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Weight stigma in healthcare settings

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Weight stigma, which is often referred to as weight bias, is discrimination and stereotyping against people living in higher-weight bodies. Healthcare is one of the most prominent settings in which people experience weight stigma.

4
 minute read
Last updated on 
March 15, 2023
Weight stigma in healthcare settings
In this article

How common is weight stigma in healthcare settings?

Weight bias is extremely common in healthcare settings. Treatment providers, even those specializing in obesity, have been shown to discriminate against overweight or obese people at alarmingly high rates. 

Research has revealed the following figures: (1,2)

  • Approximately 52% of women say their weight has been a barrier to receiving effective healthcare
  • About 79% of individuals in higher-weight bodies report consuming more food to cope with experiencing weight stigma
  • About 53% of women with obesity report healthcare providers making inappropriate comments about their weight
  • Weight discrimination increased by 66% between 2006 and 2016

Weight stigma in healthcare settings can deter individuals living in higher-weight bodies from seeking medical treatment, thus leading to subsequent health problems and rapid disease progression. 

Examples of weight discrimination from medical professionals

Weight stigma in healthcare settings can look like many different things, including:

  • Misattributing health problems to weight
  • Spending less time with overweight patients during visits
  • Providing patients with less health information
  • Shaming patients into losing weight 
  • Failing to understand the complex causes of obesity
  • Believing that weight is the most important indicator of health
  • Ignoring patient complaints and symptoms

Treatment provider attitudes toward obese patients

An estimated 40% of healthcare providers admit to holding negative beliefs and attitudes about people living in larger bodies. (1)

One study focused on provider attitudes towards people living in larger bodies and revealed that medical professionals viewed overweight patients as “annoying” and less disciplined. They even reported less desire to help these patients than their patients of average or low weight. Other studies have corroborated these findings among doctors, medical students, residents, and nurses, who viewed obese people as “unsuccessful,” “sloppy,” and “repulsive,” even going so far as to say that they didn’t want to touch obese patients. (2) 

Weight stigma is not only common but extremely prevalent in medical settings. In fact, several studies have found that doctors are the first or second most common source of weight discrimination for women, second only to family members, while men reported physicians as the second most common source, second to classmates. (2) 

Stigmatizing physical barriers in medical settings

Not all weight discrimination is as obvious as the examples above. Much of the weight bias overweight individuals experience is related to the lack of accessibility within healthcare settings and the inability to effectively treat people in higher-weight bodies.

For example, many treatment settings don’t offer appropriate-fitting hospital gowns and blood pressure cuffs, as well as accommodating x-ray and examination tables that can support their weight or size. In fact, one study revealed that 91% of facilities don’t have scales available for patients over 350 pounds. (2) Troubling stats include: (2)

  • About 40% didn’t have large enough exam tables
  • Nearly 80% of facilities didn’t have gowns for people with larger bodies
  • Over 50% didn’t have armless chairs

These are known as physical barriers to care that prevent overweight individuals from receiving appropriate and comprehensive medical care.

Harmful consequences of weight discrimination and stigma

Weight discrimination has far-reaching consequences on those who experience it, both in healthcare settings and elsewhere. Some negative effects of weight stigma include: (2,3,4)

  • Depression
  • Suicidality
  • Anxiety
  • Low self-esteem
  • Poor body image
  • Psychological stress
  • Increase in body dissatisfaction (which is a risk factor for eating disorders)
  • Binge eating episodes

Between 79% and 90% of respondents in various studies reported using food to cope with weight bias and discrimination, while about 75% of people report refusing to diet as a reaction to experiencing weight stigma in healthcare settings. (2) Subsequently, instead of helping patients, healthcare professionals actually end up worsening mental health symptoms, perpetuating disordered eating (such as binge eating), and increasing psychological stress.

And despite the psychological complications caused by weight discrimination, research indicates that men who experience weight stigma in healthcare settings are less likely to seek therapy. (2)

The connection between the obesity epidemic and weight stigma

The so-called “obesity epidemic” has induced a moral panic in healthcare providers and researchers around the world, leading them to focus on obesity as the main concern, rather than as a consequence of many intersecting systemic issues and biopsychosocial factors that can impact health. 

Many of the medical responses to this epidemic, such as recommending eating less and exercising more, actually wind up increasing weight bias, which we know leads to a myriad of additional problems. And yet, the majority of healthcare professionals continue to engage in these anti-obesity efforts anyway, essentially undermining any good intentions they may have (however misguided). 

The more healthcare providers discriminate against people living in higher-weight bodies—whether they shame them into losing weight, ignore their medical complaints, or make inappropriate comments—the more likely these individuals are to cope with food, avoid dieting, and engage in binge eating episodes, which could potentially lead to more weight gain. 

It’s clear that current approaches to combating obesity are not only ineffective but are stigmatizing and harmful. What governments and medical communities seem to fail to understand is that obesity is often a result of systemic inequities, such as lack of access to healthy food when living in what are referred to as “food deserts,”racial, sex, and gender discrimination, lack access to healthcare, poverty, childhood trauma, and cultural messaging like healthism and diet culture

Not to mention, countless people who are categorized as obese are perfectly healthy, as weight is not the main predictor of wellness and health—a fact that reveals the fatphobic attitudes of our society at large.

Instead of focusing solely on obesity, it makes more sense to find effective strategies for combatting weight stigma and discrimination in medical settings, as well as other prevalent settings, like schools and workplaces.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.

Resources

  1. Fruh, S. M., Nadglowski, J., Hall, H. R., Davis, S. L., Crook, E. D., & Zlomke, K. (2016). Obesity Stigma and Bias. The Journal for Nurse Practitioners, 12(7), 425–432. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5386399/ 
  2. Puhl, R., Brownell, K. (2006). Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity, 14(10): 1802-1815. 
  3. National Eating Disorders Association. (n.d.). Weight Stigma. https://journalofethics.ama-assn.org/article/weight-bias-health-care/2010-04 
  4. Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: important considerations for public health. American journal of public health, 100(6), 1019–1028.

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Further reading

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