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Addressing Weight Bias in Medicine

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Overcoming Weight Bias in Healthcare: What You Need to Know

If you're one of the two-thirds of Americans who are overweight or obese (defined as a body mass index of 25 or greater), going to the doctor's office may not be a pleasant experience. Unfortunately, weight bias in medicine is pervasive and may lead to disrespectful treatment from medical staff, including struggles to accommodate larger patients, insensitive remarks, and a focus on weight loss rather than addressing other medical concerns.

Weight bias in medicine can have serious health consequences for people with obesity. Factors contributing to weight are complex and cannot be reduced to a simple "calories in/calories out" equation. Weight bias may result in unhealthy eating behaviors, binge eating disorder, and lower motivation for exercise, as well as physiological reactions including increased blood pressure, blood sugar, and levels of the stress hormone cortisol.

Moreover, weight bias may lead to reduced engagement with healthcare services, including less trust of healthcare providers and poor adherence to treatment. It can also impact psychological health, causing depression, anxiety, substance abuse, and suicidal tendencies, as well as long-term health effects such as advanced and poorly controlled chronic diseases and low health-related quality of life.

To reduce weight bias and stigma, individuals with obesity can take steps such as using "people-first language" to describe their condition, refraining from referring to themselves as "obese" or "morbidly obese," and instead describing their condition as having the disease of obesity. They can also take the Harvard Implicit Association Test (IAT) for weight to discern if they have weight bias toward individuals with obesity, learn more about obesity as a disease, and educate themselves about weight bias by using resources such as those provided by the Rudd Center for Food Policy and Obesity.

Patients should speak with their physicians and their office staff if they experience bias in the office setting, and consider joining a group, such as the Obesity Action Coalition, to help elevate the message about weight bias and its harmful impact on health.

Reducing weight bias and stigma in healthcare is critical for the well-being of all patients, regardless of their weight. By advocating for themselves and educating others, individuals with obesity can help promote greater understanding and respect in healthcare settings.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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