A Bias for Medical Neglect in Obesity

New research reminds us of something that just about any person living with obesity can tell you. The prevailing bias against people living with obesity favors medical neglect. Especially for someone living with significant obesity, it is all too common to have providers dismiss medical complaints or blame them on obesity and simply instruct the patient to lose weight. As if they have never thought to try that before.

In the International Journal of Obesity, a new research letter documents obesity as a hidden barrier to adequate hypertension treatment. This study, conducted in Brazil, found that persons with obesity were more than twice as likely to receive inadequate treatment for hypertension than persons without obesity. In short, when people needed more potent hypertension medicines, they were much more likely to get them if they did not have obesity. The authors call this “therapeutic inertia.”

We call it not bothering to actually care for a person of size.

Part of a Pattern

This analysis, of course, relies on observational data and thus has limitations. This is often the case with patterns of discrimination. People don’t start with an intent to harm people based upon race, gender, or size. Instead, implicit biases come into play and patterns of disparity emerge.

This research is consistent with broader observations of disparate treatment for people with obesity. Earlier this year in Obesity Reviews, Guilherme Heiden Telo and colleagues systematically reviewed the evidence for disparities in therapeutic and clinical care for persons with and without obesity. They concluded:

“The presence of obesity bias has negative effects on medical decision-making and on the quality of care provided to patients with obesity. These findings reveal the urgent necessity for reflection and development of strategies to mitigate its adverse impacts.”

So yes, it does appear that healthcare has a bias for medical neglect of persons with obesity. This bias might explain the reluctance to deliver obesity care at scale, even today as the options for health improvements are growing better so quickly.

This is a wasted opportunity for better human health.

Click here for the study in IJO and here for the study in Obesity Reviews. For further perspective, click here.

Woman with a Cat, painting by Edouard Manet / WikiArt

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August 26, 2024