Anna Akhmatova

FNCE: The Challenge to Put Health First Over Weight

FNCE is winding up today after four days of this virtual conference. For information on weight, health, and obesity, the agenda offered some bright spots – most especially content on the lived experience of obesity. But one subject was almost completely absent. Rigorous discussion about weight neutral care, including Health at Every Size, could not be found on the agenda. The closest thing we could find was a session describing how “mindful eating and healthy weight loss strategies can co-exist.”

With very minimal discussion of weight neutral approaches to care for larger persons, though, this session dodged some of the controversy seen in recent years. Perhaps this reflects the challenge of actually putting health first over weight in a culture where weight bias envelopes everyone.

Meeting People Where They Are

Perhaps the best wisdom that Lisa Stollman and Lisa Young offered in this session was to emphasize the imperative to “meet the patient where they are.” For good measure, they both advised against restrictive dietary approaches. They also suggested staying away from focusing on “the number on the scale.”

However, these very safe maxims also avoided two harsh realities that people in larger bodies face. One is the physiology of obesity. A load of good advice about healthy behaviors will rarely resolve or even adequately control the disease of obesity when it severely affects someone’s health. Many people need medical or surgical care for obesity and they often cannot get it.

The other problem is the bias that these patients face every day in virtually every part of their lives. Explicit bias may be down, but implicit bias has actually grown against people in larger bodies. That bias causes great harm to health and the quality of a person’s life.

Bias in Healthcare

Weight bias is clearly pervasive in healthcare and it brings great harm, as Blake Lawrence et al documented recently:

“Weight bias was often expressed by HCPs through contemptuous, patronizing, and disrespectful treatment, as well as attributing all of a patient’s health issues to excess weight, which directly contributes to feelings of weight stigmatization and which is associated with avoidance, delay, or cancellation of health care appointments.”

Dietitians are not immune to weight bias. Implicit bias is especially problematic because people express it unconsciously and often without the intent to harm others. But the harm remains and implicit bias cannot easily be vanquished. Awareness is a first step, but much more work will be necessary to overcome a culture that elevates people with thinner bodies and devalues others.

But there can be no doubt. Health professionals must challenge themselves to put health first, without the influence of personal bias about body weight.

Click here for more on weight bias in healthcare. For a thoughtful and thought provoking analysis of implicit bias of all kinds and its impact in healthcare, click here.

Anna Akhmatova, drawing by Amedeo Modigliani / WikiArt

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October 19, 2021

2 Responses to “FNCE: The Challenge to Put Health First Over Weight”

  1. October 19, 2021 at 7:24 pm, Michael said:

    Hi Ted, The current data for implicit/explicit bias is up to 2016. Is there any new data on the horizon?

    • October 20, 2021 at 4:26 am, Ted said:

      People are publishing stuff all the time on implicit bias, but I haven’t seen anything more recent from the Project Implicit folks, Michael.