Prejudice Against Overweight Patients: An Issue To Ponder

Nicole, a 26-year-old mother of two, has visited her primary care physician due to a migraine headache. As he signs her prescriptions, her primary care physician says, "Life would probably be a little easier if you didn't weigh 279 pounds." The intended purpose of this article is to further explore the issue of weight discrimination in healthcare settings. Nurses Announcements Archive Article

Weight discrimination is the treatment of someone in an unfair manner due to the person's size. Even though extremely thin individuals are occasionally treated poorly due to their size, overweight and obese people are the most frequent targets. Weight discrimination occurs in families, hiring practices, schools, places of business, the media, and healthcare settings.

Yes, I said it. I have opened the can of worms. Many healthcare professionals harbor prejudices against overweight patients. Some of these biased people are remarkable in their abilities to keep their negative feelings in the closet, while others are more vocal about their animus toward people who have excess body fat.

Some physicians are notorious for their unfavorable attitudes toward overweight patients. In 2003, researchers at the University of Pennsylvania surveyed more than 600 primary care doctors and found that more than half viewed obese patients as awkward, unattractive and noncompliant (Ulene, 2010). Furthermore, a Yale study of 2,449 overweight and obese women, published in 2006 in the journal Obesity, found that they identified doctors as one of the top sources of negative comments about their weight (Rabin, 2008).

A number of nurses are appalled by overweight patients, too. A 2006 review of research focusing on nurses' attitudes toward adult overweight and obese patients reported that nurses consistently express biased attitudes toward obese patients, reflecting common weight-based stereotypes that obese patients are lazy, lacking in self-control, and noncompliant (Puhl & Heuer, 2009).

How does weight discrimination affect patients in the healthcare setting? Well, the effects can be rather detrimental because overweight patients may avoid seeking care due to the fear of being shamed or ridiculed. Several obese patients said in interviews that they went to see a doctor only when it was unavoidable and often left feeling that they hadn't gotten the help they needed (Rabin, 2008).

Are there any solutions to the issue of prejudiced attitudes against overweight patients? First, the healthcare provider must acknowledge that they have a bias. After all, a person cannot expect to solve a problem if he/she has not yet identified one. Secondly, the healthcare professional needs to practice the interpersonal skill of being nonjudgmental. Finally, the Golden Rule is applicable when interacting with patients: treat people in the same manner that you would want to be treated.

Weight discrimination is a significant issue in healthcare settings and in society as a whole. Together we can strive for equal treatment of our overweight patient populations. Although attitudes do not change overnight, the small changes that we make can snowball into profoundly positive results.

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How can we expect overweight/obese people to loose weight? Most can get the excercise thing figured out, but as everone can agree diet is 80% of the problem. Ph.d's, scientists/researchers, physicists, M.D's and any other professional involed CANNOT agree on what diet is best for us to loose weight AND maintain a healthy weight. But they all agree that it is not simple at all, it is in fact so complex that we can reach the moon, yet we have not been able to get this figured out.

Society critisizes overweight people, then gives them conflicting and often incorrect advice and they try and try and try with no success, or loose weight only to gain it back and what do we do? We tell them they are fat, lazy slobs and we cut out their stomachs...perfectly healthy organs cut out in order to try to force their bodies to accept a food lifestyle that perhaps people we not ment to maintain (aka carbs and high fructose corn syrup in nearly all the food we eat). Bariatric surgery is becoming, if it is not yet, the NUMBER ONE performed surgery in the U.S.

Why are they tired all the time? Hmm, could it be that their cells are becoming insulin resistant (aka pre-diabetic due to the overdose of daily carbs that cause huge spikes and drops of insulin), so their bodies tell them they are hungry and so they eat, but the insulin is not able to get the energy/food into their cells so it turns it to fat instead...their cells still have not gotten the energy they require so it tells them to eat MORE. They are STARVING at a cellular level. Then we tell them to eat less when they are already STARVING. We tell them they need to eat less and work out more, hence the less calories in more calories out theory, but they have only a limited supply of carbs in their liver and muscles, so they will yet again end up STARVING. This is because the body requires fuel to work and if it is not getting enough carbs because we are restricting them and we store a limited supply; basically what we are attempting to do is to get our bodies to burn FAT yet our metabolism is set to burn CARBS, so if it even burns fat it does not do it well, obviously, we don't need a scientist to tell us this, we see it for ourselves everyday. And then we wonder why we are busting our butts in the gym and starving ourselves yet we are not loosing weight?!

Think on this....our body requires essential fats and essential proteins but we DO NOT require any essential carbs. Then why are carbs our main food/energy source? Plus carbs give us short term energy and fat gives us long term energy. Think about long distance runners, they are fat burning machines, that is why they are so darn skinny! Don't say they carb load, because our bodies can only hold around 100g of glucose in our liver and around 300 in our muslces. Also sled dogs, they are omnivores just like us, yet they can run all day on fish, meat and fats. Also, forget the nonsense that the brain MUST have carbs, the brain works perfectly fine on ketones as does the rest of our body, and our muslces can store fat for energy just as well as they can store glucose. And let's not forget the nonsense about ketosis, it is NOT ketoacidosis, which is an entirely diffent metabolic problem.

The obesity epidemic starting in the 1980's when a researcher (using only the data collected that backed up his claim, not ALL the data that showed his claim was not true across the board but in fact had a lot more factors involved than simply fat intake; this is a huge problem in research studies, they have to be taken with a grain of salt) claimed that fat and cholesterol where the cause of cardiac and health issues. The media took it and went wild with it and everyone changed the way they ate. What did we replace the fats with? Carbs, lots and lots of carbs and high fructose corn syrup (the generic replacement of sugar cane). I saw a presentation where an M.D (who is pro high fat, low carb diets and has successfully treated his clients who are diabetic, overweigt, etc.) showed data collected on the obesity rate in the U.S starting in the 1980's. It showed only a handful of states that had a >10% obesity rate, and low and behold we replaced fats in our diets with carbs and it showed the rates from then til somewhere in the 2000's and we are now at around half the states being >30% obese, and no state being under >10%. Yet "they" say it's FATS that are making us fat, hmmm.

And before you argue that people are getting more fats in their diets, that's a load of bologne, just read labels. I do it all the time trying to find "healthy" stuff to eat (found that's a waste of time, because if it comes in a package, it's not going to be healthy...if it's low sugar they add more salt and sugar substitutes, if it's low salt they add more fat. I can by canned corn that has no added salt, or I can buy it with no added sugar, but I can't buy it without both). Carbs are in everything and I don't just mean a little, I'm talking 15 to 45 grams or more in a serving! And fat is usually minimal, surprisingly, reese's cups for example has twice as many carbs as fat per serving. Look at a big mac meal at mcdonald's...it's 56% carbs, then 35 % fat (unhealthy fats at that) and a minimal amount of protein at 9%. But everyone clings to the idea of the fat issue, not looking at all the additional carbs that a person gets throughout the day with donuts, cereals, icecream, sandwhiches, bread with dinner, etc.

The Primal diet (many different versions, and it's not Atkins) is something I am have been researching lately. I am overweight and have tried so many different diets and none work. I can go to the gym for hours and kill myself til I can barely walk the next day because I enjoy working out. I have lost 20lbs here and there but it never sticks. But I refuse to give up. If the advice I am getting is not working and is not adding up then it's time to switch it up. I had always heard bad things about the Primal diet (not a high protein diet but a high fat, mod protein, low carb diet) until I started looking into it myself. It is hard to wade through all the false information, but I have looked up research studies, listened to M.D's, Ph.d's, etc who are pro on this diet and if I consider Occan's Razor, because it makes SENSE to me, then it just might be the right answer. Primal is eating all natural, non-processed or pre-packaged foods, so basically lean meats, healthy fats (avacado, coconut, EVOO, nuts), fresh vegetables and fruits, no added carbs (can get around 100 or so a day and still stay in ketosis). So you still get plenty of fiber, pleny of nutrients. I have started my own garden, bought chickens for meat and eggs, collect the berries the surround my house and bought a blueberry bush. Next year I plan to add even more with an indoor micro greens garden (it's hard to grow lettuce type stuff outside), enlarge my garden, etc; I would love to get a goat for milk and cheese! For the winter I plan to freeze and jar some fruits and veggies. It is saving me a lot of money at the store, because fruits, meats and veggies are expensive (not to forget the pesticides, and my issue with getting food that looks ripe yet doesn't taste like it!), yet I can get a lifetime supply of high fructose corn syrup and carb stuffed products for a fraction of the cost, and we wonder why poor people struggle with obesity and health problems. So this diet also appeals to me in the way that I have always believed that clean, natural foods are healthy, and it gets me back to nature and animals by tending my own garden and farm, which is excercise in itself for mind and body!

FYI, I had always thought Dr. Atkins had "died from his diet" as we all heard in the media, but in fact slipped on a patch of ice and hit his head and later died from brain hemorrhage complications. His medical report listed that he had a "history of heart disease and HTN", which he did...he had a HISTORY of these conditions, which is why had started the Atkins diet. The physician treating him at his death said he was in excellent condition, no clogged arteries, etc were found on his autopsy. Crazy what we hear and believe til we find out for ourselves, huh?

Specializes in Critical Care; Cardiac; Professional Development.

Atkins works beautifully when done correctly. Sadly few actually read the book, which stresses HEAVILY the importance of vegetables and fruits. Most people just start eating bacon and steak, don't eat any vegetables at all, don't bring fruit back in after the initial two week period the way they are supposed to....and then get sick and say Atkins is a failure.

I lost all my weight on Atkins. I have kept it off 10 years now. Atkins is basically a whole foods diet. You go extreme to kickstart and then gradually reintroduce the body to whole foods. And nobody should be eating much bacon on it. At all. :p

Specializes in Trauma.

Obese people are like smokers, if they are over 20 then they have already been told about all of the bad effects and what they have to look forward to later in life. Any health care practitioner would be stupid to sit down with a 40 yr old obese patient or smoker and think anything they say will make a difference. Typically it takes a major event in life for someone to make a change as drastic as losing a lot of weight or stop smoking.

Obese people are like smokers, if they are over 20 then they have already been told about all of the bad effects and what they have to look forward to later in life. Any health care practitioner would be stupid to sit down with a 40 yr old obese patient or smoker and think anything they say will make a difference. Typically it takes a major event in life for someone to make a change as drastic as losing a lot of weight or stop smoking.

Really? Telling someone about the bad effects doesn't teach them.how to change it. How many 20 year olds know how to play kickball. Compare that number to how many know the difference between a protein and a carbohydrate...what a polyunsaturated fat is... What muscle groups are supposed to be worked together. If we continue to provide the people in our country with irrelevant education, we have no choice but to expect poor results.

What I had been led to believe was the Atkins diet was completely opposite of what I have found by researching it myself. The more I find on it the more it is similar to Paleo. Congrats on your weight loss and maintaining it, that's awesome!

I have the occasional two slices of turkey bacon with breakfast or on a salad, but try to keep it limited, because it's still a processed food.

I started on the Paleo transition period last week and have lost ten pounds already! I know that is just water weight so far, but I feel great, still have plenty of energy for working out and running around with my little ones. I really hope this works, it just HAS TO!! I've researched it down to the studs (still have a few questions I am looking into) and it makes SENSE on so many levels. I have tried so many different things in the past, I loose 20lbs here and there but it never stays off long. I am tired of never finding any clothes I like to wear; I usually end up very depressed and in tears when I go shopping. Sure I can get some cut clothes at the shops that cater to those who are overweight, if I want to spend $40 on a top! I am so tired of being tired all the time! My huny has introduced me to lifting weights and I love it (real weight lifting, not 5lb little weights for 100 reps; I benched 135 last week :) and have moved up in weight so that for certain excercises I need straps so I can hold the weight, this is because the muscle I am working can move much more weight than my hands are capable of gripping, such as back or leg muscles), unlike my cardio which I have to push myself to do and I am constantly trying different routines (like HIIT, crossfit, etc) to keep it exciting. I can see the muscles, feel them, and I notice a big difference in my body, but the fat is covering up all the definition! I can be working out and feel great, but then I look in the mirror and see my fat covering up all my hard work and it's very disheartening.

All my life I have wanted a garden and a farm. So far I only have a few chickens and a little garden, but it's a start. I love going out and checking on my garden and feeding my chickens; I love to watch them scratch around then stick their little fluffy butts sticking up in the air while they peck, very relaxing just to sit and watch them.

But back to the OP's topic, weight loss is a very complex thing involving many, many factors. It simply cannot be addressed in a 5 min visit with your M.D, who probably knows the minimum on diet and weight loss; even many nurses are not very educated on diet and excercise, all the different types and varieties, so you can find what best fits the patient.

I saw a documentary the other day about the prejudice involved with overweight people. They discussed how obesity was the last socially accepted prejudice, and that people often felt not only OK with saying mean things to overweight people, but in fact felt that they SHOULD say these things, because the overweight people were fat, lazy and ignorant and need to be told that they need to change...horrible. If it was soooo easy to loose weight, if it was all soooo simple, do you think so many people would be consenting to have their bodies cut open and health organs cut away so that they can spend the rest of their lives eating much from a 30ml medicine cup? And even then, that does not always work, look at Ricki Lake, and many others who's bariatric surgery has failed them.

Could it be....could it just possibly be, that the food we are trying to force our bodies to metabolize healthily is not the food we were ment to eat? Carb products (flour, high fructose corn syrup, grains, breads) are nothing but cheap fillers that give us short term energy, don't fill us up and leaves us hungry and tired 2 hours later, lead to insulin resistance, lead to fat storage and so on and so on.

Specializes in Trauma.
Really? Telling someone about the bad effects doesn't teach them.how to change it. How many 20 year olds know how to play kickball. Compare that number to how many know the difference between a protein and a carbohydrate...what a polyunsaturated fat is... What muscle groups are supposed to be worked together. If we continue to provide the people in our country with irrelevant education, we have no choice but to expect poor results.

Do you really think a 20 year old does not already know being overweight is bad for them? Has not already been advised to lose weight? Has not had someone in the health care profession tell them to substitute fruit and veggies for high fat foods like Big Macs and fries, and drink more water and less soft drinks?

One major problem I see is society is hurting young girls by trying to boost their self esteem. They tell them they "beautiful just like they are." That is a good thing to teach children, but don't overlook the health problems they face later in life if they don't get their weight under control.

Why are we so quick to condemn smokers and take up for the overweight?

Because losing weight is not as easy as not drinking soda and not eating high fat foods. As I said before in my first post, if it were that easy, it wouldn't he such a problem.

Specializes in Oncology.

I treat overweight patients the same as non-overweight patients. I do urge them to lose weight for their health. And I do admit I get mad when they refuse to help with transfers, expect you to do all ADLS for them, turn them, lift them, or get mad when you tell them you have to wait to get help lifting/turning them (I'm very small and can't kill my back lifting these people) but I don't treat them poorly. Just get annoyed at the back strain or if they refuse to help and are just "dead weight"

I am not overweight but have struggled with issues with weight in my past. I understand it's a sensitive topic. If I am in with a cut and the doctor says "well you need to lose/gain weight" I'd see why there would be offense taken.

I had a patient once complain of back pain all the time. She was non-mobile due to it. She was also chairbound because of her extreme weight. I offered her some advice on posturee, she told me she could not do that because of the pain and the roundness of her large, obese abdomen. I offered her some dietary advice that might help her lose some abdominal girth and help with the posture and the pain, she wasn't mad and I don't feel I was disrespectful.

No one chooses to be fat. Some people do eat to deal with mental/emotional issues. Others have other health problems that cause the obesity. Others, still, just don't want to exercise and eat poorly. Doesn't make them bad people.

We need to confront the obesity problem, but while remembering that patients have feelings. Should I sugarcoat the truth? No, obesity will cause you pain, joint problems, heart problems, etc., etc., and the list goes on. Should you lose weight if you're overweight? Yes. Do you need to feel bad about it? No, just take positive steps to help yourself, that's all I ask. Oh. and that you don't choose to go in your depend instead of get up or asking for assistance, than refuse to help turn yourself while I'm moaning in pain turning you. Just my $.02.

Specializes in ICU.

A rose is a rose is a rose. Called by any other name, it is still a rose. Obese patients are obese. Call it whatever you want, obesity is an epidemic nationwide. And yes, no matter how justified people may try to make their case sound, it is NOT healthy. Obesity is linked to a MULTITUDE of health problems. I think, however, that the stigma attached to obese patients is the classic example of an MI patient post cabg asking his wife to sneak in pizza and hamburgers (personally seen this happen in my CVICU). Obesity (like smoking) has many negative consequences. And most often, as in most cases in life, those who yell about it the loudest are those who need to lose weight.

And yes, I like many americans, tend to judge a book by it's cover. If you work in my CVICU, and you're 120# overweight, and you go into a patients room to lecture them post cabg on the benefits of losing weight, I and the patient both are going to pretty much ignore you. Prejudice has no place in healthcare as a provider. But we have gotten to the place in america that people can't handle pure simple honesty...

Specializes in Hospice / Ambulatory Clinic.
So there's nothing to be said for "preventative health?"

Yes it's not a license to be rude. Weight and poor health are always tied together. You can be fit and fat and skinny and unhealthy.

Specializes in Trauma.
Because losing weight is not as easy as not drinking soda and not eating high fat foods. As I said before in my first post, if it were that easy, it wouldn't he such a problem.

Yes it does take more than just that. Prevention is much easier than correction. It has to start as children. Stop filling their bottle or sippy cup with Coke. Cook them vegetables instead of a Happy Meal. Give them a dang apple or banana rather than a handful of cookies.

Growing up I think my family went through salt faster than a gallon of milk. When we sat down to eat the first thing everyone did was reach for the salt shaker, before taking a bite. I weened myself off of salt while in the military. Today I use my salt shaker about as often as I do my oregano. I only drink water with dinner, have a Mt. Dew about 3 times month, don't eat anyplace with a drive-thru window, and buy a pack of cookies a month. At the end of 1 year I lost 25 lbs. and I was not even trying to lose weight. That was 3 years ago and my weight has stayed the same.

Specializes in LTC and School Health.

You are so right. Preach!