Weight Bias in Health Care

Doctor: “Well, what do we have here?” Mother: “He burned his hand on a stove.” Doctor: “Did you warn him not to touch a hot stove?” Mother “Of course I did!”
Doctor: “Well, I’m afraid we can’t help him. Clearly, he did this to himself.” That’s absurd, isn’t it? That a doctor would compromise care for a
patient because he did it to himself. But unfortunately overweight and obese people
are the victims of this kind of irrational weight prejudice almost
everyday. Whether it’s in the form of negative attitudes, societal
stigma, or unfair treatment. My name is Emme, and as the first plus size supermodel
trust me, I know what it’s like to be judged based on my size. And that’s why I’m here today, to raise
your awareness of exactly what weight bias is, how it shows up in medical practices, and who its victims, sources and
consequences are. I’m hopeful that by the time that we come to the end of this
brief journey, you’ll be inspired to make subtle but critical changes in
your own medical practice and perhaps even adjust your own perceptions in
treatment of your overweight and obese patients. Weight stigma is bias and discrimination
discrimination aimed at overweight people based on a series of social attitudes that
people develop that can start very early in life that assume that there’s
something wrong with overweight people and that they should be punished for
their condition. Patient: “Hi, could you help me?” Receptionist: “Do you have an appointment?”
Patient: “Yes, I made it a year ago.”
Receptionist: “Name?”
Patient: “Cole.” Receptionist: “Natasha?” “You can take a seat.” “Over a year ago? She must really hate
coming to the doctor.” One important area were wight bias is
expressed is in medical care. Overweight people are very often
reluctant to go get medical care, preventive services in particular,
because of biased attitudes they feel that they’re
going to encounter at the hands of health care professionals. There’ve been
studies with physicians with medical students, with nurses, with dietitians, with
psychologist and with other health care professionals, showing quite negative attitudes and
feelings that there’s something wrong with the overweight person that their weight condition is their
fault and that because they haven’t lost weight there’s something seriously
lacking in their personality Child Patient: “Mom, mom. That lady’s huge.” Mother: “Shhh.” Weight bias can be as hurtful and
difficult to counter as a racial prejudice, and yet there’s no anti-discrimination
laws to protect people who are overweight. Weight bias is so prevalent in our
society that most people don’t even stop to question it. As a result, overweight individuals
confront negative stereotypes and prejudice often on a daily basis It’s important to recognize just how common
this problem is in the United States. We recently examined a nationally
representative sample of American adults and found out the prevalence of weight
discrimination is comparable to racial discrimination, and is in fact more common than
racial discrimination among women. We also found that the prevalence of weight
discrimination is more common than discrimination due to ethnicity, religion,
sexual orientation or physical disability. It’s important to consider that
statistically six out of ten patients in your waiting room are already overweight or obese, and that number is rapidly on the rise.
And most of you know that obesity has doubled in the past twenty years in both
children and adults, and frighteningly, it’s tripled in teens. One in five
children is overweight and overweight children tend to become
overweight adults. Thirty percent of adults are obese and we’re right on track for this trend to
continue. Whether or not you want to deal with this
the obesity epidemic is increasingly going to impact your practice and as
these numbers continue to grow anything you can do to make your overweight and
obese patients feel more comfortable and accepted will translate into an improved working
environment and a more successful practice and most importantly, better health outcomes for your patients. Receptionist: “Miss Cole,” “The nurse will take you in.” The stigma of obesity is so strong,
that even health-care professionals specializing in the treatment of obesity hold negative attitudes towards the
obese and infer that these people have blameworthy
behavior Nurse: “Step on the scale please.” Patient: “I’d rather not”. Nurse: “We have to weigh you.”
Patient: “It’s the same as last time.” Nurse: “We need it for our medical records.” Nurse: “Two hundred and sixty pounds.” “What, are you five four?” “You’ve gained weight since last year.” “It looks like your diet isn’t working.” “Please move into the examination room. The
doctor will be right with you.” Nurse: “How hard is it to push yourself away
from the table?” Receptionist: “I know, and get off the couch.” “Nothin’ to it, but to do it.”
Nurse: “You have to work hard to get that overweight.” Physicians limit their interactions with
obese patients, are ambivalent about treatment roles and are reluctant to
perform certain screenings. Studies have revealed that nurses too
view obese patients as lazy, over- indulgent, non-compliant and less
successful than their average weight counterparts. Nurses self-reported alarming statistics.
One study found that in a third to half of the nurses surveyed admitted feeling uncomfortable caring for obese
patients. Many would prefer not to touch
obese patients. A quarter of them agree that obese
patients repulse them and fully a third we prefer not to care for obese
patients at all. And these are their caregivers. Nurse: “This thing isn’t big enough for you.” Nurse: “Here, change into this.” Nurse (out the door): “Does anyone know where the
extra large blood pressure cuff is?” Weight bias could affect an individual’s
health in many ways. just being a victim of discrimination
could affect your health but then you add to that the fact that people don’t
get care as they should because of the biased attitudes they expect to encounter. It creates a real problem. health care providers are not immune to
wait bias and unfortunately many overweight and obese patients report
negative experiences from multiple groups of providers. As an example, we surveyed over twenty
four hundred overweight and obese adults and we asked them to tell us about the
different sources of weight bias in their lives. What we found is that physicians are the
second most common source of weight bias reported. Fully sixty nine percent of people
reported weight bias from physicians, Forty six percent from nurses, thirty seven
percent from dietitians and twenty one percent for mental health professionals.
So this really is a common experience for many individuals in the health-care
environment. Let’s take a look at the impact of all of this to see why this is such a
critical and urgent issue. Well there are a range of negative
consequences of weight bias for both emotional and physical health. For example we know that individuals who
experience weight bias are more vulnerable to depression, low self-esteem,
poor body image and even suicidal behaviors. We also know that individuals who
experience weight bias are more likely to engage in unhealthy eating behaviors
like binge eating and avoiding physical activity, both of which may ultimately
only reinforce weight gain and additional obesity. It’s not a leap to conclude that when
patients experience bias their preventative care is compromised. So what’s the solution? What can you do? The solutions are so simple. Treat your overweight and obesity
patience with the same courtesy you treat all of your other patients. Receptionist: “Mrs. Cole, how are you today?
Patient: “Good, thank you.”
Receptionist: “Good, are you here for your 10:30 appointment?”
Patient: “I sure am.” Receptionist: “Great, just take a seat. The doctor will
see you shortly.”
Patient: “Thank you.” There are a number of things that health professionals and medical offices
can do to combat weight bias. The first is just to take a look at the
physical environment of the office. So for example, making sure that in the
waiting room there’s room for people to move around, that there are
chairs that are large enough to accommodate all patients. And it’s important to even look at the
reading material in the office because things like, you know, fashion magazines that have a lot of very stereotypical
images of women and exaggerated images of, you know, female beauty can sometimes
be disturbing to patients feeling like they’re constantly surrounded by those
images. Another thing the medical professionals
can do is make sure that the place where they weigh patients is private, so we
recommend that the scale is often a separate section of the office, it’s not
visible to other people. And another thing that helps a lot is to
actually ask the patient if they would like to be weighed. It’s a way of showing
respect for the patient’s decision whether or not they feel that that’s
important for them to do during that visit. Nurse: “Hello, would you like to be weighed today?” Patient: “No, there haven’t been any significant
changes.” Nurse: “Fair enough. There’s a gown right there and I’ll be right
back to take your blood pressure.”
Patient: “Great.” Provide larger sized gowns, larger, sturdier examination tables. Provide larger blood pressure cuffs to
your patients who require a larger size. It’s very important for health care
providers to increase awareness about their own attitudes and assumptions based
on weight and providers can ask themselves
questions like, Do i make assumptions based on weight regarding a person’s
character or intelligence or success or lifestyle? Am I comfortable working with patients of
all sizes? Do i get appropriate feedback to
encourage healthful behavior change? Am I sensitive to the needs and
concerns of obese individuals? Do I treat the individual or only the
condition? Another important aspect of reducing weight
bias to really understand the complexity of obesity. People think that for someone who’s
overweight all they need to lose weight is some self control and trying harder
to eat less and exercise more. If that only worked we wouldn’t have the
problem that we have today. The causes of obesity are very complex. It is a
combination of genetic factors, environmental factors, psychological
factors and it’s important to recognize that so that when we look at someone
and we see whatever their body weight is we don’t make assumptions about their
behaviors based on that information. It’s important for providers to
recognize that patients may have had negative experiences with weight bias from
previous providers so when they come into the office for the first time
providers need to be aware of these issues. We often hear from patients that when
they go into the doctor for a problem such as an ear ache that the doctor
frequently will blame the issue on their body weight even though it has nothing
to do with the presenting problem. Many patients have tried to lose weight
repeatedly in the past but have been unsuccessful, And so when a patient comes into the
office for the first time, telling a patient that they need to lose weight is something that the patient has
probably heard many times before and it’s not necessarily the most helpful
advice to give. One thing that providers can do is to
really emphasize behavior changes rather than just a number on the scale. We
want to be setting goals for patients that are realistic and achievable. So things like can they increase their
consumption of fruits and vegetables, reduce intake of soda, walk more frequently during the day, very tangible strategies and goals
that patients can work on to improve their health. It’s also important for providers to
recognize that relatively small weight losses can have important improvements for overall
health and so even if an individual is able to lose five or ten percent of
their body weight, that can have very important implications for their
overall health. They may be able to get off certain medications or
lower their blood pressure, and communicating this to patients can be
very empowering as they try to make behavior changes. If weight loss was easy, we would not have the
current obesity epidemic that we have so it’s very important for providers to
acknowledge how difficult this is and to provide support. Patients are in three times more likely
to address diet and lifestyle changes if their doctor constructively and
sensitively called their way to their attention. Yet less than half of physicians
actually do. Doctor: “Well, Mrs. Cole, all your vitals look
great, it sounds like you’re doing great. Would you mind if we talked about your
Patient: “Sure. I know I could eat better, get more exercise.” Doctor: “I’m glad to hear you’re thinking about ways to
improve your health but it’s important to remember that body
weight is only partly determined by diet and exercise. Still, we can all stand to make lifestyle
improvements. Let’s talk about what you’re doing now
and how effective that is.”
Patient: “Okay.” The medical community offers great
opportunities to help address the issue of weight bias, because with positive attitudes, people
will get better care but not only that but it’ll be modeling for the world
about how overweight people should be treated what weight is. It shows that weight
is an issue that needs to be dealt with in medical settings in a
straightforward, positive, constructive way. And as people see this then they
see that weight isn’t an issue where there should be tremendous
prejudice and stigma directed at individuals, rather it should be
a straightforward medical condition just like anything else. In spite of millions of dollars spent
every year on weight loss efforts, long-term results in America point to the fact that they are
obviously other factors that play beyond intention and commitment. Yet the increasing prevalence of obesity
in our society has oddly not reduced weight bias. With more and more
people overweight, one might think tolerance would increase, but it hasn’t. At the Rudd Center, we work hard to
eliminate the problem of weight bias. We believe that there’s a strong social
injustice occurring here, that hundreds of millions of people
around the world are deeply affected by this and it just doesn’t need to occur.
Race bias doesn’t need to occur, gender bias doesn’t need to occur and weight
bias doesn’t need to occur. Thank you for taking the time to watch
this educational video on weight stigma. For more information please visit the
Rudd Center for Food Policy and Obesity at yaleruddcenter.org.

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