Weight Bias in Your Doctor's Office: The Problem and Action Steps You Can Take to Solve It

Posted By Kantorlaw || 16-May-2013

Researchers from Johns Hopkins recently revealed interesting findings in weight bias, confirming what many people in larger bodies have known to be true for decades.

Published in the medical journal Obesity, researchers studied interactions between 39 primary care doctors and more than 200 patients with high blood pressure. This group consisted of 120 obese patients (body mass index -B.M.I. of 30 or greater), 60 overweight patients (B.M.I. of 25 to 30), and 28 patients of "normal weight" (meaning they had a B.M.I. below 25). The reason for this particular doctor's visit was to discuss high blood pressure.

Overall, the patients in every B.M.I. category were treated equally. No significant difference was observed, with the doctors giving equal time and attention to the topics discussed. However, after transcripts of the visits were further analyzed, one remarkable difference was detected: doctors seemed to be much nicer to their "normal-weight" patients. They demonstrated a greater sense of concern and empathy including making comments such as "I'm glad you're feeling better" to a woman who had experienced hot flashes, and "I agree with you. That gets extremely frustrating when that happens" to a "normal-weight" patient that experienced difficulties getting an appointment with a specialist.

Sadly, there was a lack of empathy and care when analyzing transcripts from doctors who visited with patients in larger bodies. Lead author of the study, Dr. Kimberly A. Gudzun, explained the detrimental effects of this discrimination, as patients are far more likely to follow their doctor's advice, and to have a better health outcome, when they believe their doctor empathizes with their plight.

Why the difference in behavior? A group of researchers studying weight bias among health professionals found that "On both implicit and explicit measures, health professionals associated the stereotypes lazy, stupid, and worth-less with obese people." It is no surprise that these deep-set fat phobic notions make larger patients feel reluctant or embarrassed to seek health care. This overt idealization of thinness, and disparagement of larger bodies, creates an inadequate and insulting healthcare experience.

Many larger bodied patients have experienced this deficiency in empathy, including weight-focused advice from their doctors. I recently spoke to a friend who had been complaining of a very painful knee injury. After several visits to her doctor for her worsening injury, he informed her that her pain resulted from her weight. While I found this incredibly difficult to believe, my friend deferred to her doctor's opinion, attributing her injury to her weight. She apologetically explained to me that she should exercise more. I happen to know that she is an active and healthy person and I suspect that her doctor might have taken her pain more seriously, and examined her further, if she had been thinner.

Ragen Chastain (Dancer, Choreographer, Writer, and Speaker) explains her frustration with weight bias in the medical community, "Mistreatment by doctors is, to me, one of the most dangerous side effects of the obesity panic and the stigma, shame, and stereotyping that comes with us. Doctors don't listen to us, aren't nice to us, and insist that we should try to do something that nobody has proven is possible for a reason that nobody has proven is valid with almost zero chance for success."

This issue of weight bias is shockingly common, even within the medical community, indicating a lower standard of care. With many visits focused on weight-based solutions, you can expect to find undiagnosed broken bones, asthma confused with depression, and a general reluctance to deal with any other aspect of your health besides weight. In a country where two out of three adults and one out of three children are overweight or obese, this weight bias is affecting millions, at a steadily increasing rate (The Yale Rudd Center).

Authors Rebecca M. Puhl, Ph.D. and Chelsea A. Heuer, M.P.H.voiced the persistent and fixed nature of this destructive bias. "Despite decades of studies documenting weight stigma and discrimination toward obese people, these attitudes remain pervasive and their public health implications are still largely ignored." Furthermore, they found that weight stereotypes and stigmatization DO NOT motivate individuals to adopt healthier behaviors, providing evidence that this social injustice does just the opposite. Weight stigma has the potential to increaseunhealthy eating behaviors, increaseavoidance of physical activity, and even encourage avoidance of seeing medical professionals.

Here are five simple things that you can do to shift our culture's thinking from weight-centered to health-centered:

Become Resolved!
ASDAH and the Size Diversity Task Force are partnering on a project right now called "Resolved" asking people to make a resolution to participate in a cultural shift. Sharing your story can be an empowering and healing experience. Send in a video discussing how weight bias has impacted your treatment by doctors, and what you are resolved to do to make a change. To see an example, check out Ragen's video here: http://danceswithfat.wordpress.com/2013/05/01/our-health-in-our-hands/. I hope this video inspires you to take part in changing the way the world looks at weight!

TIPS FOR PATIENTS (from Lavinia Rodriguez, Clinical Psychologist)
Patients also have a role to play in establishing a good relationship with their doctors. Here are a few things you can do to make sure that your medical concerns are addressed in the right way:

Furthermore, Psychologist and HAES expert Deb Burgard recommends that you "try asking the doctor what the treatment would be for a thin person, since there are NO conditions that are only found in fat people and thus there are treatments that do not involve weight change for everything." Dr. Burgard is currently working on a set of "Best Practices for the Care of Higher Weight People." Please see her survey to contribute your opinions and ideas.

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