The heavy burden of weight stigma in healthcare

For many people, a visit to the doctor’s office is fairly standard, but for patients considered overweight or obese by their doctors, even a routine check-up could be damaging to one’s mental and physical health.

For patients with larger bodies, biases, both subtle and explicit, could have extreme consequences. Many will receive inadequate healthcare due to the personal and interpersonal stigma surrounding their bodies.

A 2018 report by Elsevier concluded that body-related shame is a contributing factor in healthcare avoidance. Body-related shame can come from a lot of sources, but it is becoming increasingly apparent that this stigma may come from one’s own doctors. Registered dietician Dr. Lauren Butler explained that patients with larger bodies often face inequities when pursuing treatment for health concerns.

“Healthcare providers will often tell someone in a larger body that the first line of treatment is to lose weight,” Butler said.

Butler further provided an example of healthcare professionals prescribing weight loss.

“Instead of just saying ‘oh let’s get you evaluated to see if you need a knee replacement,’ [health care professionals] will first tell them ‘you need to go and lose weight and come back and we’ll evaluate you again.’ Whereas a person in a smaller body, if they came in for those same complaints and symptoms, they make it so the first line of approach is ‘we’re going to go ahead and schedule a surgery,’’ Butler said.

A  2016 study by the American Diabetes Association concluded that when a healthcare provider perceives a patient as non-adherent to their advice, a common stereotype of people with obesity, the provider makes less of an effort to build a relationship and the quality of care could suffer.

Butler further explains that even subtle biases apart from bedside manner could negatively impact the experience of a patient with a larger body.

“They may feel stigmatized in a health care provider’s office. For example, if they go in and there aren’t chairs that are large enough for them to sit in comfortably. So even if someone says nothing at all to them about their weight, shape and size, there’s implicit bias [in favor of] smaller bodies in the healthcare setting,” Butler said.

Senior Carly Zubrzycki shared her perception of the social impact that results from weight stigma in healthcare settings.

“When health professionals say your body is bad, it morphs the standard of what beauty should be. Thus, it can commonly result in eating disorders to meet those standards,” Zubrycki said.

Health at Every Size (HAES) is a framework created by Lindo Bacon, PhD that strives for inclusion and acceptance of all body shapes, sizes and abilities. The HAES community invites visitors of the website to take the pledge. The HAES pledge asserts the three basic components of the framework: respect, critical awareness and compassionate self-care.

The HAES community website explains why people are drawn to the movement.

“People are tired of diets, tired of feeling like failures, and tired of being scared of food. They are excited to find a paradigm that is committed to advancing social justice and respecting the diversity of human bodies (including, explicitly, larger bodies), a paradigm that starts from the very basic premise that they can trust themselves, one that respects pleasure rather than denial,” the website states.

Butler is supportive of the HAES ideology and uses it in her own work, though she explains that people tend to have misconceptions about the principles of the framework.

“Health at Every Size says we can have full, happy, meaningful, healthy lives at any size. I think oftentimes people think about Health at Every Size and they think ‘oh that approach just says you can be fat and not take care of yourself,’” Butler said.

Butler continued, explaining that despite misconceptions, the HAES framework is just designed to provide health and lifestyle guidance to anyone without stigmatizing certain bodies.

“[HAES] says that at whatever body weight, shape and size you are, we need to have healthcare spaces, physical activities, social and cultural settings, where you can go into that space and feel comfortable and feel at ease to participate in what is available,” Butler said.

While the consequences of weight bias are part of a complex social issue, professional practices that are more inclusive of all bodies are emerging. With the evolution of frameworks that advocate for the care of people in larger bodies, accessible healthcare for people of all weights, sizes, shapes and abilities is becoming more realistic.