Weight bias in healthcare is a harmful problem that can greatly affect patients. Despite their best intentions and commitment to high quality of care, healthcare providers sometimes hold negative attitudes towards individuals with higher body weights, which can lead to poor care and negative health outcomes. These biases can appear in various ways, such as disrespectful behavior, a lack of empathy, and insufficient medical evaluations.

The consequences of weight bias can be severe, including worse health outcomes, decreased patient happiness, and a lack of trust in healthcare. It’s important to recognize and address weight bias in healthcare to ensure that all patients receive the same level of compassionate and effective care, regardless of their body weight.

This article will explore the issue of weight bias in healthcare, discussing its prevalence, causes, and impact on patient care.

Prevalence of Weight Bias in Healthcare

Weight bias affects both patients and healthcare providers. According to research, by 2012, the incidence of weight discrimination had increased by 66 percent since 1995. The study also revealed that healthcare providers with higher levels of weight bias tended to interact negatively with patients, interrupting them, displaying less empathy, and providing less health information.

A recent study on obesity stigma discovered that patients with obesity often receive discriminatory treatment from healthcare providers. They may be blamed for their weight, receive inappropriate comments or jokes, and even experience negative body language from providers. This kind of behavior can make patients feel ashamed and less likely to seek healthcare in the future. These studies underscore the urgent need to address weight bias in healthcare and promote patient-centered care for all individuals, regardless of their weight.

One of the leading researchers in the field of weight bias in healthcare is Sean Phelan, PhD, MPH. Phelan’s work focuses on understanding the negative attitudes and stereotypes that many healthcare providers hold towards individuals with higher body weights, and how these attitudes impact patient care. Phelan’s research suggests that interventions aimed at improving provider attitudes and altering the clinic environment can reduce the impact of weight bias on patient care.

A recent study published in Frontiers in Psychiatry highlights the issue of weight stigma in eating disorder (ED) treatment. The authors argue that weight management practices inherently perpetuate weight stigma and propose a shift toward weight-inclusive care, which emphasizes health behavior change rather than weight itself.

How Weight Bias Appears in Healthcare:

  • Assuming a patient’s weight is the cause of their health condition without conducting a comprehensive medical evaluation
  • Recommending weight loss as a treatment for every health condition, regardless of its underlying cause
  • Providing inadequate pain management to patients with obesity due to assumptions that they have a higher pain tolerance, despite evidence that obesity has minimal influence on pain sensitivity
  • Displaying negative body language or dismissive attitudes toward patients with obesity
  • Blaming patients with obesity for their weight, regardless of underlying factors such as genetics, medications, or medical conditions
  • Making inappropriate comments about a patient’s weight during medical examinations
  • Referring to heavier patients with negative terms like “lazy” or “weak-willed”
  • Using inadequate medical equipment for patients with obesity, such as smaller blood pressure cuffs, hospital gowns, imaging and image-guided interventions, or examination tables
  • Focusing solely on a patient’s weight and neglecting other health concerns or factors, such as mental health or social determinants of health

Consequences of Weight Bias in Healthcare

Distrust in Provider-Patient Relationship

For the healthcare system to work, there needs to be trust between patients and their healthcare providers. If a patient has negative associations with healthcare because of biases, they may not want to go to appointments, feel like they can’t trust their healthcare provider, and may not want to talk about personal health information. This can make it hard for healthcare providers to give the best care possible and figure out what’s wrong with the patient. Even the most well-meaning healthcare providers can alienate patients because of inherent weight biases.

According to Dr. Scott Kahan, the director of the National Center for Weight and Wellness in Washington, D.C., “About 5% of women of a normal weight delay medical care and 35% of women with obesity delay care [and] a third or so say they don’t want to get lectured about their weight.”

Increased Societal Stigma

Weight bias in healthcare can make people with higher body weights feel like they’re being judged and looked down on. This can create a culture of fear and negativity, where people with obesity are discriminated against and treated unfairly in many parts of their lives. They might have a hard time at work, school, or in public places. This can lead to even more health problems, like feeling stressed, alone, and not having the resources they need.

Misdiagnosis of Medical Conditions

In some cases, weight can be a risk factor for certain medical conditions. But a patient’s symptoms can arise from a complex web of underlying issues, and the only way to offer proper care is with thorough diagnostics and evaluations. However, providers with unacknowledged weight biases may assume the patient’s weight is causing their symptoms, and not look into it any further. This can make it harder for the patient to get the right diagnosis and treatment plan.

According to the University of Illinois Chicago, a study analyzing National Health and Nutrition Examination Survey (NHANES) data from 2005-2012 found that nearly half of overweight individuals, 29 percent of obese individuals, and 16 percent of those with obesity type 2/3 were “metabolically” healthy, while over 30 percent of individuals in the normal weight category were “metabolically unhealthy.” Therefore, relying solely on BMI as a health indicator may result in misdiagnosis, with real medical concerns being overlooked.

Worsened Mental Health Conditions

Bias of any nature, including weight bias, can also worsen mental health conditions in patients with obesity. Stigmatizing and discriminatory treatment can increase stress, anxiety, and depression. This, in turn, can worsen existing mental health conditions and create new ones. Patients who experience weight bias may also avoid seeking mental health treatment, resulting in a lack of treatment for their mental health conditions.

The Growing Awareness of Weight Bias

In recent years, patients such as Rebecca Hiles and Ellen Maud Bennett have brought attention to the fact that weight bias can lead to the misdiagnosis of critical illnesses like cancer.

Hiles shared her story of being misdiagnosed with weight gain instead of cancer, which led to a delay in treatment and ultimately contributed to her cancer’s progression. “It was very scary to sort of exist in a body that I thought was failing me and have medical professionals who didn’t seem to take me seriously,” Hiles said. After years of being told she needed to lose weight, Hiles was diagnosed with cancer after a tumor was found in her bronchial tube.

Similarly, Bennett’s cancer symptoms were attributed to her weight, delaying her diagnosis until it was too late. Benett’s obituary read, “Over the past few years of feeling unwell she sought out medical intervention and no one offered any support or suggestions beyond weight loss. Ellen’s dying wish was that women of size make her death matter by advocating strongly for their health and not accepting that fat is the only relevant health issue.”

These cases highlight the impact of weight bias in healthcare and the need for increased awareness and education for healthcare providers. Weight bias can result in misdiagnosis and delayed treatment, putting patients’ lives at risk.

The Urgent Need to Address Weight Bias in Healthcare

Weight bias in healthcare is a prevalent and harmful issue that can have severe consequences for patients and the healthcare system. Healthcare providers often hold negative attitudes towards patients with obesity, resulting in poor care, decreased patient satisfaction, and diminished trust in the healthcare system. Weight bias can also worsen existing health conditions, create new ones, and lead to societal stigma. Addressing weight bias in healthcare is crucial to promoting patient-centered care and improving patient outcomes.

Strategies to combat weight bias include education and training for healthcare providers, policy changes to promote equity, and increased patient advocacy. By recognizing the impact of weight bias in healthcare and taking concrete steps to address it, we can work towards a more just and equitable healthcare system for all patients, regardless of their body weight.