Perspective on Bias in Diabetes and Obesity

Folks who have not detected a shift in public discourse about obesity are simply not listening. In that shift, we detect some easing in longstanding bias about this disease. But perspective is difficult. Is the proverbial glass half full with progress to celebrate? Or is the remaining void a reminder that overcoming weight bias and obesity stigma is a daunting challenge? We see some clues in recent research on bias about both obesity and diabetes.

Brooke Bennett and Rebecca Puhl have published new data, collected in January 2023, telling us that the bias physicians hold against people with obesity is presently not so different from the bias they direct at people with diabetes.

On top of that, we note new data from Project Implicit, suggesting that implicit bias against people with higher body weights is no longer growing. These data are less recent, reflecting trends through 2020.

Bias About Diabetes and Obesity

On the surface, there can be no doubt. The new data from Bennett and Puhl suggests a troubling pattern of bias toward both people with obesity and people with diabetes among physicians. A third of them report that treating patients with either diabetes or obesity is repulsive to them. This response is almost exactly the same for diabetes as it is for obesity.

Is this good news or bad news? After all, it tells us that two-thirds of physicians are no more repulsed by people with obesity than they are by people with diabetes. We want to believe that this is better than the state of affairs in 2012 when Gary Foster and colleagues reported than only a third of physicians actually disagreed with having a negative reaction toward the appearance of patients with obesity.

But that may well be our bias for optimism. It really is pretty appalling that a full third of physicians feel that caring for people with either of these conditions is repulsive. Maybe those physicians need to get a different job.

An Inflection in Implicit Bias Trends?

The data from Project Implicit, published by Tessa Charlesworth and Mahzarin Banaji last year, offers a similar story of good news and bad news. The good news is two fold. First, explicit bias toward people with higher body weight started going down in 2010 and that downward trend continues through 2020.

Second, it is now clear that implicit weight bias is no longer rising. That upward trend stopped sometime after 2010 and the levels of implicit bias seen in data from Project Implicit remains stable.

The bad news is that this bias is quite strong and stubborn. It is stronger than implicit bias about sexuality, race, and skin color. It is similar to bias about age and disability.

A Daunting Challenge

So let’s face facts. Humans are stubborn in their biases and the bias about body weight is firmly embedded in our culture. Further, looking at attitudes about people with diabetes tells us that pushing away the stigma that people with obesity face will not be easy or quick.

But implicit biases about sexuality, race, and skin tone were once deeply entrenched, too. The data from Charlesworth and Banaji tell us that these biases are fading away. From this we take heart. We can see clearly that overcoming oppressive bias is far from impossible.

Click here for the study by Bennet and Puhl, here for the study by Charlesworth and Banaji.

Blue Glass with Carbonated Water, photograph by W.carter / Wikimedia Commons

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August 8, 2023