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Obesity has historically been regarded as a moral failing<\/a>, and people with obesity describe<\/a> being seen as deficient, lazy, and\/or undeserving of respect, lacking willpower and self-discipline, and gluttonous<\/a>. Negative judgments about obesity persist<\/a> not only in society at large but also in healthcare settings, despite the American Medical Association\u2019s declaration of obesity as a disease<\/a> in 2013.<\/p>\n These views contribute to weight bias<\/a> (negative ideologies associated with obesity), which can lead to weight stigma (discriminatory acts and ideologies targeted toward individuals because of their weight and size).<\/p>\n Ironically, as obesity rates have increased, so have the rates of bias<\/a> and stigmatization toward individuals of larger body sizes. Paradoxically, research<\/a> suggested an association between weight stigma and increased food intake, eating without being hungry, emotional eating, binge eating, and long-term weight gain.<\/p>\n Weight bias and stigma in medicine remain a systemic barrier<\/a> to healthcare, but the medical community is working to address the problem, and there are practical steps physicians can take to make their practices weight inclusive.<\/p>\n Weight stigma in healthcare settings is communicated to patients verbally and nonverbally<\/a>. Patients reported being \u201cfat shamed,\u201d as described in a recent article<\/a> in Fortune<\/em> magazine.<\/p>\n \u201cI always go in [to medical appointments] with my guard up,\u201d one patient said in the article. That patient was told by an obstetrician\/gynecologist that she was \u201ctoo fat\u201d and that the physician couldn\u2019t treat people like her after the doctor tried and failed to insert an intrauterine device.<\/p>\n Nonverbal shaming can include looks of disgust or contempt, discussions that lack warmth, and a demonstrated unwillingness to touch the patient.<\/p>\n Weight discrimination can have serious consequences for patient health. Patients who have experienced weight bias in a medical setting are more likely to cancel appointments and avoid preventive care<\/a>, which increases their medical risk. For example, women with obesity are less likely to be up-to-date on Pap smears and screening mammograms, often due to perceived weight stigma and lack of appropriately sized examination equipment.<\/p>\n \u201cWeight stigma is a major concern that needs to be addressed in clinical practice and medical education,\u201d Kathleen Robinson, MD, PhD, assistant professor of internal medicine-endocrinology and metabolism, Iowa Carver College of Medicine, Iowa City, Iowa, told Medscape Medical News.<\/em><\/p>\n Robinson and colleagues surveyed<\/a> 395 individuals who were asked about their experiences related to weight stigma and healthcare. Of these, 73 provided narrative responses, some of which included experiences of being shamed.<\/p>\n \u201cWe found ongoing tension between the framing of weight as solely a result of personal responsibility vs weight as a multifactorial condition with an array of uncontrollable aspects,\u201d Robinson reported.<\/p>\n \u201cAnd we found healthcare providers made assumptions about patients based on body size, such as what they were eating or whether they were exercising, and didn\u2019t necessary ask about or acknowledge the patient\u2019s previous experiences with losing weight or what their actual lifestyle was,\u201d she said. Advice was often \u201ctrite and dismissive,\u201d rather than addressing the patient\u2019s specific needs and history.<\/p>\n Weight stigma can result<\/a> in physicians dismissing patients\u2019 non\u2013weight-related concerns, refusing care, or attributing health problems to obesity without considering other causes.<\/p>\n \u201cIf a patient with obesity presents with knee pain, for example, it\u2019s all too often attributed to excess weight,\u201d Kasuen Mauldin, PhD, RD, professor and director of the Dietetic Internship Program, San Jose State University, San Jose, California, told Medscape Medical News<\/em>. \u201cBut there are many causes of knee pain, of which mechanical weight-related stress is only one. So, before you attribute the knee pain to the patient\u2019s weight, ask yourself how you would handle the same complaint in someone of lower body weight and size and conduct the same workup.\u201d<\/p>\n Stigmatizing attitudes in healthcare arise from a lack of education and the mistaken belief that weight is a primary indicator of health.<\/p>\n David Strain, MD, PhD, associate professor of cardiometabolic health, the University of Exeter Medical School in Exeter, England, said the \u201cdogma\u201d he learned in medical training was that obesity \u201cis a pure function of eating too much and exercising too little, so the treatment was simply \u2018eat less, move more.\u2019\u201d<\/p>\n He likened this advice to telling a person with lung cancer: \u201cAll you need to do is stop smoking.\u201d Smoking is a risk factor for cancer, but the process is more complex. Smoking cessation is one of many interventions, and some nonsmokers also develop cancer, said Strain, who is chair of the British Medical Association\u2019s Board of Science.<\/p>\n In this weight-centric approach to health, lower weight is regarded as healthier than higher weight, Amanda Velazquez, MD, director of Obesity Medicine, Cedars-Sinai Center for Weight Management and Metabolic Health, Los Angeles, told Medscape Medical News<\/em>. And weight \u2014 typically measured as body mass index (BMI) \u2014 is generally viewed as being within the patient\u2019s control.<\/p>\n However, obesity isn\u2019t a single entity but a \u201ccomplex, multicausal, chronic disease with variable clinical phenotypes defined by abnormal or excessive adiposity,\u201d according to a 2023 consensus statement<\/a> of the American Association of Clinical Endocrinology (AACE).<\/p>\n The statement expands on<\/a> the AACE\u2019s previous efforts, including its adoption of a new diagnostic term for obesity: Adiposity-based chronic disease (ABCD). The association recommends complication-centric staging that facilitates personalized interventions. Therapy should include not only percent weight-loss goals but also alleviation of obesity-related complications, rather than weight loss per se. This approach is \u201cconsistent with the medical model for treatment of chronic disease and may help reduce weight stigma and weight bias.\u201d<\/p>\n Additionally, the European Association for the Study of Obesity in 2024 issued a new framework<\/a> for the diagnosis, staging, and management of obesity in adults to better align with the recognition that it is an adiposity-based chronic disease. The document offers \u201cpillars of treatment\u201d that include behavioral modifications like physical activity, psychological therapy, obesity medication, and metabolic\/bariatric procedures.<\/p>\n Like the AACE statement, it noted<\/a> that BMI alone is insufficient for diagnosing obesity. Instead, it recommends an algorithm for diagnosing and staging obesity based on BMI, fat accumulation, and a clinical component including medical, functional, and mental domains.<\/p>\n A new metric \u2014 the body roundness index \u2014 has been proposed<\/a> as a substitute for BMI. But opinions are mixed, and it needs to be validated in additional independent cohorts.<\/p>\n Addressing weight stigma in healthcare involves changing the clinical approach to patients with obesity.<\/p>\n Physicians should focus on helping patients set and work on behavioral goals rather than on losing weight, Mauldin said. \u201cIf you go to a financial planner, you won\u2019t be told, \u2018Get rich.\u2019 Instead, you\u2019ll be given concrete, practical steps, such as diversifying investments or saving money every month. Similarly, instead of focusing on weight, it\u2019s better to focus on actionable items, such as food substitutions, filling the plate with vegetables, or increasing movement.\u201d<\/p>\n Measuring and discussing a patient\u2019s weight may not always be necessary at every appointment and may perpetuate the weight-centric model \u2014 especially when a person is presenting with an unrelated concern, Mauldin said. A weight-centric approach can contribute to the notion that obesity drives all illness, leading to potential neglect of other etiologies.<\/p>\n An alternative model is Health at Every Size<\/a>, which supports \u201csize acceptance to end weight discrimination and to lessen the cultural obsession with weight loss and thinness,\u201d Velazquez said. It promotes \u201cbalanced eating, life-enhancing physical activity, and respect for the diversity of body shapes and sizes.\u201d<\/p>\n Mauldin emphasized that a weight-inclusive approach means treating patients \u201cholistically, in a nondiscriminatory way, in line with the patient\u2019s internal cues, such as whether they\u2019re hungry, and away from weight being just a number on the scale, which is a weight-centric approach.\u201d<\/p>\n Physicians also can address weight stigma by making sure they have equipment that accommodates patients of all sizes.<\/p>\n Experts recommend ensuring that blood pressure cuffs and patient gowns are large enough for patients with overweight and obesity and opting for patient chairs without arms. \u201cCouches or love seats might be a better choice,\u201d Mauldin suggested.<\/p>\n Examination tables, scales, MRI machines, and similar equipment should be able to accommodate individuals of all sizes and weights. And don\u2019t keep the scale in the hallway. \u201cBeing weighed in such a public place might be uncomfortable, not only for patients with larger bodies but for other patients, too,\u201d Mauldin said.<\/p>\n Additional tips<\/a> include having a split lavatory seat and properly mounted grab bars to help the patient get up more easily, floor-mounted toilets and well-supported toilet bowls, urine specimen collector cups with handles, extra-long phlebotomy needles and tourniquets, and a large vaginal speculum.<\/p>\n How physicians talk to patients about weight is important in reducing stigma and creating a safe space because weight is a very sensitive topic, Velazquez said.<\/p>\n Strain advises physicians to ask their patients for permission before broaching the subject of weight and to not use the term normal weight, which implies that obesity is abnormal. \u201cStatistics from the US and the UK show that demographics have shifted, and enough people are overweight that it\u2019s no longer abnormal for a person to be overweight. It\u2019s inaccurate, as well as being stigmatizing.\u201d<\/p>\n He also recommends avoiding scare tactics like telling patients they\u2019ll have a heart attack or get diabetes. These statements are \u201cinaccurate because a larger percentage of people living with obesity haven\u2019t had a heart attack or haven\u2019t developed diabetes compared to those who have.\u201d<\/p>\n This negative messaging contributes to a sense of self-blame and shame in people with diabetes or cardiac issues, suggesting it\u2019s \u201ctheir fault that this happened and they could have made the problem disappear, as if by magic,\u201d said Strain, co-author of a consensus statement<\/a> on the importance of language in engagement between healthcare professionals and patients with obesity.<\/p>\n Mauldin advised \u201cnot commenting on people\u2019s appearance, whether positive or negative. Train your staff not to even say, \u2018Wow, you lost weight; you must be doing better,\u2019 or \u2018You look great.\u2019\u201d<\/p>\nBusiness Impact of Weight Stigma<\/strong><\/h2>\n
Business Evolution in Thinking<\/strong><\/h2>\n
Business Tips for a Weight-Inclusive Practice<\/strong><\/h2>\n
Business Broaching a Sensitive Topic<\/strong><\/h2>\n