11
NEWS
Weight stigma remains a
barrier to patient care
Obesity has historically been
regarded as a moral failing, and
people with obesity describe
being seen as deficient, lazy, and/
or undeserving of respect, lacking
willpower and self-discipline, and
gluttonous. Such negative judgments
about obesity persist not only in
society at large but also in healthcare
settings.
These views contribute to weight
bias (negative ideologies associated
with obesity), which can lead to
weight stigma (discriminatory acts
and ideologies targeted toward
individuals because of their weight
and size). Furthermore, research
has also suggested an association
between weight stigma and increased
food intake, such as eating without
being hungry, emotional eating, binge
eating, and long-term weight gain.
Kathleen Robinson, MD, PhD,
assistant professor of internal
medicine-endocrinology and
metabolism, Iowa Carver College of
Medicine, Iowa City, Iowa,
and her colleagues surveyed 395
individuals who were asked about
their experiences related to weight
stigma and healthcare. "We found
ongoing tension between the
framing of weight as solely a result of
personal responsibility vs weight as a
multifactorial condition with an array
of uncontrollable aspects," Robinson
reported. "And we found healthcare
providers made assumptions about
patients based on body size, such as
what they were eating or whether
they were exercising, and didn't
necessary ask about or acknowledge
the patient's previous experiences
with losing weight or what their
actual lifestyle was." Advice given
was often "trite and dismissive,"
rather than addressing the patient's
specific needs and history. Weight
stigma can result in physicians
dismissing patients' non-weightrelated
concerns, refusing care,
or attributing health problems to
obesity without considering other
causes.
Weight bias and stigma in medicine
therefore remain a systemic barrier
to healthcare, but the medical
community is working to address
the problem, and there are practical
steps physicians can take to make
their practices weight inclusive.
Physicians should focus on helping
patients set and work on behavioural
goals rather than on losing weight.
Instead of focusing on weight, it is
better to focus on actionable items,
such as food substitutions, filling the
plate with vegetables, or increasing
movement. Measuring and discussing
a patient's weight may not always be
necessary at every appointment.
Another alternative model is 'Health
at Every Size', which supports
size acceptance to end weight
discrimination and to lessen the
cultural obsession with weight loss
and thinness. It promotes balanced
eating, life-enhancing physical
activity, and respect for the diversity
of body shapes and sizes.
Physicians also can address weight
stigma by making sure they have
equipment that accommodates
patients of all sizes. Experts
recommend ensuring that blood
pressure cuffs and patient gowns
are large enough for patients with
overweight and obesity and opting
for patient chairs without arms.
Examination tables, scales, MRI
machines, and similar equipment
should be able to accommodate
individuals of all sizes and weights.
Additional tips include having a split
lavatory seat and properly mounted
grab bars to help the patient get up
more easily, floor-mounted toilets
and well-supported toilet bowls,
urine specimen collector cups with
handles, extra-long phlebotomy
needles and tourniquets, and a large
vaginal speculum.
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