The Impacts Of Weight Bias In Medicine

Ideally, it may seem that everyone should be able to access healthcare without fear of being treated differently or disrespectfully by healthcare providers. However, for some people, the reality is different. Thinner individuals and people of average weight may not realize that for overweight and obese people, navigating the healthcare system may be an unpleasant and demeaning experience. Weight bias in healthcare can be common and have serious negative impacts. Learning more about these impacts may help individuals and healthcare providers fight toward reducing stigmas based on body weight and size. 

What is weight bias?

If you are experiencing a crisis related to an eating disorder or would like further resources, reach out to the ANAD Eating Disorders Helpline at 1-888-375-7767 from Monday through Friday, 9 am to 9 pm CT. 

Researchers define weight bias as “negative weight-related attitudes, beliefs, assumptions, and judgments towards individuals who are overweight and obese…including individuals of low and high weights.” Typically, people perceived as carrying excess weight may experience more weight bias than those perceived as underweight. However, anyone of any weight outside of what is considered “normal” or “acceptable” can experience weight stigma and bias. 

Weight bias can occur in various settings, including healthcare, employment, education, media portrayals, personal relationships, and others. Weight bias can result in the following forms of body weight discrimination:

• An overweight or obese person not being hired or promoted in favor of a thinner person, despite their qualifications
• An obese child being treated by their teacher as less intelligent than a child of average weight
• A comedian making jokes about overweight people needing to lose weight so that they can be considered more attractive

However, weight bias does not have to involve direct human interaction. It can appear in intrinsic components of everyday life, like when mundane items like airplane seats, chairs, bathrooms, and hospital gowns are not designed to accommodate overweight people. 

How does weight bias show up in healthcare?

Weight bias in healthcare can be demonstrated in various ways. Health professionals may subscribe to a long-standing belief in medical care that being overweight is “always” connected to negative health consequences, and weight loss “should be” the first treatment option for obese patients. 

While the United States is facing an obesity epidemic, and many health conditions can be linked to obesity, healthcare is complex. The solutions to many health issues may not be as straightforward as losing weight, and many larger-bodied people are healthy. 

Healthcare providers may believe that lower weight is intrinsically tied to better health, a belief they may have been explicitly taught as medical students. This belief, combined with other societal stereotypes depicting overweight people as unmotivated, lazy, unintelligent, unhygienic, and unattractive, can cause physicians and other healthcare professionals to treat overweight patients poorly and potentially discriminate against them. 

The negative effects of weight bias in healthcare

Weight bias in healthcare can lead to unfavorable impacts, including but not limited to the following. 

Sickness and misdiagnosis 

A care provider may make assumptions about medical conditions based on a person’s weight and could develop a treatment plan primarily focused on losing weight when weight may not be related to a patient’s symptoms. The treatment plan may not be effective, and the patient’s condition may worsen as a result. In some cases, a delayed diagnosis can lead to a patient becoming extremely ill or dying.  

Embarrassment and shame 

Patients who believe their doctors are negatively judging them based on their weight may also feel embarrassed. This shame could make them less willing to share crucial health information about themselves and their lives with their doctors. For example, a patient may think, “My doctor already thinks I have poor self-control because I am overweight – I probably should not tell them that I also smoke cigarettes.” 

The patient might then never receive the access to smoking cessation resources they could have been given if they were able to be honest with their doctor, and they may be at a heightened risk for medical conditions such as lung cancer as a result. 

Reduced receptivity 

Not seeking support 

A negative impact of weight bias in healthcare is that some patients who experience weight discrimination may decide they are fed up with the medical system entirely. They may stop interacting or engaging with their doctors at all, forgoing essential procedures such as an annual flu shot or a routine gynecological cancer screening. Avoidance of healthcare can have significant health consequences, including missing signs of potentially serious health conditions that may be more treatable if detected early. 

How to address weight bias in medicine

Below are some ways individuals who identify as having a larger body may address weight bias and tips for people who want to make a difference, regardless of body size. 

Advocate for yourself

Although it can be scary, an effective way to combat weight bias in healthcare can be to share your concerns with your doctor. If you believe your doctor may be treating you differently because of your weight, communicate with them. You can try framing your experience by providing helpful feedback, such as telling them what specifically made you uncomfortable. 

Some doctors may not be aware that they are treating overweight people differently. Like other biases, weight bias can be unconscious. Healthcare providers who do not realize they are behaving discriminatory may welcome feedback that can guide them in providing a more inclusive patient experience. 

If you are nervous about having this conversation with your healthcare provider, it could be helpful to rehearse the subject with a friend or loved one to be more confident speaking up for yourself to your doctor. In addition, having someone present at appointments can ensure you have a witness if discrimination occurs. 

Raise awareness of the issue

Advocating for yourself when you experience weight bias is a form of addressing the problem after it has occurred, meaning some harm has already been done (although the provider may mitigate the effects of that harm by apologizing and being more aware of how they relate to overweight patients in the future). However, you may be able to help prevent weight bias in health care from ever happening in the first place by raising awareness.

If you have been treated poorly or not taken seriously by a healthcare provider because of your weight and are comfortable telling others about it, you can share your experience with friends, family, and loved ones. You could even share it with strangers on social media if you feel so inclined. The more people who are aware of the issues weight bias can cause, the more people may be willing to speak up and advocate for patients to be treated with respect regardless of their weight status.

Even if you do not have your own experiences with weight bias in healthcare, talk about the problems that it causes and how weight is not as closely linked to health outcomes as was once thought. Education can be the first step toward changing a systemic bias. 

Support options 

Constantly advocating for yourself to be treated with basic human dignity in a healthcare setting can be emotionally draining. Additionally, continually facing weight bias from health care providers can negatively impact your self-esteem. It may be challenging to work towards societal change without making time for self-care. If you think your experiences navigating weight discrimination in healthcare may be impacting your mental health, it might be beneficial to speak to a therapist. 

Negative in-person experiences within the medical system might make an individual skeptical about working with another healthcare provider. If this is the case for you, online therapy through a platform like BetterHelp may be more accessible. With online therapy, you can meet with your provider from the comfort of your home, and you can communicate with them via messaging, phone, or a video call with the camera turned off if you are worried that they may treat you differently because of your physical appearance. 

Online therapy can be as effective as traditional in-person therapy for addressing concerns related to experiencing weight bias in healthcare. One study found that participants who completed a course of online therapy reported higher levels of self-esteem and empowerment in their daily lives after treatment. If you are hoping for additional support as you are processing weight bias, online therapy could be a helpful resource.