Patients with obesity face weight bias, stigma, and discrimination1
Occurrences of weight bias and stigma are present in multiple domains of living, such as media, educational institutions, the workplace, and health care facilities. As such, consider approaching the topic of weight management with sensitivity and awareness.2,3
How patients with obesity may feel
People with obesity often internalize weight stigma, which affects their confidence in their ability to lose weight.4
Understanding the scope of weight bias5
As obesity rates have risen in the last several decades, so has the evidence of weight stigma and weight bias. In fact, weight discrimination in the US is commonly reported at rates comparable to those of racial discrimination.5
*Prevalence of obesity based on National Health and Nutrition Examination Survey data from 2017-2020 and data from the 2023 US Census estimates.6,7
Multiple adverse health consequences can result from experiences of weight stigma.5
Because perceived weight bias among health care professionals can impact health care utilization by people with obesity, interventions to reduce explicit weight bias are critical. Education on the multifactorial nature of obesity can help make a difference in the delivery of health care.5
Adapted from Puhl et al, Clin Diabetes. 2016;34(1):44-50.
A1c, glycated hemoglobin.
Strategies to address weight bias
A formal diagnosis of obesity has been associated with better outcomes for patients.9
Education that emphasizes the complex causes of obesity has been shown to reduce weight bias in the health care setting.5
The impact of bias on the quality of communication may be reduced through training and practice in patient-centered communication strategies.5
Recommendations for compassionate care of people with obesity10
See, acknowledge, and treat the whole person
Patients with obesity often perceive that their physicians are stigmatizing their weight. By focusing on the patient’s overall well-being, you can help them develop sustainable lifestyle habits rather than just pursuing weight loss. This holistic approach involves considering their emotional, physical, nutritional, social, and spiritual health.
Identify bias and assumptions
Patients who have experienced bias may have developed consequences such as unhealthy eating behaviors and distrust of health care professionals. Weight bias contributes to health disparities but can be overcome with careful consideration of your communication style.
Practice patient-centered communication
Consider motivational interviewing techniques, in which you emphasize your patient’s autonomy through empathy and reflective listening.
Create a welcoming environment
Plan for what may make your patients with obesity feel more comfortable in your office. This can include everything from appropriately sized furniture and equipment to weighing patients in private. It’s also useful to give your staff opportunities for sensitivity training focused on obesity.
Pursue lifelong learning
The field of obesity medicine is changing at a rapid pace. Take advantage of the educational resources offered by organizations such as the American Board of Obesity Medicine and the Obesity Action Coalition to ensure you stay ahead of the curve.
Compassionate care
Recognize that obesity is a chronic, progressive, relapsing disease11
Avoid using BMI as the sole criterion for determining obesity11
Encourage person-first language as a potential step in improving terminology11
Use positive and supportive language to frame obesity as part of a broader health narrative, avoiding stigmatizing terms and emphasizing a compassionate approach11
Emphasize healthy behavioral changes without referencing weight11
When discussing weight with your patients, it’s critical to communicate with them in an unbiased manner
Selected weight-related terminology and associated emotions for adults living with overweight and obesity12*
*A study involving 1,693 adults living with overweight and obesity was conducted via an online survey from April 28, 2019, to June 23, 2019, with participants recruited through various channels such as social media and patient obesity organizations. The sample was predominantly female (96%) with an average age of 49.2 years and a median BMI of 31.4 kg/m². The survey explored preferences for 22 weight-related terms and emotional responses to these terms using a 5-point Likert scale and 7 core emotions.12
BMI, body mass index.
INITIATING A PLAN
Patients may be waiting for health care professionals to discuss weight management
DISEASE PROGRESSION
Can excess weight impact health?
References:
1. Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus statement for ending stigma of obesity. Nat Med. 2020;26:485-497.
2. Puhl RM, Heuer CA. Obesity stigma: important considerations for public health. Am J Pub Health. 2010;100(6):1019-1028.
3. Fruh SM, Graves RJ, Hauff C, Williams SG, Hall HR. Weight bias and stigma: impact on health. Nurs Clin North Am. 2021;56(4):479-493.
4. Fulton M, Dadana S, Srinivasan VN. Obesity, Stigma, and Discrimination. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 26, 2023.
5. Puhl RM, Phelan SM, Nadglowski J, Kyle TK. Overcoming weight bias in the management of patients with diabetes and obesity. Clin Diabetes. 2016;34(1):44-50.
6. Stierman B, Afful J, Carroll MD, et al. National Health and Nutrition Examination Survey: 2017-March 2020 prepandemic data files-development of files and prevalence estimates for selected health outcomes. National Health Statistics reports No. 158. June 14, 2021. Accessed September 18, 2024. https://www.cdc.gov/nchs/data/nhsr/nhsr158-508.pdf
7. US Census. Quick facts. Accessed May 14, 2024. https://www.census.gov/quickfacts/fact/table/US/LND110210
8. Spahlholz J, Baer N, Konig H-H, Riedel-Heller SG, Luck-Sikorski C. Obesity and discrimination – a systematic review and meta-analysis of observational studies. Obes Rev. 2016;17(1):43-55.
9. Ciemins EL, Joshi V, Cuddeback JK, Kushner RF, Horn DB, Garvey WT. Diagnosing obesity as a first step to weight loss: an observational study. Obesity (Silver Spring). 2020;28:2305-2309.
10. Kennedy AB, Taylor SS, Lavie CJ, Blair SN. Ending the stigma: improving care for patients who are overweight or obese. Fam Pract Manag. 2022;29(2):21-25.
11. Brown A, Flint SW, Batterham RL. Pervasiveness, impact and implications of weight stigma. eClinicalMedicine. 2022;47:101408.
12. Brown A, Flint SW. Preferences and emotional response to weight-related terminology used by healthcare professionals to describe body weight in people living with overweight and obesity. Clin Obes. 2021;11(5):e12470.
