Clinic Visit

Dealing with Health, Erasing Stigma and Bias

Regarding obesity as a disease is associated with lower weight bias among physicians. That’s the title of a new study in Stigma and Health. Before now, researchers have had experimental evidence. They’ve shown that positioning obesity as a disease could reduce weight stigma and bias. Now, in addition, this new study gives us real world evidence. When healthcare professionals deal with obesity as a disease, they have a more positive feelings toward patients with obesity. They’re more empathetic, and less likely to blame and shame their patients.

It’s a pretty straightforward case for getting away from the old way of looking at obesity – an easily preventable condition caused simply by bad personal choices.

Persistent, Implicit Attitudes

Weight bias has its roots in destructive notions about an idealized body image. For a decade now, implicit bias about skin tone, race, religion, gender, and age is going down. Even bias about sexual orientation is declining. But bias based on body size and weight is going up.

Why? Well one factor is misguided public health messaging. In particular, we have a problem with “obesity is bad” awareness campaigns. The latest example is the obesity-is-like-smoking campaign from Cancer Research UK. Likewise, the American Heart Association persists in casting obesity as a bad behavior, rather than a disease.

Bad attitudes – especially from people with a cause – are slow to fade. Too slow.

Claiming Fat as an Identity

On the other side of the ledger, Linda Bacon insists the reals problem is simple. It’s the very word “obesity” itself. Mustn’t say it. In her trademarked Health At Every Size enterprise, she has many good concepts. Her self-help books are brimming with them. However, she defines obesity purely as a matter of weight. By omitting any consideration of metabolic function and adipose tissue regulation, she can dismiss the science of obesity. Obesity is nothing more than a tool for pathologizing body size, in her view.

Fat activists want to embrace body size as a identity. They claim the word “fat,” aiming to take the sting out of what hits many people as an epithet. Good for them.

Bacon and fat activists are absolutely right about size diversity. It’s a fact of life we should embrace. But they’re flatly wrong to mischaracterize obesity and dismiss it as a health concern. Obesity is not about size. It’s all about health. The effects of dysfunctional adipose tissue physiology will not disappear if you ignore them.

The Complex Chronic Disease of Obesity

Simply stated, dealing with the disease of obesity objectively has the potential to reduce stigma and bias. Ignoring it doesn’t work. Neither does shame and blame. Obesity is not a behavior and it’s not an identity. It’s simply a chronic disease that results when a normal body function – energy storage – doesn’t work right. A whole cascade of problems follows.

Dealing objectively with this condition helps a person’s health. And it can help to erase stigma and bias.

Click here for the new study in Stigma and Health. For prior research on this subject, click here, here, here, and here.

Clinic Visit, photograph © Obesity Canada / flickr

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July 10, 2019

5 Responses to “Dealing with Health, Erasing Stigma and Bias”

  1. July 10, 2019 at 9:14 am, Stephen Phillips said:

    Obesity is simply an excess of adipose tissue, according to some standard. Some forms of obesities are associated with disease(s) and some are not. Simply classifying all obesities as a disease can be stigmatizing and result in psychosocial, insurance and employer consequences. We advocate for for an obesity diagnosis that would clearly identify those with No Evidence of Disease (NED)…(Obesity NED). This is a best practice in science, medicine and fairness.

  2. July 10, 2019 at 1:46 pm, Ted said:

    Actually, Stephen, your sentiment is correct, but your definition of obesity is slightly off. The World Health Organization defines obesity as “abnormal or excessive fat accumulation that presents a risk to health.” So if there’s no health issue, there’s no obesity.

  3. July 10, 2019 at 6:04 pm, Michael said:

    This is interesting. Has there been a study closely looking at the % of NEDs (i.e. with no physiological, nor mechanical, nor psychological diagnoses) vs % of EDs?

  4. July 11, 2019 at 4:43 am, Ted said:

    I suggest taking a look at this study: https://doi.org/10.1503/cmaj.110387

    A small proportion of people with BMI in the range of obesity have an Edmonton Obesity Staging score of zero.

  5. July 14, 2019 at 9:47 pm, michael said:

    yep… in this study EOSS=0 was 1.7% of those attending an obesity clinic.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4427774/pdf/JOBE2015-619734.pdf