Weight Bias in Healthcare

Weight bias in healthcare is a subject near and dear to my heart. Having been overweight since I was five years old, I have experienced this a time or two. The reason this is important to me is so other people know how to advocate for themselves in order to get to a problem that may or may not be weight related. I am realistic and aware that weight does increase some health problems. This is the very reason I went through Bariatric Surgery so I could lose weight and my weight related problems. That said not all health problems are weight related. I also do not want the type of person I am judged based on my number on a scale or how I look.

My definition of weight bias is when a clinician cannot see past the patient’s weight or makes assumptions about the person based on weight. This patient must not exercise, eat healthy, or even try to get motivated. I had a clinician who told me once that he did not care what I had to do to lose weight, I should just do it. When I expressed how hard weight loss is for me, he told me that if I were on a deserted Island, I would probably lose weight. Weight bias is when a clinician is not able to perform motivational interviewing to get to the heart of a health issue and leap right to conclusions about this patient and their weight problem.

I read an article by Leigh Richards, a nursing student sharing her own story of weight bias. She had an appointment for a health issue when the physician who really did not know her suggested weight loss surgery. She did so without asking any questions or even getting to know the patient.  You can find the article through this link. https://blogs.ohsu.edu/studentspeak/2019/04/26/weight-bias-in-healthcare-an-opportunity-for-action/ What I liked about her article was sharing her tips for fighting weight bias. Her personal experience is that she declines to be weighed unless it is medically necessary. When advised to lose weight she says she asks the clinician what the advice would be for the condition if this were a thin person. She finds clinicians who find value in her as a whole person and she makes her wishes known, advocating for herself.  This really resonated with me and I thought it was good advice.

Once I declined to be weighed at my physician’s office and the medical office staff told me I couldn’t refuse. She was so baffled about my refusal and then instantly became indifferent and cold to me. Never mind that the scale is in the middle of the hallway and it seems every time they called out my weight for all to hear. I would often avoid the medical community because I did not want another lecture or the whole focus of the visit to be on my weight. That can be dangerous.

Another article I read reminded me weight bias is more than just what we have mentioned already. It’s also when a clinic or hospital setting is ill equipped to care for overweight patients. They used the example of having gowns that do not fit, exam tables that are too small, equipment that is not big enough or fit right, and discriminating based on weight. This article can be found here: https://journalofethics.ama-assn.org/article/weight-bias-health-care/2010-04

One example I have of this is when I was pregnant with my son and every time, I went to the doctor my blood pressure was really high. The nurse though always used the wrong BP cuff for my size which gives false results. The doctor wanted to prescribe more medication based on this result and I declined. I did take my BP at home and have my co-workers check for me. Those readings were normal. In the end I did end up with severe high blood pressure and pre-eclampsia. I felt though my specialist treated me like my weight was the problem. He told me to lose weight if I wanted another child. Later after doing my research I was shocked to learn how many thin women have pre-eclampsia because I was made to feel it was weight related.

My own personal advice is to advocate for yourself. If you are comfortable with yourself and do not wish to lose weight, speak up. If you do wish to lose weight or change something, that is okay too. The bottom line though is to ask those questions to get the clinician past the weight bias. Being in healthcare I am aware that a lot of attention is on this subject right now. We are realizing as a healthcare team that shaming or blaming an overweight person is not helpful to their holistic care. Find a clinician or healthcare provider that helps you get to your healthcare goals no matter what they are. Advocate they use appropriate equipment.

It was so nice going to my bariatric surgeon’s office. This was one place I was told that my weight is not all of my fault and I was treated with dignity and respect, never shamed. I do realize I was asking for weight loss help, but this team truly knows how to take care of overweight patients without bias. All of the equipment and spaces were designed for overweight patients.

I hope you found this information helpful. If you feel comfortable, feel free to leave a comment about your own experience. My goal in writing this is to help people understand weight bias and not to avoid clinicians or critical check ups because of fear of blame or shame.

Even though this article is about weight bias, I still must say that you should always seek healthcare advise to find out what options are right for you. Once you feel comfortable with your clinician though, you can truly make an informed decision about your own health.

Best of wishes,

Mandy

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