Understanding Obesity: Impacts of Weight Bias and Discrimination

By Amy Webb, Psychology Intern at Horizon’s Stan Cassidy Centre for Rehabilitation

“In our society, we look at obesity as a character or behavioural flaw.” – Mary Forhan, PhD

Obesity is an oversimplified and stigmatized topic. We live in a society obsessed with weight. In North America, people spend billions of dollars staying slim and losing weight. Unfortunately, what comes along with this obsession is incredibly pervasive weight bias, stigma and discrimination.

Weight bias: Our personal attitudes toward weight
Weight stigma: Ingrained societal stereotypes about weight
Weight-based discrimination: Acting on weight bias and stigma to treat people who are overweight or have obesity unfairly
Internalized weight bias: People who are overweight or have obesity agreeing with the negative stereotypes about their bodies

Weight bias is often considered the last openly acceptable form of bias and discrimination in society. It refers to a wide range of discriminatory and harmful attitudes (e.g., “lazy,” “unmotivated,” “did this to themselves”) and it comes from the public, media, family, friends, and health care workers.

Unfortunately, research shows that health care workers are some of the worst perpetrators of weight-based stigma. Of course, health care workers care about their patients and strive to provide quality care. However, like the rest of society, health care workers are not immune to societal attitudes toward weight and obesity. In fact, 64 per cent of adults with obesity report having experienced weight bias from a health care worker.

In health care, weight stigma can look like blaming serious health issues on weight, therefore ignoring other possible causes, or perpetuating simplistic messages, like obesity is caused by “eating too much, moving too little.”

Research has demonstrated that some health care workers view people with obesity as lacking self-control, being less compliant, less hygienic, less successful, unfit for marriage, messy, and unhealthy based on their weight. Health care workers tend to overestimate the extent to which a person can control their weight, choosing to attribute weight to a lack of discipline.

The consequences of weight bias and discrimination are harmful. In health care, weight bias negatively affects patient engagement because it adds perceived barriers to health care. These perceived barriers include patients expecting differential treatment, having low trust and poor communication with their health care provider, avoiding or delaying accessing health services, and participating in ‘doctor shopping’. It can also cause patients to receive a lower quality of care and a less patient-centred approach to care.

Weight bias can also be significantly damaging to mental and physical health. It can cause increasing rates of obesity, depression, anxiety, self-esteem issues and eating disorders. Weight bias also contributes to decreases in quality of life, and in the amount, enjoyment and motivation for physical activity.

It’s Time to Change How We Think About Obesity

Since October 2015, the Canadian Medical Association has recognized obesity as a chronic disease. It is defined as “a complex, progressive, and relapsing chronic disease characterized by abnormal and/or excessive body fat that impairs health.”

Many people believe that obesity can be controlled by “eating less and moving more,” but it is not that simple. More than 300 genetic, physiological, psychological, social, and environmental factors contribute to obesity, and many are beyond an individual’s control. Research tells us that around 70 per cent of the risk of struggling with obesity in our lifetime is genetic!

For an excellent summary about the inherited factors of obesity, the systems at work in the brain, and treatments for this medical condition, visit MacklinMethod.com.

How Can We Reduce Weight Bias and Discrimination?

1. Address obesity as a chronic disease. This is one of the strongest tools to reduce and eliminate weight bias and discrimination.
2. Lead with empathy and understanding. Understand that it is a complex disease that people don’t choose to have. Understand that simplistic interventions and approaches like eating less or moving more are not enough or effective.
3. Check-in with our own weight bias and avoid assumptions. Self-reflection is essential to help us understand what biases and beliefs we might have.
4. Watch the wording and messages we use. Ask their language preference (e.g., obesity, fat, plus size) and use person-first language (e.g., a person living with obesity or person with obesity). Weight is not a behaviour, nor is it a proxy for health. Differentiate between people diagnosed with obesity and people with higher body weights who do not have obesity.
5. Advocate. Call attention to inappropriate blaming or shaming jokes, comments, or conversations. Speak out when spaces, places, or people are discriminating. Include the patient’s voice, use patient-centred care, and support policy action.
6. Create supportive health care environments. These must be thought of before the patient arrives. Avoid displaying magazines or other images that advertise the thin ideal, talk about weight loss, or promote ways to lose weight. Show regular people engaging in healthy behaviours that are not stigmatizing. Make sure that structures, tools, and fixtures are appropriate and comfortable (e.g., ensuring there are large enough gowns, blood pressure cuffs, waiting room chairs and examination tables, and that weight scales are kept in a private area and the number isn’t involuntarily shared). Leaving the room to find a larger blood pressure cuff, for example, only further perpetuates weight bias.

If it is your professional role to talk about weight and obesity with patients:

1. Ask for permission to discuss weight
2. Use the Canadian Adult Obesity Clinical Practice Guidelines