Can We Reduce Weight Bias in Healthcare?

Weight bias in healthcare is getting in the way of meeting the primary mission of healthcare providers – improving the health of people seeking care. In fact, for people with severe obesity, there’s good reason to believe that weight bias in healthcare does more immediate harm that obesity itself. A brilliant new narrative synthesis in Obesity Reviews by Britta Talumaa, Adrian Brown, Rachel Batterham, and Anastasia Kalea addresses this question head on. But they go beyond merely describing the problem. They offer an inventory of strategies for reducing it.

A Driver of Health Inequity

Folks who study health equity have known it for decades. “Social stigma is a fundamental driver of population health inequalities,” write Talumaa et al. But only recently have people begun to realize that weight stigma is an important component of this problem. The “obesity epidemic” has been framed in such a stigmatizing way as to promote weight bias in healthcare and public health. Diagnosis codes labelled persons with severe obesity as “morbidly obese,” a description that healthcare professionals would never attach to any other condition.

A person with cancer is not “morbidly cancerous.” But objectivity and compassion go out the window when a person has severe obesity. Every part of the experience of seeking healthcare can become humiliating for a person with clinically significant obesity.

So it’s little wonder that people with obesity tend to avoid healthcare. Even when they seek it, their immediate needs are often dismissed. Inevitably, a person’s health suffers.

Five Ways to Reduce Bias

In their review, Talumaa et al identify five strategies for reducing weight bias in healthcare.

1. Education. Many providers are clueless about the problem they are perpetuating.

2. Causal Attribution. Many providers buy into the false narrative that obesity is a simple matter of choosing to eat too much unhealthy food and exercise too little. Without a better understanding of obesity pathophysiology, reducing weight bias is tough.

3. Empathy. Many providers do not stop to consider the lived experience of people with obesity. Evoking empathy can help.

4. Weight Inclusivity. When health systems dismiss the needs of larger patients, weight bias becomes systemic. Gowns don’t fit big persons. Equipment doesn’t work for them. The problems multiply and reinforce each other.

5. Mixed Methods. Bias is a complex and multifactorial problem. So more than one tool for overcoming it will be necessary.

If you step back from this problem, it’s really not hard to recognize. Overcoming it might be a challenge, but Talumaa et al have given us a pretty good map for the journey.

Click here for the paper by Talumaa et al, here and here for more about it, and here for a recent dialogue about it on Texas Public Radio.

Casting the Damned into Hell, painting by Hans Memling / WikiArt

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

August 11, 2022