Weight Bias: A Clinical Concern That Cannot Be Ignored

Lisa Schulmeister, RN, MN, APRN-BC, OCN®, FAAN

Editor-in-Chief OncLive Nursing

Oncology Nursing Consultant, Adjunct Assistant Professor of Nursing Louisiana State Health Sciences Center in New Orleans, Louisiana

My eye doctor recently added an extra wide chair in his waiting room, which got me thinking about the prevalence of obesity. According to the CDC, 35% of adults are obese (body mass index [BMI] ≥30 kg/m2) and 69% are overweight (BMI ≥25 kg/m2, and includes the obese).You would think that obesity would be more socially acceptable now, since it’s so prevalent; however, this is not the case and apparently healthcare providers are among the worst offenders for being weight biased.

Weight bias can be expressed nonverbally (eg, rolling eyes) as well as verbally via derogatory comments and jokes, which really aren’t funny when considering that weight-related stigmas and discrimination reduce quality of life and have long-term consequences for emotional and physical health.

Although we would like to think that healthcare providers are nonjudgmental, we’re not. In several studies, it’s been suggested that physicians and nurses across a range of specialty areas harbor negative stereotypes toward obesity, such as perceptions that patients who are obese lack self-control, are unmotivated or lazy, and are more likely to be noncompliant with treatment (interestingly, researchers have not found a correlation between obesity and noncompliance).

Explicit and Implicit Bias

Medical and nursing students bring weight bias with them when they enter school. Researchers have found that the majority of these students possessed both explicit (outwardly expressed) and implicit (automatic, unconscious) weight biases. Many students expressed frustration about caring for patients who are obese, viewed them to be difficult to deal with, and were pessimistic that obesity counseling and treatment could be successful.

In addition, the students reported observing weight bias frequently in the clinical setting; 63% of students had witnessed other students making jokes or negative comments about patients with obesity, 40% had observed instructors making negative comments, and 65% had witnessed healthcare providers making negative comments.

What’s troubling about this statistic is that when combined with data on healthcare utilization that found that people affected by obesity tend to avoid preventive healthcare services, it’s the perfect set-up for delayed diagnosis of disease and missed opportunities for screening and early detection. In fact, one study found that women avoided or delayed routine gynecologic care not because of fear of finding something wrong, but rather, because of fear and shame associated with being put on a scale.

An Opportunity for Health Education

Weight bias is a clinical concern that cannot be ignored. First and foremost, as clinicians we need to examine our own perceptions about people who are overweight or obese (it may also be helpful to consider if negative stereotypes also exist about patients who are significantly underweight). We need to think about how we express these perceptions and consider our actions in the healthcare setting. All too often, the patient’s weight is not discussed at all; consequently, an opportunity to provide health education is missed.

Weight-related discussions, which really are health-related discussions, need to occur in a safe and supportive environment for both the patient and healthcare provider. We need to be educated about complex etiology of obesity and its biological and genetic factors, and be aware of the challenges of achieving significant long-term weight loss. We also need to do a better job talking about obesity and engage in proactive and supportive communication to elicit health behavior change. Lastly, as role models for students entering the healthcare professions, we need to be thoughtful about how we describe our patients and need to avoid perpetuating weight bias and negative stereotypes.

One strategy is to use what’s called “people-first” language. We already do this in oncology care; for instance, we take care of people with cancer and not “cancer patients.” Similarly, terms such as “obese patient” need to be replaced by people-first language, such as "people with obesity" or "individuals affected by obesity."

Oftentimes, we forgo opportunities to intervene and provide health education about obesity because of our lack of knowledge. Educational resources on weight bias in the healthcare setting, including videos, toolkits, informational handouts, and continuing medical education, are available at the Yale Rudd Center for Food Policy and Obesity (www.yaleruddcenter.org). If every one of us took the time to better educate ourselves about the epidemic of obesity and became more sensitive and skilled in addressing obesity, the health of America would surely improve.