Young Woman Picking the Fruit of Knowledge

OCW2021: How Bias Factors into Access to Care

OCW2021 Access to CareToday for Obesity Care Week (OCW2021), the focus is access to care. But access to care is not such a tidy, self-contained subject. That’s because the problems we have with access to obesity care often actually start with weigh bias – the OCW2021 theme for Monday.

Let us explain with the experience of a good friend to illustrate.

Prove Yourself

Our friend has health insurance that covered her bariatric surgery. It all went well enough at first, but some time after her surgery a complication showed up. She began suffering from difficulty breathing and reflux. The cause was a hernia and she needs revision surgery to relieve her suffering.

But here’s the rub. Her surgeons want her to lose a specific amount of weight before they will schedule the revision. From there, the details get a bit tedious. However, the net outcome is that she is struggling with one more hurdle to healing. She must prove herself by losing more weight before she can get the care she needs.

Implicit and Internalized Bias

None of the characters in this drama about access to care are expressing explicit bias. These surgeons devote their work to improving the health of people living with obesity. This patient believes in herself enough to persist and seek the care that she needs.

Nonetheless, implicit and internalized bias is very likely part of this story. Research tells us that even obesity care professionals are susceptible to implicit bias. It’s very easy to doubt how compliant a patient will be, to wonder if they will do anything to compromise the clinical outcome from the surgical care they provide. After all, patients are human and humans make mistakes.

Bias also affects the patient. A lifetime of blame and shame quite naturally has an effect on one’s confidence and self-image. It makes it harder to push back when we’re not getting the care we need and deserve. This is what internalized bias is all about.

A Business Opportunity

So bias opens the door for a business opportunity in health insurance. If the patient is willing to back off, it’s easier to deny coverage for obesity care. Less coverage means less expense and more profit. That’s not necessarily the explicit rationale. But bias makes it easier to rationalize. Bias that is common among healthcare providers will back you up. We’ve had primary care providers tell us we don’t need to keep taking that anti-obesity medicine that’s working quite well. “If you just eat less and keep moving, you won’t regain the weight you’ve lost,” they tell us.

That’s one less claim for the pharmacy benefit plan to pay.

Many Dimensions to This Problem

As you can see from the illustration above, access to care is a problem with many dimensions. Much of it traces back to the biases we hold about obesity and the people who live with it. To improve access requires us to confront our biases.

Click here and here for more about access to care and its critical importance for your health. Special thanks to Nikki Massie, the Bariatric Foodie, for sharing the perspective she has gained from her diverse community of people living with obesity.

Young Woman Picking the Fruit of Knowledge, painting by Mary Cassatt / WikiArt

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March 3, 2021

One Response to “OCW2021: How Bias Factors into Access to Care”

  1. March 03, 2021 at 7:16 am, Michael Jones said:

    Ted, spot on. I practice obesity medicine full-time and am certainly not immune to such bias. What’s worse is that I’ve struggled with obesity most of my adult life, so my bias also effects me. Despite my fight to squash it, it remains, it’s engrained. Thanks for the reminder once again.