Weight Bias in Healthcare for Clients & Clinicians

The experience of being ignored in a healthcare setting is an independent risk factor for illness. It’s not ONLY upsetting and frightening, it can cause physiological issues as well. 

One group of people who, studies have shown, receive a disproportionate amount of bias in a healthcare setting is those who are in larger bodies or perceived to be “overweight.” 

From the perspective of someone who occupied a larger body as a child and young adult, I can also speak to the fact that the doctors I experienced often brushed off my symptoms as a “weight issue.”

Have a headache? LOSE SOME WEIGHT! Experiencing anxiety? CUT THOSE CALORIES! 

And, I can still remember so distinctly, at the age of 12, a doctor trying to scare me about getting diabetes. “If you don’t eat turkey sandwiches only for lunch and a yogurt for dinner, you are going to get diabetes!”

This study in 2014 found that 67% of doctors experience weight bias. Besides being emotionally dismissive and damaging, there are physical consequences of patients feeling stigmatized and ignored. The only way practitioners are able to support patients is if they LISTEN, with an open mind and ear, to what their patients are expressing. Professionals who specifically help those with weight have this bias as well (ironic, isn’t it?) 

In this article, we aim to explain the damaging effects of weight bias and propose solutions for both clients and clinicians on how to receive and give effective healthcare by eliminating weight bias. 

What is weight bias? 

Weight bias is defined by the Obesity Action Coalition (OAC) as a negative attitude, belief, judgement, stereotype, and/or discriminatory act aimed at individuals simply because of their weight. It can be obvious or more subtle and may occur in any setting including the workplace, healthcare, education, media, and even personal relationships. An example of weight bias in healthcare may look like going to the doctor for a headache and being given a dismissive and unrelated recommendation for weight loss, lacking any eye contact or thorough examination. It may also be in the form of unsolicited diet advice from a medical doctor who, a) does not ask for your consent, and b) is not actually qualified to do so. 

Why does weight bias exist? 

There are many forms of prejudice that exist within our society, some with more social awareness and regulation than others. Today, weight bias can essentially be a “socially acceptable form of prejudice,” without people even realizing that’s what’s going on. Many weight-biased people overstate how “controllable” a state of overweight/obesity actually is. On the contrary, many national organizations, including the American Medical Association, recognize obesity as a chronic disease based on research demonstrating the genetic basis of obesity and the complexity of the condition.2 In short, this means that weight is more nuanced than people realize, and it may not be as easily controlled as many believe. 

Why is it harmful? 

Many people who engage in weight-shaming behaviors make harmful and often inaccurate assumptions about people in larger bodies. They mistakenly think that their harmful words will motivate positive behavior change in the receiver (assuming that the receiver needs to make behavior changes in the first place). However, it may actually have the opposite effect. Experiencing weight bias can actually lead to the development of disordered eating behaviors, excessive dieting, compulsive exercise and/or a further increase in weight due to behaviors such as excessive fasting and consequently binge eating. It can also cause an avoidance of exercise (due to a fear of being weight-shamed), and/or the development of maladaptive eating habits (i.e. binge eating related to the emotional stress of weight bias.)

Weight bias creates an environment where clients feel unsafe to ask the important questions they need to progress in their health journey. It also leaves the practitioner’s judgment at a disadvantage, as narrow thinking about one aspect of health can lead to missing essential warning signs about other aspects of health. 

Weight bias is commonly associated with anxiety, stress, depression, low self-esteem, and body image issues. While disease consequences and mortality tend to be higher in overweight populations, “it has been proposed that the stigma associated with weight may actually be causing some of the negative health outcomes associated with excess weight rather than the excess weight itself, including increased mortality risk.” (Alberga, 2016)

When weight is relevant

It’s important to note that we can never look at just one measure to determine someone’s health status. Even when weight is relevant to health, there are many other factors that can paint the whole picture (i.e. bloodwork, energy levels, sleep, digestion, etc.) 

However, weight can be a helpful datapoint in assessing someone’s health. Instead of measuring weight alone using a scale number or BMI calculation, it is more important to assess body composition (muscle mass vs. fat tissue), waist circumference, and waist-to-hip ratio as these factors tend to be more closely associated with chronic disease risk. 

When assessing weight, we want to take a look at the deviation from your normal baseline. Is your current weight typical for your body over the course of your life? Do you have frequent weight fluctuations (think: a history of yo-yo dieting)? Our bodies have a setpoint range that they like to sit at, so weights above or below this range may indicate that there is an underlying issue within the body that needs to be addressed. 

It’s important to remember that implementing an overall healthy lifestyle (nutrient-dense foods, stress reduction, daily movement, adequate sleep, etc.) can have numerous health benefits regardless of weight. We never want to sacrifice these components in favor of weight loss. 

How to defeat weight bias as a patient

As a patient, YOU have the right to adequate healthcare, including proper treatment from your practitioners. Here are some tips for demanding a better experience from your current practitioner: 

  1. You have the right to ask not to be weighed. Many times, stepping on the scale is a common practice in doctors’ offices, even when it has nothing to do with the condition you are there for in the first place. You can always ask not to be weighed if it is not necessary. If it is necessary, you can ask the nurse/doctor for a blind weight – this means that they record your weight but it is not told to you verbally or written in your copy of your health record. Click HERE to download our “Don’t Weigh Me” card to bring with you to your next appointment. 
  2. Speak up + Set your boundaries. I know this can be incredibly intimidating, (and that it’s easier said than done,) but remember that you are the paying “customer” at the doctor’s office. You have every right to be your own health advocate. Try communicating with your practitioner regarding the goals they set for you – let them know if you have any concerns or if these goals are unrealistic for you. Share how the experience made you feel with your doctor or their staff so that they can understand and do better. 
  3. The grain of salt approach. Go into each appointment knowing that every piece of information you receive is a recommendation and that you have the right to use the information or dismiss it. 
  4. Move on. If a provider does not make you feel comfortable – or worse, makes you feel uncomfortable – it may be time to switch providers. Continuing your follow-up care is vital to your health and treatment protocols, so if a negative experience is affecting this care then it is important to continue elsewhere. 

How to defeat weight bias as a practitioner

As practitioners, we are simply humans that hold societal biases that have developed over the course of our lives. However, it is our responsibility to overcome these biases to look at our patients/clients objectively and provide a safe space and the best care we possibly can. Treating clients differently because of their weight can cause them to avoid following up with us in the future, potentially missing out on crucial early diagnoses that may have a harmful impact on their health. It’s a direct and negative impact on their health. Here’s how we can level up to help our patients: 

  1. First, we need to curate an environment where all patients feel safe. If you have an office, think of the pictures on your walls. Are the people in these images inclusive of your client population (race, age, ethnicity, size)? If you have chairs in your waiting room/office, does your furniture comfortably accommodate people of all body types?
  2. Discern what’s helpful. Your goal in your profession is to help people (we so know that!) Go into each and every appointment you have with the understanding that applying weight stigma and bias to your patients is 0% productive or helpful. It is distinctly harmful. Even if your instinct is to characterize people or their conditions based on their weight or clump their condition together with their weight, understand that while weight may be a SYMPTOM of something happening in a person’s body or life, it is not your role to overemphasize or exclusively focus on that if it is not the concern, chief complaint or priority of the client. It is your role to address the concerns of your patient in a scientific and compassionate way. If we only look at weight as a DIAGNOSIS, as opposed to a SYMPTOM, we can easily miss diagnoses that are driving weight gain. 
  3. While we all engage in continuing education courses regarding our field of practice, it is crucial that we also continue to learn about the experiences of diverse populations – size included. 
  4. If a client presents with a larger body and abnormal lab values, let’s focus on addressing those lab values and/or symptoms rather than the weight itself. This may include addressing nutrition, exercise, and lifestyle factors independent of weight. While weight loss may be a side effect of these beneficial lifestyle changes, it would not be the primary goal. It may be helpful to think of a situation in terms of, “what recommendation would I give to a client with these symptoms that was in a ‘normal’ BMI range?” 
  5. Don’t think this applies to you? Try taking the Harvard Implicit Association Test (IAT) for weight to see if you hold any weight bias toward those in larger bodies. 
  6. Ask for consent when offering nutrition information – and especially if nutrition is not within your scope of practice, you can offer a referral to a nutrition professional if your patient distinctly asks for one. Do not assume your patient wants nutrition information, again, especially if you are not a nutrition expert. Provide health-specific solutions that are not weight centered. We are likely to over-emphasize the importance of weight in health due to our biases, and if we can’t propose effective solutions or referrals in the appointments, there isn’t a reason to bring weight up at all. 

Bottom Line

Every single patient deserves to be treated with respect and made to feel comfortable with their medical providers. At Michelle Shapiro Nutrition LLC, we believe a positive and trusting provider-patient relationship is an essential part of the healing journey. We work one-on-one with clients to approach all health goals in a body-neutral way, whether they be heart health, blood sugar management, anxiety reduction, or even weight loss.  

CLICK HERE to book a FREE discovery call with one of our Registered Dietitian Nutritionists!

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