Weight Bias Can Be a Barrier to Quality Health Care

By Admin

Seeking care for any reason can be a stressful experience. People are often nervous about visiting healthcare facilities and being examined, especially in the midst of a global pandemic. Unfortuatley, along with other possible biases experienced in an institutional setting, discrimination based on weight is an issue that is not only emotionally upsetting but can actually lead to reductions in the quality of care received. As overweight and obesity rates are rising steadily in many countries throughout the world, people are often reluctant to seek care due to negative experiences in the past. Sometimes described as an “acceptable” form of prejudice due to its prevalence, weight bias can cause health professionals to focus more on a patient’s weight than on a possible diagnosis. In fact, providers may not even be aware of their own biases. Anti-fat stereotypes and idealized thinness are so prevalent in western cultures that it is very easy to internalize them, regardless of intent. In truth, there may be many different reasons for a individual’s weight at any given time, and assumptions about a heavy person's lifestyle and habits are often inaccurate. But the damage of these assumptions in the healthcare industry can have an extremely negative impact on the populations they serve. By addressing weight bias in healthcare, individuals affected by obesity may be more likely to seek professional guidance and engage in treatments that can help them in the future.

A Highly Prevalent Bias

Studies show that healthcare providers are generally less respectful of patients with high proportional weight, known as a high BMI or body mass index, compared to those patients with lower weight ratios. The most common weight bias among physicians is the tendency to view heavy or obese patients as undisciplined or less health-conscious than thinner patients. In some cases, physicians may be less inclined to prescribe novel or rigorous treatments to a heavy patient due to stereotypes about low compliance among heavier individuals. This can lead to a snowballing of negative assumptions by both parties involved, and the consequences can be extremely harmful to the patient.

According to a scoping review published in the journal Primary Health Care Research and Development, lower engagement with healthcare services among heavy or obese individuals is a direct consequence of negative experiences. Among other types of experiences reported, some of the more common complaints include contemptuous or patronizing attitudes, disrespectful treatment, ambivalence, and especially the attribution of health issues to excess weight. These examples show how easy it is for healthcare professionals to focus on the issue of weight, regardless of current ailments or patient concerns. Whether these biases are inherent in the healthcare system or simply a result of cultural and media influences is questionable, but no one, regardless of the cause, should be made to feel unwelcome or inadequate simply for seeking care in a time of need.

Cultural Assumptions Are Often Inaccurate

Biased attitudes are not only immoral and unethical but are often inaccurate as well. In regard to weight and obesity, common biases are often based on misinformation about what it means to have a higher-than-average BMI. High weight and/or obesity can be caused by a variety of influences such as genetics, health conditions, and environmental factors, and in some situations, lifestyle changes can be difficult. In one example, particularly young patients with sleep apnea were shown to have limited exercise capacity due to reduced cardiac output and low oxygen volume during exertion. This means that people with conditions such as obstructive sleep apnea (OSA) can be predisposed to weight gain due to the consequences of the disorder. The COVID-19 pandemic is another example. The term “Covid 15” or “Quarantine 15” refers to pounds gained during the pandemic due to quarantines and other lifestyle changes. While there is no evidence of widespread weight gain directly related to the pandemic, there is plenty of evidence about heightened stress during the past couple years, and weight gain is a common response to stress and stress hormones.

Diet and exercise may be the first things that come to mind when addressing weight issues, but the relationship between weight, food, and activity can be much more complex than many people assume. Someone who is thin is no more likely to be active or live a healthy lifestyle than a heavier person, and body weight is not always an accurate indicator for health risks. In fact, associations between weight, diet, and activity can be counterproductive to the goal of weight management.

According to one study, the entire premise of a “normal weight” can be problematic. Weight is overemphasized for higher-weight individuals and can lead to harmful dieting known as “weight cycling,” which is characterized by rapid losses followed by rapid gains (often resulting in the regaining or surpassing of the original weight). Advocates of a more weight-inclusive approach have begun to view the issue of weight in new terms, focusing more on nutrition and whole-body health than ideal weight standards or BMI. Along with the eradication of weight bias, this approach represents a major shift in the direction of a more patient-centered care.

Putting an End to Discriminatory Practices

Obesity is unquestionably a primary health concern for much of the world, and particularly for the U.S., where over 40 percent of adults are currently obese. But to better serve this population, as well as the many of Americans who are not obese but still feel the negative impact of the high-weight stigma, it is important to recognize barriers to quality healthcare posed by these biased attitudes and to look toward more equitable and patient-centered solutions.

Experts in the field of bariatric medicine have suggested a call to action among healthcare providers to look both internally and externally for possible sources of bias. In practice, this means taking a personal inventory where necessary, and more broadly, to support a more thorough understanding of the complex etiology of obesity.. Physicians, according to the call to action, should explore all causes of presenting problems, rather than focusing on weight, and while providers should indeed recommend weight control treatments and/or lifestyle changes for anyone suffering from symptoms of chronic obesity, this should be done with complete awareness of the potential difficulties involved. According to this approach, a healthcare facility should be a supportive and bias-free environment for all patients regardless of appearance or health status, and all medical professionals should be actively working toward this goal.