Obesity is linked to over 200 diseases and influences the development of the leading causes of death in the United States—cardiovascular disease, metabolic syndrome, and cancers. It’s a major public health concern that frustrates healthcare providers. However, do we allow our frustration with the disease to spill out as frustration with the person who has the disease? When we see a patient with obesity, it’s easy to ask ourselves, “How could you let yourself be so unhealthy?” or “Why am I working hard for you when you can’t make the lifestyle changes?” It’s possible that we’ve heard or even used derogatory language about a patient in our workplace (“Fatso over there can’t get it under control”).
Weight bias, defined as holding a negative attitude toward those with obesity, frequently leads to stereotypes and discrimination. Stereotypes of patients with obesity include laziness, lack of intelligence, nonadherence to medical advice, and lack of self-control. Unfortunately, an abundance of research shows that patients with obesity frequently feel stigmatized by their healthcare providers, including nurses. This bias may manifest in the time we spend with our patients, the amount of patient education we provide, our verbal communication and body language, and how quickly we respond to patient needs. The hospital setting itself, although improving, also communicates a preference for thin patients with a lack of bariatric-sized equipment, including beds, gowns, scales, or chairs.
Researchers find a lack of understanding about the causes and complexity of obesity frequently leads to bias. The accepted causes of obesity in mainstream America include poor diet and sedentary lifestyle. This leads many, including healthcare providers, to place blame on the patient for their body habitus as strictly a result of lifestyle choices. However, hormones, genetics, socioeconomic status, food insecurity, stress, medications, sleep, and childhood trauma all can influence the development of obesity. Having just one parent with obesity doubles a child’s risk of developing obesity and having two parents with obesity increases that risk 15-fold. The rate of childhood obesity has tripled since 1970s. Once a child develops obesity, it’s likely to remain into adulthood.
Sadly, as those who’ve tried to lose weight can attest, weight loss can prove quite challenging. Some may think it is simply due to lack of willpower or self-control. However, weight loss is complex, and hormones can work against us. For example, the resting metabolic rate can decrease up to 15% and hunger hormones increase. This is one reason why the Obesity Medicine Association defines obesity as “a chronic, progressive, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”
Even if we try to hide our biased attitudes from our patients, they can still sense our disapproval. Puhl and colleagues surveyed 318 individuals with excess weight and obesity about their experiences of weight stigmatization. Common themes included feeling hurt, disrespected, depressed, embarrassed, or shamed. Some reported eating as a means of coping, further perpetuating their weight problem. Others emphasized that they felt misunderstood. Frequently, these individuals change providers or delay or avoid healthcare, which worsens disease processes. This proves problematic given that those with obesity frequently have related comorbidities and increased need to access healthcare.
We must improve our understanding of the disease and combat weight bias so that our patients feel comfortable in our care. We can begin by asking ourselves, “What stereotypes do I believe about patients with obesity?” Then we can implement patient-first language (“patient with obesity,” not “obese patient.”). Because patients with obesity likely feel sensitive about their weight, ask them first if it’s ok to discuss their weight with them. Then focus on healthy behaviors, not just a number on the scale, and small, tangible, realistic goals. Recognize that a patient may have tried several times before to lose weight, acknowledge the difficulty of making lifestyle changes, and offer praise when changes are made. Many medical treatments for obesity exist, so we should inform patients of pharmacological and surgical options in addition to diet, exercise, sleep, and stress reduction.
We can and should continue the fight against obesity—but misdirecting our zeal toward the person with the disease, not the disease itself, can be detrimental to that fight. Recognizing weight bias and decreasing its occurrence serves as important steps. This means working with patients to tackle the disease, not accidently “tackling” the person! Their health, and the health of our nation, depends on it.
Caroline Moore, PhD, RN, FNP-C, is a Clinical Instructor, Georgia Baptist College of Nursing, Mercer University. Tracy Oliver, PhD, RDN, LDN, is an Associate Professor, Louise Fitzpatrick College of Nursing, Villanova University.
Reference:
- Puhl RM, Moss-Racusin CA, Schwartz MB, et al. Weight stigmatization and bias reduction: perspectives of overweight and obese adults. Health Educ Res. 2008;23(2):347-358. doi:10.1093/her/cym052
