Waiting Room

Immediate Harm of Weight Bias in Delayed Care

Obesity is a slow burn. It erodes a person’s health over time, causing other diseases and an earlier death. In contrast, the harm of weight bias and stigma is immediate. First, there is the everyday onslaught of dehumanizing treatment one receives. A constant barrage of insults and slights creates stress that chips away at both physical and mental health. But perhaps the most shocking harm that comes from weight bias is the systemic bias against people with obesity in healthcare. For reasons both subtle and explicit, weight bias leads to delayed and denied care.

Two Sources of Delay

Delayed care due to weight bias has two sources. First of all, people living with obesity have such humiliating experiences when they seek care that they learn to avoid it.

On top of that, systemic bias in the healthcare system created barriers to obtaining care that can cause years of delay or prevent adequate care altogether. This shows up in disparities of healthcare utilization for people living with obesity. It creates an “ongoing nightmare” for people with obesity seeking medical care.

Years of Delay for Treating a Heart Arrhythmia

One example would be the experience of Sarah Bramblette, who is a board member for the Obesity Action Coalition. She has lived with obesity from her early years of childhood. She has also sought treatment for it, having bariatric surgery in 2003 and revision surgery six years later. Furthermore, she is coping with diagnoses of lipedema and lymphedema – two conditions that often get misdiagnosed as obesity. They do not respond to the same treatments that can be effective for obesity.

But in late 2018, Bramblette learned that she was having a heart arrhythmia called a supraventricular tachycardia (SVT). The physician discussed medical options with her, as well as a procedure called ablation to restore a normal heart rhythm. But she was too heavy for the table they would use for the procedure and she had other concerns, so she opted for trying medication first.

Two years later, after another emergency visit for SVT, she and her primary care provider decided that she should get ablation therapy to resolve her arrhythmia. She could not, though, because the procedure table could not accommodate her weight. She was left with no option, unless she could shed a significant amount of weight – something she had tried for much of her life to do with little lasting success.

Almost two years later, Bramblette has finally received her ablation procedure and the early signs are that the SVTs may be resolved. With the help of semaglutide, she was able to shed 75 pounds and meet the arbitrary weight limit of the procedure table. The weight loss did nothing for her arrhythmia, but it did get her through the final hoop for getting treatment.

The Story Repeats

Bramblette’s story, unfortunately, is not an isolated one. Healthcare systems systematically deny or delay care for people because of their size. People living with obesity internalize the stigma they experience and deny themselves care, too. Combine this source of bias in healthcare to others, such as systemic racism, and the harm multiplies.

Just as we need to end racism in healthcare, we must put a stop to systemic weight bias. It amplifies the harms of obesity.

Click here for more about ending weight bias in healthcare.

Waiting Room, painting by Vincent van Gogh / WikiArt

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August 15, 2022