What is weight bias? What are the consequences of weight bias? What can we, as health care practitioners, do to make sure that individuals living in larger bodies do not face the detrimental effects of weight bias?
Weight bias is defined as negative attitudes and views about obesity and about people with obesity. Obesity is a medical condition that is multifactorial, however the public seems to think that individuals living with obesity are to blame for and have control over their weight. Weight stigma includes the social stereotypes and misconceptions about obesity and can include actions against people with obesity that may cause exclusion and marginalization of this population. Weight stigma can also include beliefs that people living with obesity are lazy, awkward, non-compliant, slow, unintelligent, unsuccessful, and lack self control, these beliefs cause weight stigma to occur in employment settings, educational environments, health care settings, as well as through the media. Weight stigmatization can manifest in a multitude of ways, some being verbal teasing, physical harassment, barriers in day-to-day life, denial of access to health care, inadequately sized equipment, reduced salaries, lack of insurance coverage for weight management, etc. Directly related to health care, health professionals report having less respect for patients with obesity, and believe that patients with obesity are unmotivated, lazy, and unlikely to follow treatment plans.
Individuals that experience weight stigma and weight bias face negative health consequences, and although obesity itself is a disease that impairs health, the stigma of obesity may exacerbate some associated mental and physical health problems. Some negative health consequences that weight bias is associated with include shame, anxiety, depression, body dissatisfaction, disordered eating, substance use, higher blood pressure, and ultimately poor management of chronic health conditions due to potential avoidance of health care. Additionally, individuals that experience weight bias are likely to internalize these attitudes, which leads to self-directed shaming and is associated with poor mental health, binge eating, avoidance of physical activity, and is recognized as a chronic form of stress. Ultimately, weight discrimination and weight stigma are large burdens to health, and act as a barrier to health and weight management.
A whopping 69% of adults living with obesity report personal experiences of stigmatization from health care professionals. Additionally, we know that weight bias is a fundamental cause of health inequities, so what can we, as health care practitioners, do about it? First, health care practitioners need to consider if programs and services simplify obesity and if they use stigmatizing language. Second, adopt people first language in health systems, say “patient with obesity” rather than “obese patient”. Third, avoid assuming problems are the result of weight status, and help address the factors that drive obesity. Fourth, regulations should be put in place for the physical environment of health care settings to be inclusive, and insurance coverage needs to be expanded. Fifth, consider a Health at Every Size approach, teach behavior changes that promote health and well-being regardless of body size. Lastly, acknowledge that to shift the paradigm and reduce weight bias and weight stigma, we as health professionals need to be willing to be uncomfortable and address our own biases; consider taking the implicit association test through Harvard University’s project implicit. An additional resource for healthcare workers is the BalancedView online learning resource, which is designed to raise awareness about weight bias and stigma in health care and help healthcare workers in reducing it in practice. Further, more resources can be found on the Obesity Action Coalition site regarding weight bias, people first language, and other education.
References:
1. https://obesitycanada.ca/weight-bias/; accessed June 15, 2021.
2. Weight bias and obesity stigma: considerations for the WHO European Region. World Health Organization, Europe. https://www.euro.who.int/__data/assets/pdf_file/0017/351026/WeightBias.pdf
3. Pearl, R. 2018. Weight Bias and Stigma: Public Health Implications and Structural Solutions. Social Issues and Policy Review, 12(1), pg. 146-182.
4. Dennett, C. 2019. Weight Bias in Dietetics Education. Today’s Dietitian, 21(3), pg. 36.