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Weight bias at the doctor – is it happening to you? And what can you do about it?

Feature, Food Relationship, Women's Health | March 7, 2022

Green vegetables, nuts and fruit smoothies spread across a kitchen table.
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Weight stigma is a problem that 61% of Canadians report having experienced, and yet, many people are still unfamiliar with the term or its impacts on health1.

So what is weight stigma?

The literature defines it as “the social rejection and devaluation that accrues to those who do not comply with prevailing social norms of adequate body weight and shape”2. In simple terms, the society we live in values thinner bodies above larger bodies. You can read about diet culture and its impacts here. Being in a larger body is seen as a moral failing and results in discriminatory attitudes and actions that impact job prospects and promotions, interpersonal relationships, and healthcare treatment3.

Within healthcare, weight stigma is pervasive and has adverse outcomes on health. But before diving into this topic further, I want to acknowledge that I have never experienced weight stigma myself.

So, to highlight what this can look like within the healthcare system, I will share stories of those who have experienced it.
*Disclaimer: this post includes discussions about diets and eating disorders

  • A person with normal lab values, blood pressure, and no indicators of ill health is told at their annual physical to track calories and consider weight loss medication based on their BMI.
  • An individual in a large body with recent blood work indicating blood sugars well within the normal range is told they are highly likely to develop diabetes and suggested to start a ketogenic diet.
  • A person who, during the course of competing in bodybuilding, developed a known eating disorder, gains weight after finishing the competition. Their doctor prescribes weight loss medication to stop the weight gain.

I could go on for pages with examples that I’ve been told of weight stigma within health care, which is unsurprising given two-thirds of people in a larger body report experiencing weight stigma from their doctors1.

A doctor measuring a woman in a larger body's stomach with a tape measure.

Research highlights that doctors have strong implicit and explicit weight bias that results in inequitable care for individuals in higher weight bodies4. For example, due to the stereotype of individuals in larger bodies being lazy or unmotivated, doctors are more likely to believe that they will not adhere to recommendations and spend less time providing education to these individuals5. Additionally, symptoms are over-attributed to weight resulting in physicians being less likely to consider treatment beyond weight loss advice or referrals to other healthcare providers5.

Stigmatizing healthcare experiences results in individuals delaying or avoiding seeking health care, ultimately resulting in larger-bodied individuals presenting to doctors with more advanced concerns because primary preventative care was not initiated1,5. I can attest to many clients telling me they have cancelled or avoided doctor appointments for fear of fat-shaming. In addition to the multiple physical health consequences that can occur from weight stigma in healthcare, individuals who perceive they have experienced weight-based discrimination are two and a half times more likely to have a mood or anxiety disorder2.

So, why is this happening?

First, I want to point out that not all doctors or health care providers perpetuate weight bias. But unfortunately, many do without recognizing the potential harm they are causing. Our society values thinness, and there is a preconceived notion that losing weight is a good goal for our health, leading to unconscious bias and actions.

What can be done?

There is a lot of work to do within healthcare to change providers’ attitudes. This includes education around the inadequacies of using BMI as an indicator of health, understanding the complex biopsychosocial and systemic factors that impact weight beyond calories and exercise, and recognition that dieting has negative psychological and physical impacts.

However, this change takes time, and while we can’t control the attitudes of others, we can work on building our own resiliency so that the attitudes of others impact us less. I like to think of this as building metaphorical armour. For example, if you experience a negative comment from a doctor without any armour on, you’re likely to be hurt and thrown back into diet culture. But if you have layers of armour on, you can go to your medical appointments prepared to get the care you deserve.

At Ignite Nutrition our team of dietitians and psychologist can help you up your armour by:

  1. Advocating for you with your health care professionals. One step to dismantling weight bias is education around the shortcoming of BMI as a marker of health and the multiple biopsychosocial factors that influence weight far beyond exercise and diet2. As dietitians, we hold a position of authority and use our power as your ally to advocate to your doctor or health care professionals2
  2. Empowering you to manage conversations with health care providers. For example, learning ways to decline being weighed during doctor visits or asking for care beyond weight loss advice.
  3. Helping you develop a healthier relationship with food and your body. Through this process, you will develop confidence and conviction that your actions are best for your own well-being so that you are not pulled back into diet culture.
  4. Developing self-compassion skills and breaking down your own internalized weight bias, which research shows are elements in developing resilience against weight stigma6.
  5. Direct you to resources for further education or to develop a community of like-minded individuals because you’re not alone and peer support is a vital component for building resilience.

Interested in learning the psychological and physical impacts dieting can have?

Check out these blog posts:

 

If you want to build some of these resiliency skills and get the healthcare you deserve, book an appointment with our team today.

A doctor measuring a woman in a larger body's stomach with a tape measure.

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References

  1. Puhl, R. M., Lessard, L. M., Himmelstein, M. S., & Foster, G. D. (2021). The roles of experienced and internalized weight stigma in healthcare experiences: Perspectives of adults engaged in weight management across six countries. PloS One, 16(6), Article e0251566. https://doi.org/10.1371/journal.pone.0251566

  2. Tomiyama, A.J., Carr, D., Granberg, E., Major, B., Robinson, E., Sutin, A., & Brewis, Alexandra. (2018). How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Medicine,16, Article e123. https://doi.org/10.1186/s12916-018-1116-5

  3. Jackson, S.E. (2016). Obesity, weight stigma and discrimination. Journal of Obesity Eating Disorders, 2(1). https://doi.org/10.4172/2471-8203.100006

  4. Sabin, J. A., Marini, M., & Nosek, B. A. (2012). Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PloS one, 7(11), Article e48448. https://doi.org/10.1371/journal.pone.0048448

  5. Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity reviews, 16(4), 319–326. https://doi.org/10.1111/obr.12266

  6. Forbes, Y., & Donovan, C. (2019) The role of internalised weight stigma and self‐compassion in the psychological well‐being of overweight and obese women. Australian Psychologist, 54(6), 471-482. https://doi.org/10.1111/ap.12407