Can We Reduce Weight Bias in Healthcare?

Casting the Damned into HellWeight 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

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August 11, 2022

3 Responses to “Can We Reduce Weight Bias in Healthcare?”

  1. August 11, 2022 at 10:06 am, Le Moore said:

    This article makes so much sense. There is a parenting theory that the more the word fat is used then the less of a bad connotation it has. Is there a stigma attached to the the word fat? Will this help the stigma go away? Will this help improve empathy?

    Rewrite the 4th point about weight inclusivity and replace the words larger and big with the word fat. I don’t think that would be helpful towards reducing weight bias and stigma.

    I know some children are being taught that it’s OK to make a statement, “It’s OK if you are skinny, fat, tall, short – we can be different in lots of ways, but that’s just fine.”

    At first glance, that sounds very positive. But when I hear those same children point out that someone is fat (even in an honest point blank way) I cringe and am offended. I get it, why is it OK to say look at that tall person in the world tall isn’t automatically negative?

    So far, I have not been able to have a discussion that goes anywhere, because of the insistence that the word fat will eventually just be an accepted word and that this is the only way to make that happen.


    • August 11, 2022 at 3:25 pm, Ted said:

      I see nothing wrong with people trying to reclaim the word “fat.” But many people are uncomfortable with it. The only thing I can’t accept is the rejection of science that tells us obesity is real and it really harms a person’s health. That said, I utterly reject judging a person’s health based on their body size and shape. Mind your own health, I would say to anyone who does that.

  2. August 11, 2022 at 10:43 am, Allen Browne said:

    Wow! dynamite article. depressing and thought provoking and inspiring.