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Chapter 3: Bias and Stigma in the Clinic

Screening and counseling patients on sensitive health topics is a key component of our work, but many providers find it difficult to talk about weight. Studies consistently document low rates of screening and counseling among physicians, although research indicates patients who are counseled about their weight are more likely to lose weight in the future.  

This section examines some of the barriers to counseling and offers tips and tools. Much of the information presented in this chapter is derived from materials and resources produced by the Obesity Action Council, a national non-profit organization dedicated to providing a voice to individuals affected by obesity, and Yale University's Rudd Center for Food Policy and Obesity, a non-profit research and public policy organization.

Barriers to Screening and Counseling

The literature documents several reasons for low screening and counseling rates, including:
 
  • time restraints during a busy practice
  • biases and stigma against women who are affected by excess weight
  • lack of effective treatment options and practical tools
  • low confidence or insufficient training in weight management skills and counseling
  • concern that raising the topic will be interpreted by the patient as being insensitive
 

Research on Provider Bias

Research indicates that patients who are affected by the disease of obesity frequently feel stigmatized in the healthcare setting. As a result they tend to avoid seeking medical care, and when they access care, they spend less time interacting with physicians and discussing medical concerns. They are less likely to utilize preventive health services and exams, and more likely to cancel or delay making appointments.

Weight bias and stigma is more prevalent than you may realize. Here’s what the research has to say:

Physicians are common sources of stigma. In a study that surveyed more than 2,400 adult women about their experiences of weight bias, 69 percent of respondents reported that physicians were a source of weight bias, and 52 percent reported they had been stigmatized by a doctor on multiple occasions. Doctors were the second most frequent source of bias reported, out of a list of more than 20 possible sources of weight stigma.

Nurses self-report their views that individuals affected by obesity are non-compliant, overindulgent, lazy and unsuccessful. Studies of self-reported attitudes among nurses indicate that:

  • 31 percent “would prefer not to care for individuals affected by obesity”
  • 24 percent agreed that individuals affected by obesity “repulsed them”
  • 12 percent “would prefer not to touch individuals affected by obesity”

Identify Your Own Biases

One of the most important strategies to reduce weight bias or prejudice that can unintentionally be communicated to patients is to identify your own personal assumptions and attitudes about weight.

You can begin this process by asking yourself the following questions:

  • How do I feel when I work with patients of different body sizes?
  • Do I make assumptions regarding a person’s character, intelligence, abilities, health status or behaviors based only on their weight?
  • What stereotypes do I have about persons with obesity?     
  • How do my patients affected by obesity feel when they leave my office? Do they feel confident and empowered, or otherwise?

Practice Bias-Free Treatment Approaches

To learn how to talk to your patients about weight using approaches that are sensitive, respectful, and effective, visit Yale University's "Preventing Weight Bias" toolkit.

Encourage Sensitivity Throughout Your Clinic

It is important to avoid placing blame on patients for excess weight or their difficulties in losing weight. Most patients have tried to lose weight, repeatedly. As indicated in Chapter 2, lack of success has much more to do with complex environmental, economic, mental health, genetic and cultural factors than it does with willpower or other personal factors.

Be sure that your medical staff has an accurate understanding of the complex causes and treatment options for obesity. Talk with your staff and colleagues about ways to improve the clinic experience for patients affected by obesity, including guidelines for the respectful weigh in of patients. Review the physical space in your clinic and create a more welcoming environment based on steps listed in Chapter 4.

Model Healthy Behavior

A 2011 study showed that physicians with a normal BMI were more likely to counsel patients about weight management. [2]

All healthcare professionals should consider committing to the same healthy behaviors they expect of their patients. To find out more, visit the Patient Promise

References

[1] TBD

[2] Bleich SN, Bennett WL, Gudzune KA, Cooper LA. Impact of Physician BMI on Obesity Care and Beliefs, Obesity 2012, 20 (5), p.999-1005

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