The Light Comes Gently

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

Implicit Weight Bias Is GrowingRecently, 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

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May 14, 2019

2 Responses to “Killing Us Gently with Implicit Weight Bias”

  1. May 14, 2019 at 8:35 am, Cathy Arsenault said:

    Words like actions tell who we are. We can not “sell” remission of the disease. We must never confuse the fact that WLS is life-saving to those of us the suffering but is not a cure. It is a tool. Education and support are an absolute must!!
    Permanent? How is that even possible?

  2. May 14, 2019 at 5:50 pm, Michael said:

    Blaming bariatric patients who will all normally regain some weight after surgery contributes to woeful long-term follow-up rates. This fuels anti-surgery/surgeon bias from physicians. If surgical programs want better support from their peers, payers and providers, the first step is to look closely at what they say and do to their patients.