Weight Bias in Health Care



well what do we have here he burned his hand on a stove did you warn him not to touch a hot stove of course I did well I'm afraid we can't help him clearly he did this to himself that's absurd isn't it that a doctor would compromise care for a patient because he did it to himself but unfortunately overweight and obese people are the victims of this kind of irrational weight prejudice almost every day whether it's in the form of negative attitudes societal stigma or unfair treatment my name is Emmy and as the first plus-size supermodel trust me I know what it's like to be judged based on my size and that's why I'm here today to raise your awareness of exactly what weight bias is how it shows up in medical practices and who its victims sources and consequences are I'm hopeful that by the time that we come to the end of this brief journey you'll be inspired to make subtle the critical changes in your own medical practice and perhaps even adjust your own perceptions and treatment of your overweight and obese patients weight stigma is bias and discrimination aimed at overweight people based on a series of social attitudes that people develop they can start very early in life that assume that there's something wrong with overweight people and that they should be punished for their condition hi could you help me do you have an appointment yes I made it a year ago named Cole Natasha mm-hmm you can take a seat over a year ago she was really hate coming to the doctor one important area where weight bias is expressed is in medical care overweight people are very often reluctant to go get medical care preventive services in particular because of biased attitudes they feel that they're going to encounter at the hands of health care professionals there have been studies with physicians with medical students with nurses with dieticians with psychologists and with other health care professionals showing quite negative attitudes and feelings that there's something wrong with the overweight person that their weight condition is that their fault and that because they haven't lost weight there's something seriously lacking in their personality ma ma ladies you weight bias can be as hurtful and difficult to counter as racial prejudice and yet there's no anti-discrimination laws to protect people who are overweight weight bias is so prevalent in our society that most people don't even stop to question it as a result overweight individuals confront negative stereotypes and Prejudice often on a daily basis it's important to recognize just how common this problem is in the United States we recently examined a nationally representative sample of American adults and found that the prevalence of weight discrimination is comparable to racial discrimination and has in fact more common than racial discrimination among women we also found that the prevalence of weight discrimination is more common than discrimination due to ethnicity religion sexual orientation or physical disability it's important to consider that statistically six out of ten patients in your waiting room are already overweight or obese and that number is rapidly on the rise and most of you know that obesity has doubled in the past 20 years in both children and adults and frightening Lee it's tripled in teens one in five children is overweight and overweight children tend to become overweight adults 30% of adults are obese and were right on track for this trend to continue whether or not you want to deal with this the obesity epidemic is increasingly going to impact your practice and as these numbers continue to grow anything you can do to make your overweight and obese patients feel more comfortable and accepted will translate into an improved work environment and a more successful practice and most importantly better health outcomes for your patients miss Cole the nurse will take you in the stigma of obesity is so strong that even health care professionals specializing in the treatment of obesity hold negative attitudes towards the obese and infer that these people have blameworthy behavior step on the scale please I'd rather not we have to weigh you it's the same as last time we need it for our medical records 260 pounds what are you 5'4 you've gained weight since last year it looks like your diet isn't working please move into the examination room the doctor will be right with you how hard is it to push yourself away from the table and now and get off the couch nothing to it but to do it you got to work hard to get that overweight physicians limit their interactions with obese patients are ambivalent about treatment roles and are reluctant to perform certain screenings studies have revealed that nurses to view obese patients as lazy over indulgent non-compliant and less successful than their average weight counterparts nurses self-reported alarming statistics one study found that in third to half of the nurses surveyed admitted feeling uncomfortable caring for obese patients many would prefer not to touch these patients 1/4 of them agree that obese patients repulsed them and fully a third would prefer not to care for obese patients at all and these are their caregivers this thing isn't big enough for you here change into this Sehwa know where the extra-large blood pressure compass so weight bias could affect an individual's health in many ways just being the victim of discrimination could affect your health but then you add to that the fact that people don't get care as they should because of the biased attitudes they expect to encounter creates a real problem health care providers are not immune to weight bias and unfortunately many overweight and obese patients report negative experiences from multiple groups of providers as an example we surveyed over 2400 overweight and obese adults and we asked them to tell us about the different sources of weight bias in their lives what we found is that physicians were the second most common source of weight bias reported fully 69 percent of people reported weight bias from physicians 46 percent from nurses 37% from dieticians and 21 percent from mental health professionals so this really is a common experience for many individuals in the healthcare environment let's take a look at the impact of all of this to see why this is such a critical and urgent issue well there are a range of negative consequences of weight bias for both emotional and physical health for example we know that individuals who experience weigh bias are more vulnerable to depression low self-esteem poor body image and even suicidal behaviors we also know that individuals who experience weight bias are more likely to engage in unhealthy eating behaviors like binge eating and avoiding physical activity both of which may ultimately only reinforce weight gain in additional obesity it's not a leap to conclude that when patients experience bias their preventive care is compromised so what's the solution what can you do the solutions are so simple treat your overweight and obese patients with the same courtesy you treat all of your other patients this is Cole how are you today good idea here for your 10:30 appointment I share I am great just take a seat the doctor will see you shortly thank you there are a number of things that health professionals and medical offices can do to combat weight bias the first is just to take a look at the physical environment of the office so for example making sure that in the waiting room there's room for people to move around that there are chairs that are large enough to accommodate all patients and it's important to even look at the reading material in the office because things like you know fashion magazines that have a lot of very stereotypical images of women and exaggerated images of you know female beauty can sometimes be disturbing to patients feeling like they're you know constantly surrounded by those images another thing that medical professionals can do is make sure that the place where they way patients is private so we recommend that the scale is off in a separate section of the office it's not visible to other people and another thing that helps a lot is to actually ask the patient if they would like to be weighed it's a way of showing respect for the patient's decision whether or not they feel that that's important for them to do during that visit hello would you like to be weighed today no there haven't been any significant changes fair enough there's a gown right there and I'll be right back to take your blood pressure rate provide larger sized gowns larger sturdier examination tables provide larger blood pressure cuffs to your patients who require a larger size it's very important for healthcare providers to increase awareness about their own attitudes and assumptions based on weight and providers can ask themselves questions like do I make assumptions based on weight regarding a person's character or intelligence or success or lifestyle am i comfortable working with patients of all sizes do I give appropriate feedback to encourage helpful behavior change am I sensitive to the needs and concerns of obese individuals do I treat the individual or only the condition another important aspect of reducing weight bias is to really understand the complexity of obesity people think that for someone who's overweight all they need to lose weight is some self-control and trying harder to eat less and exercise more if that only worked we wouldn't have the problem that we have too the causes of obesity are very complex it is a combination of genetic factors environmental factors psychological factors and it's important to recognize that so that when we look at someone and we see whatever their body weight is we don't make assumptions about their behaviors based on that information it's important for providers to recognize that patients may have had negative experiences with weight bias from previous providers and so when they come into the office for the first time providers need to be aware of these issues we often hear from patients that when they go in to the doctor for a problem such as an earache that the doctor frequently will blame the issue on their body weight even though it has nothing to do with the presenting problem many patients have tried to lose weight repeatedly in the past but have been unsuccessful and so when a patient comes into the office for the first time telling a patient that they need to lose weight is something that the patient has probably heard many times before and is not necessarily the most helpful advice to give one thing that providers can do is to really emphasize behavior changes rather than just the number on the scale we want to be setting goals for patients that are realistic and achievable so things like can they increase their consumption of fruits and vegetables reduce intake of soda walk more frequently during the day very tangible strategies and goals that patients can work on to improve their health it's also important for providers to recognize that relatively small weight losses can have important improvements for overall health and so even if an individual is able to lose five or ten percent of their body weight that can have very important implications for their overall health they may be able to get off certain medications or to lower their blood pressure and communicating this to patients can be very empowering as they try to make behavior changes if weight loss was easy we would not have the current obesity epidemic that we have and so it's very important for providers to acknowledge how difficult this is and to provide support patients are three times more likely to address diet and lifestyle changes if their doctor constructively and sensitively called their weight to their attention yet less than half of physicians actually do well mrs. Koll all your vitals look great it sounds like you're doing great would you mind if we talked about your weight sure I know I could eat better get more exercise I'm glad to hear you're thinking about ways to improve your health but it's important to remember that body weight is only partly determined by diet and exercise still we can all stand to make lifestyle improvements let's talk about when you're doing now and how effective that is okay the medical community offers a great opportunity to help address the issue of weight bias because with positive attitudes people will get better care but not only that but it'll be modeling for the world about how overweight people should be treated and what weight is it shows that weight isn't is an issue that needs to be dealt with in medical settings in a straightforward positive constructive way and is people see this then they see that weight isn't an issue that where there should be tremendous prejudice stigma directed in individuals rather it should be a straightforward medical condition just like anything else in spite of millions of dollars spent every year on weight loss efforts long term results in America point to the fact that there are obviously other factors at play beyond intention and commitment yet the increasing prevalence of obesity in our society has oddly not reduced weight bias with more and more people overweight one might think tolerance would increase but it hasn't at the Rudd Center we work hard to eliminate the problem of weight bias we believe that there's a strong social injustice occurring here that hundreds of millions of people around the world are deeply affected by this and it just doesn't need to occur race bias doesn't need to occur gender bias doesn't need to occur and weight bias doesn't need to occur thank you for taking the time to watch this educational video on weight stigma for more information please visit the Rudd Center for Food Policy and obesity at Yale red center org you

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