What is weight bias?

Weight bias is the discrimination against fat or obese individuals (also known as “fat phobia”) and is based on the cultural belief that for a person to be healthy, they have to be thin. While this belief is not scientifically sound (4), many medical providers have internalized weight bias, causing them to inappropriately judge fat and overweight individuals.

Fat phobic beliefs extend beyond judgments about one’s physical figure. Studies show that people who have internalized fatphobia tend to also make negative assumptions about fat individual’s personal habits, health, and moral character (1-2). One study evaluated fat phobic beliefs in third-year medical students. The data revealed that students who had reported bias against fatness judged obese individuals are being more responsible for their body weight, despite not having any evidence to support this assumption (2). Furthermore, these individuals were perceived as unattractive, lazy, less likable, less disciplined, and more deserving of their health conditions. Such judgments are unfair, untrue, and can cause serious physical and psychological harm, especially in medical settings where bias has been shown to affect treatment decisions and outcomes.

Examples of weight bias in healthcare

• Some examples of weight bias in healthcare include:
• Experiencing negative/disrespectful attitudes from health care professionals,
• Embarrassing weighing procedures,
• Lack of appropriately sized medical equipment (i.e. MRI machines, medical gowns), and
• Unsolicited, shame-based advice to lose weight (3), even when the medical issue the patient initially sought help for is not related to weight (7).

Can you imagine going to the doctors about a sprained ankle and being told to go on a diet to help your ankle heal? Or having your ankle pain dismissed as being a result of your fatness, when you actually had untreated bone fragments and arthritis? These are just a few examples of the negative impact weight bias has had on patients! (7)

Weight bias has a negative impact on patients and medical providers

We rely on healthcare professionals to be unbiased, educated, and supportive when it comes to our health and wellbeing. Bias of any kind influences person-perceptions, judgments, interpersonal behavior, and decision-making (6). If a medical provider has internalized fat phobic ideas about health, a fat patient may not receive the quality of care they deserve.

Weight bias in healthcare:

• Can cause providers to misdiagnose issues
• Results in patients getting unwarranted, irrelevant, and embarrassing advice
• Undermines the patient’s health and can discourage healthy behaviors
• Causes avoidance of (medical) care and mistrust of doctors (6)
• Can cause, promote, and perpetuate disordered eating/diet culture
• Does not inspire or empower patients to live healthier lives

Diet culture has caused medical professionals to focus on fatness instead of fitness

Diet culture has perpetuated an inaccurate image of health. The belief that thinness is equivalent to health is a major reason weight bias continues to exist in medical settings. It is unfortunate that the focus on reducing fatness instead of increasing fitness has guided treatment recommendations, because it ultimately causes more health-related problems than it has solved.

For example:

A: If a patient’s weight is within the “normal” range, but they have been engaged in disordered eating behaviors and a doctor comments that their weight “looks good,” the doctor is only reinforcing the disordered behavior, which puts the patient’s health at risk.

B: Conversely, if a patient is overweight, even though they exercise regularly and eat well, the doctor may advise they reduce their caloric intake, also putting the patient’s health at risk.

A groundbreaking study from 2007 demonstrates the extent to which diet culture has distorted our understanding of health. Researcher Steven Blair found that “people who are overweight and active may be healthier than those who are thin and sedentary” (4). The data suggests that the death rate of individuals who are obese or moderately fit die is half that of people who have a normal-weight but are unfit (5). This is a huge effect! These findings clearly demonstrate that focusing on fitness instead of fatness has better health outcomes for patients.

Who does weight-bias in healthcare affect?

Obese patients are most often the victim of weight bias in medical settings and are far more likely to be harassed because of their body size– A staggering 69% of obese women report experiencing weight bias from health professionals (1). Patients with a history of dieting, disordered eating, and eating disorder(s) are also susceptible to experiencing stress over being weighed at the doctors. For some, it can even trigger harmful eating and exercising behaviors.

That said, we live in a fatphobic society. As a result, many people fear weight gain, weight related criticism and advice, and being weighed at the doctor, regardless of their actual body size or shape. Think about it– Have you ever gone through extra lengths to ensure your shoes, belt, keys, or jewelry would not add numbers to the scale? Or felt nervous about what the number would be or what the doctor would say about your weight? If you answered yes, then it’s likely that you have internalized the “thin-ideal” and on some-level, have a bias against being in a bigger body. This is not your fault, but it is your responsibility to unlearn these harmful beliefs.

4 Strategies to address weight bias in healthcare

1. Challenge doctors to decentralize weight in conversations about health – Ask your doctor to use other metrics of health such as blood pressure, temperature checks, urine and blood analysis, self-reported mood, energy levels, exercise habits, and so on.
2. Advocate for yourself at the doctor’s office – Always ask your doctor if it is medically necessary to be weighed. If you are uncomfortable with being weighed, for whatever reason, you are always allowed to request skip this part of your health evaluation, ask to be blinded to
3. Media Literacy – As a society, we have become so accustomed to hearing people make snide comments and jokes about fat people. Fat people are often portrayed as goofy and unintelligent in movies and TV shows. Point this stereotype out to your loved ones and children when you see it. Start a conversation about how this portrayal of fat people causes physical and psychological harm.
4. Become a fat activist – Speak-up! You can fight fat bias by standing up for fat individuals when those you are with make weight-based jokes, assumptions, and judgments. For example, you can say something like:

• “Why do you think that’s an acceptable thing to say about someone else?”
• “Please don’t comment on other people’s weight. It’s disrespectful and dehumanizing.”
• “That judgment is based on fatphobia. You don’t know anything about that person.”
• “Fat people don’t deserve to be shamed by a stranger for simply existing. Every person and every body is worthy of respect.”

The moral of the story? It’s time for the old, weight-based method of evaluating health to go. Doctors need to explore health beyond the BMI when diagnosing issues, making suggestions, and determining treatment plans if they want to truly help their patients live empowered, healthy lives. And every individual, regardless of body-size, deserves to be taken seriously, treated with dignity, and accommodated appropriately when at the doctor’s office.

Sources:

1. Brief intervention effective in reducing weight bias in medical students. (n.d.). PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3791507/

2. Ross, K. M., Shivy, V. A., & Mazzeo, S. E. (2009). Ambiguity and judgments of obese individuals: No news could be bad news. Eating Behaviors, 10(3), 152-156. https://doi.org/10.1016/j.eatbeh.2009.03.008 

3. Budd, G. M., Mariotti, M., Graff, D., & Falkenstein, K. (2011). Health care professionals’ attitudes about obesity: An integrative review. Applied Nursing Research, 24(3), 127-137. https://doi.org/10.1016/j.apnr.2009.05.001 

4. Kite, L., & Kite, L. (2020). More than a body: Your body is an instrument, not an ornament. Houghton Mifflin.

5. Sui, X., LaMonte, M. J., & Laditka, J. (2008). Cardiorespiratory fitness and adiposity as mortality predictors in older adults. Journal of Cardiopulmonary Rehabilitation and Prevention, 28(2), 146-147. https://doi.org/10.1097/01.hcr.0000314211.24923.54

6. Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & 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 

7. Parker, L. (2021, January 23). 29 times doctors were fatphobic that are beyond unacceptable. BuzzFeed. https://www.buzzfeed.com/laraparker/times-doctors-were-fatphobic

8. Alberga, A. S., Russell-Mayhew, S., Von Ranson, K. M., & McLaren, L. (2016). Weight bias: A call to action. Journal of Eating Disorders, 4(1). https://doi.org/10.1186/s40337-016-0112-4