How to Handle Weight Bias and Stigma in Healthcare

Written by CCTC Staff Writer

Anyone in a larger body can probably tell you about a time when they were teased, treated unfairly, or looked down upon because of their size. They experience the negative effects of weight bias and weight stigma, even in the healthcare field, where clinicians should understand the relationship between weight and health.

But the perception of weight is very slowly changing — in healthcare and in society.

Read on for:

The definition and history of weight bias and weight stigma
How healthcare providers perceive weight as it relates to health
The impact of healthcare providers’ perception of weight
What to do if you worry about facing weight stigma

An In-Depth Look at Weight Bias and Weight Stigma

A weight bias is a negative belief, ideology, and/or stereotype associated with being overweight or obese.

Implicit weight biases are automatic beliefs that come into one’s head unconsciously, without effort, usually due to cultural and environmental messages about weight. People who act on implicit biases may not even recognize that their actions are because of that bias.

When someone has an implicit bias, they can learn to recognize the automatic thought, consciously deny it, and not act on the automatic thought.

Explicit weight biases are intentional and conscious. Someone with an explicit weight bias consciously voices the belief, either in their own head or through their intentional actions.

Weight stigma refers to discriminatory beliefs and acts towards someone due to weight bias.

Implicit vs Explicit Weight Bias Example:

If someone prefers to sit next to a thinner person as opposed to a larger bodied person despite the fact that there is enough room for them in either seat, this is an implicit bias.

Someone with this bias may sit down next to the thinner person, without even consciously realizing why they chose one seat over another.

If someone thinks that the larger person should be walking to their destination instead of taking the bus, they have an explicit bias. They believe that larger people are lazy compared to smaller people, and assume that they don’t exercise at all.

If that person decides to voice their explicit bias, this becomes a discriminatory act — also known as weight stigma.

How is weight viewed in the healthcare field?

Many healthcare professionals hold the belief that if you are clinically overweight, you are unhealthy. Healthcare providers show weight bias in several ways.

They may assume that people at a higher weight:

Are automatically at a higher risk for disease
Are ill because of their weight
Need to change their diet and exercise habits
Need to lose weight

Acts of weight stigma in healthcare may include:

Diagnosing a patient based on weight alone
Prescribing diet and exercise regimes without discussing a patient’s current habits
Not listening to patients when they argue that their issues don’t have to do with their weight
Not screening for eating disorder behaviors
Praising or even encouraging unhealthy methods of weight loss
Respecting larger patients less than smaller patients

How common are weight-based beliefs and practices in healthcare?

Unfortunately, the focus on weight is extremely common. Over half of all healthcare professionals exhibit some form of weight bias.

In a national sample of 4732 medical students (Medical Student CHANGES Study), 74% of students had implicit and 67% of students had explicit weight bias.

And according to the Obesity Medicine Association, over 50% of clinically overweight patients in the US have reported multiple episodes of stigmatization, and 70% of women report physicians as a source of stigma.

Consequences of Weight Stigma in the Healthcare Setting

Avoidance of Care

Facing weight stigma in clinical settings, even once, can impact an individual’s trust in the healthcare field in the short-term or permanently.

In particular, patients who experience weight stigma:

Are less likely to come in for checkups or screenings; most notably, larger-bodied women do not come in for breast cancer screenings as often as they should, in large part due to stigma
Distrust healthcare providers and discount their advice
May have overwhelming stress during appointments and forget what they were instructed to do
“Doctor shop” often; this causes discontinuities in care and health problems may go unnoticed or medical needs are unmet
Are less likely to follow a weight loss program if needed, as they do not identify as someone able to change
Put off going to the doctor until the problem is so far advanced that it’s difficult to treat

Avoidance of Healthy Movement

While weight stigma is often thought to have a positive influence on dieting and weight loss, studies have shown that weight stigma leads individuals to avoid exercise, not engage in it.

They may not engage in healthy movement out of the fear of being judged. Or they may internalize the idea that being clinically overweight is their fault and they’re lazy.

Self-Stigmatization

When people in larger bodies start believing the negative beliefs that others have about them, they have internalized weight bias.

When they start to act according to those negative beliefs, such as self-sabotaging because they don’t believe they are worthy of good things, this is self-stigmatization.

While teasing from peers and negative media imagery are certainly damaging, hearing from a medical professional that weighing more is a bad thing can really cause a person to start believing all the negative things they hear around them.

Mental Illness

People who have faced weight stigma are more vulnerable to mental illnesses, including depression, anxiety, body image disturbances, binge eating, lowered self-esteem, and higher suicidality.

And weight stigma has been linked to a decrease in therapy seeking, most likely due to the fear that therapists will also commit acts of weight stigma.

Physical Illness

Waiting to ask for help, avoiding a balanced diet and exercise, and suffering from chronic stress can all cause the body to develop illnesses such as high blood pressure and cardiac issues. Unfortunately, these are the very illnesses that clinicians believe are caused by weight.

What should you do if you are a person in a larger body seeking healthcare:

1. Find a provider who meets your specific needs.

Look for a healthcare provider who understands that weight is not the sole indicator of health. This provider will take your complaints and concerns seriously, testing you for the same problems a smaller person may have before trying to link your issue to your weight.

They will also respect you as a person, involve you in your treatment decisions, and refrain from prescribing disordered diet and exercise regimes.

Related: This is what weight-inclusive healthcare looks like.

2. Educate those around you.

If you are unable to switch healthcare providers, you may have to educate your current providers about weight bias and stigma.

It’s a difficult subject to approach, as most people don’t want to see themselves as biased or stigmatizing.

However, these conversations have to happen if your care (and society's mentality surrounding weight) is going to change.

If your provider tells you they’re concerned about your weight, ask why. If they say you are at risk for things like heart disease, ask if they can run tests to confirm this. If you express a concern and they immediately assume it’s because of weight, ask them what they would say to a smaller person.

Then, ask for them to perform those same tests before considering how weight may be affecting you.

Take someone in your support system with you to appointments if you think it will help.

3. Take care of yourself: physically, mentally, and emotionally.

If you are physically and mentally able to, try to engage in healthy movement. Don’t see exercise as something you have to do because a doctor told you to, but an act of love for your body.

Note: Anyone, at any weight, can suffer from a restrictive eating disorder. If you are struggling with restriction, you should not exercise, no matter what you weigh.

Weight bias and stigma can take a toll on your mental health.

Talk to your supports, use mindful self-care, and any helpful coping strategies to manage stress before, during, and after medical appointments.

4. Monitor your mental health.

If you notice any signs of anxiety, depression, mood disorders, or an eating disorder (which can happen to anyone, no matter their size) talk to a weight-inclusive mental health professional about your concerns.

If you or a loved one is suffering from an eating disorder, take the first step today and talk to someone about recovery or simply learn more about the holistic eating disorder recovery programs we offer.

Ai PonoJune 8, 2021