose that weight.

Sadly, this tendency to blame and shame people with obesity is common and it causes great harm. And it leads to more obesity, as Dr. Scott Kahan explains:

Doctors think they are being helpful. But there are studies showing that when patients have a shaming interaction, they lose less weight than people who don’t have those types of negative interactions.

Putting an end to implicit weight bias will not be easy. Often the perpetrators aren’t intending to shame a person. But the effect is just as shattering. So we must start with healthcare professionals. They can and should do better.

Click here for more from Today and here for an excellent presentation from Sara FL Kirk on reducing weight bias in healthcare education. For perspective finger-wagging in healthcare, click here.

The Light Comes Gently, photograph © Glasseyes View / flickr

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.

May 14, 2019