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.

work-cited.txt

Specializes in Forensic Psych.
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.

Is it really my responsibility to keep my mouth shut if it's assumed that someone has "heard it before?" I have a good diabetic friend who took terrible care of his disease for years - I'm pretty sure he was told to watch his diet and monitor his blood sugar at EVERY physician's visit.

I understand the difference between a bias against overweight PEOPLE and simple concern for a patient, and I'm not at all ok with rudeness, but I don't see why obesity should be treated unlike any other glaring health issue.

Yes, it's more complicated than eating right and exercising. I'm taking health problems out of the equation because your physician should already be aware of that aspect, but people have self control issues. They have emotional eating issues. They face poverty. They simply don't understand HOW to eat healthily. They don't have a support system. They have a busy schedule that doesn't lend itself to cooking and exercising. We're all intelligent people, we all know this stuff.

But aren't we supposed to be problem solvers? Plan makers? Encouragers? We can't solve problems if we keep our mouths shut because we don't want to offend anyone. Once again, there are OBVIOUSLY ways to phrase things that are inappropriate, and levels of badgering that are counterproductive. I just don't agree that it's in the job description to shrug and say "whatever."

Specializes in Forensic Psych.

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.

This argument has been done to death. We all know someone's grandmother smoked until she died in her sleep at 105 years old.

We all know someone's aunt had a glandular problem that caused her to be obese but she still ran marathons and never had a health problem in her life.

The point of preventative health is pinpointing issues that are likely to be a problem in the future. Obesity is likely to be a problem if not controlled. Smoking is likely to be a problem if not abandoned. Thus, grandma and aunt have nothing to do with anything.

Preventative health care is the future. The only way we're going to be able to cut costs is to "make sure" people aren't getting sick to begin with. Should be interesting, to say the least.

Edit: I just want to temper this by saying I'm being a bit dismissive because I don't think those examples have much bearing on the point, not because I don't see them as valid. Personally, I have adrenal insufficiency. It kept me quite thin (and quite sick) for a long time, but my regime of twice daily steroids has filled out my waistline and then some. It was depressing and I struggled a lot, but they best thing a doctor did for me was sit down with me for 30 minutes. He explained the science of the Atkins diet to me, walked through a list of supplements that would speed up my metabolism and lower my fat absorption, and gave me some really awesome tips on how to beat the fat. I want to be like him when I grow up

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). QUOTE]

Well of course they sneak food in. It is a big pet peeve of mine that people fail to see how unhealthy and unappetizing food is that is presented in the hospital environment. It tastes like cardboard, looks like it's been siting around for days and it is presented in an environment that is not easy to eat in. On top of this, during a time of stress is not the best time at all to get someone to change their habits aka their diet. They will of course seek comfort food in a scary and unfamiliar environment. It takes a lifetime to start these bad eating habits, they are not going to be changed with just ten minutes of pt education, giving them only food they don't want to eat and/or limited food choices and shaming them when they make the wrong choices...the rule of thumb is that it takes 6 months to make a habit and 6 months to break it.

If they can take on good eating and excercising habits and maintain them without cheating for a full 6 months, the chances are they will not revert back to their old habits without something major interferring (death in the family, etc.).

And as someone else on here says, just eat vegetable, just eat a banana, etc. It's just so easy to say "just go do this and this", when there is so much more to it than that. Many people first of all struggle with the food costs that come with eating healthy whole foods and meats, it is very expensive and food stamps only go so far. Many do not know how to stretch that money. Many are given bad advice every where they turn and give up frustrated. Many do not know how to prepare and cook veggies in a way that still makes them tasty. A big, big problem is their home environment. They may have made the decision to change, but they may be surrounded by friends and family who will do their absolute best to make it as difficult as possible, because they themselves refuse to change. How often do we see and obese person, and his/her family is also obese? Oh, basically all the time.

Saw a show about a man trying to loose weight because he was severely obese and had many health problems. He lived with his mom and her family was around a lot. They were all fat, and when he would bring in something healthy to eat, his mom and aunt would bring in mcdonald's and eat it in front of him, all the time making fun of his food and telling them how delicious the big mac was as they stuffed it in their faces. At every turn they fought to bring him down, his own family, the people who should be behind him 100%, yet family is usually the first to try and trip you up. How many of your pt's may be in this same situation?

Specializes in Trauma, ER, ICU, CCU, PACU, GI, Cardiology, OR.

needless to say, the overweight issue affects so many of us, not only our patients but the medical staff as well. on the other hand, i agree to some point regarding preventive medicine, which is part of the answer unless you happen to have a medical condition plus a family history of obesity, which then it is easy said than done. having said that, when i use to be a staff nurse every time a obese pt. came along they would give me that assignment just because i'm a male, and most of the time the pt. themselves would tell me that they were aware of those nurses that didn't want to take care of them because of their dead weight of 312pds. and they also said to me "gitano i'm sorry that you have to put up with me" at this level, we are facing a battle across the nation regarding obesity and the fast food industry with their "biggie size or super size me" motto is not helping the situation, we need to bring awareness to this phenomenon. however, we as a society tend to be so political correct these days in order not to offend anyone or in fear to be sued, that we tend to pass the bucket....just saying :cool:

Specializes in Trauma.
This argument has been done to death. We all know someone's grandmother smoked until she died in her sleep at 105 years old.

We all know someone's aunt had a glandular problem that caused her to be obese but she still ran marathons and never had a health problem in her life.

The point of preventative health is pinpointing issues that are likely to be a problem in the future. Obesity is likely to be a problem if not controlled. Smoking is likely to be a problem if not abandoned. Thus, grandma and aunt have nothing to do with anything.

Preventative health care is the future. The only way we're going to be able to cut costs is to "make sure" people aren't getting sick to begin with. Should be interesting, to say the least.

I totally agree, but it is impossible to "make sure" people don't get sick in the first place. I am in my late 40's and have heard about how bad smoking is for you all of my life, but guess what, people start smoking everyday. I don't care how good of a nurse someone is most of the time you cannot save people from themselves. While I was a pre-nursing student I heard MANY of my pre-nursing classmates talk about how they are going to change the world. For some reason they think being a nurse will give them special powers when dealing with a pt. They think a pt will take what a nurse tells them, adhere to it religiously, and live to be 110. s

It's one thing to address someone's weight and another to treat them disrespectfully or disparagingly becasue of their weight is another.

while there are insensitive jerks from all walks of life, i still question how many are being rude vs assertive?

from my experience, obesity is a taboo subject in our society...

and more often than not, there isn't any one correct way in sharing one's concerns.

what i perceive as appropriate, another person will hear it as cruel.

i have a hunch that many obese people are extremely sensitized to what they fear they'll be told, and defenses build accordingly. :twocents:

Now I'm not excusing the patient from personal responsibility. But it seems ridiculous to me that people can participate in all kinds of voluntary self-ordered care (like drug rehab and psychological services) but can't get their PCP to refer them to a nutritionist or get their health insurance to pay 30 bucks a week to see a personal trainer.

interesting...

in that pcps won't make referrals to the appropriate specialists.

on my husband's side of the family, obesity is problematic and a few members have been very proactive in trying to lose weight.

ea had their own dr and ea dr referred them to nutritionists/dietitians, as well as sev'l other resources.

personally i've never met a dr who wouldn't make referrals and am shocked to hear of your experiences.

i too, am frustrated with the pervasive discouragement from talking about obesity.

obesity has risen to crisis proportions in this country and yet there always seems to be some type of excuse/reason as to why we shouldn't approach *that* subject.

i find it esp disappointing amongst healthcare professionals.

that said, i def agree that treaters shouldn't remind one of their obesity every time there's an office visit.

but if the cc is (partly) r/t obesity, then talking about it is applicable.

i would consider it negligent if a treater DIDN'T share his/her concerns. (yes, it's that serious an issue.)

i'm very sorry for anyone that has experienced harsh and cruel degradation...i truly am.

but i don't believe this is the majority of drs/treaters.

of course all discussions are futile, if the addicted person isn't ready to change, for whatever reason.

and it is crucial that families support their loved one, with all making sacrifices deemed necessary for success.

as they say, it takes a village...

and do believe there is a lot of support out there for if/when one is ready.

until then, let's treat ea other with due consideration and sensitivity, today and always.

gonna go eat my (seedless) watermelon. :)

leslie

Specializes in Forensic Psych.

Now I'm not excusing the patient from personal responsibility. But it seems ridiculous to me that people can participate in all kinds of voluntary self-ordered care (like drug rehab and psychological services) but can't get their PCP to refer them to a nutritionist or get their health insurance to pay 30 bucks a week to see a personal trainer.

There are MANY chiropractors, physical therapists occupational therapists nutritionists etc that provide services that can improve the lives and health of the obese. Until our healthcare systems are willing to better accommodate these physical and theory based medical services I wouldn't anticipate that we can see a decline in weight related health issues.

This is very, very true, but I wouldn't be surprised if we see this change in the near future. Eventually insurance companies are going to realize that a nutritionist and a personal trainer are FAR less expensive than $2000 worth of medications per month, countless specialist visits/tests, and weight loss surgery.

Of course, I'm sure they'd much rather just exclude overweight people from their policies to begin with...

To be totally honest, I do have a certain amount of prejudice regarding morbidlly obese patients. When I have one I know that it really will increase my workload for the day; from having to use the hoyer lift, to washing the patient, changing incontinece briefs, even just a simple dressing change can be more difficult, not to mention the co-morbidities. It can be really tough on a healthcare worker's body.

Specializes in Pedi.

The issue I have with this is providers' inability to think outside the box... if you don't fall within the magic narrow range of your "ideal body weight", then you automatically have a problem. I developed a severe eating disorder when I was 18 and lost 1/3 of my body weight in 5 months. It was the only time in my life where I was of "ideal body weight" and it was the most unhealthy I have ever been. I have no doubt that I would be long dead by now if I kept that up yet on paper, I was a "healthy" weight. Today, I am happy and healthy yet technically "overweight" and I don't react all that well when my doctor goes on auto pilot and says stuff like "try to lose weight because of your BMI". The first time she said something like that I realized why I am a nurse and not a doctor... because nurses see the patient as a person with a history rather than just a number.

Specializes in nursing education.

One of my dearest, most wonderful, most generous friends is morbidly obese (two-plane-tickets obese). I love her so much, and it is so hard to watch her struggle with pain; it is difficult for her to breathe. She struggles with finding health care because she feels that every doctor will tell her that all her problems are because she is fat. It is a vicious cycle. Difficult to exercise, because of pain and fatigue; depressing as heck; the job discrimination; wearing a CPAP; her life is just HARD.

Yet, I am a health professional; I know what excess weight does to a person. We have had clinic patients who have DIED because of being that obese. Abdominal fat creates insulin resistance...and on and on...

It seems so simple. But it is so complicated.

Specializes in Hospice / Ambulatory Clinic.

I think it has been pointed out that often times the interaction is that the fact that you are obese is mentioned and blamed for xyz problem but no solution so it often feels like a judgement.

90% of my weight gain has been from medications. My provider at the time pointed out that I had gained weight since starting the medication, denied the fact that it was med related and told me to eat "salads" (yes but what KIND of salad ;) )

I think that is we didn't say YOU are obese and instead said you suffer from obesity the message might come across better. When you "are" obese it becomes hard to separate the pathology from the person.

Specializes in Forensic Psych.

I totally agree, but it is impossible to "make sure" people don't get sick in the first place. I am in my late 40's and have heard about how bad smoking is for you all of my life, but guess what, people start smoking everyday. I don't care how good of a nurse someone is most of the time you cannot save people from themselves. While I was a pre-nursing student I heard MANY of my pre-nursing classmates talk about how they are going to change the world. For some reason they think being a nurse will give them special powers when dealing with a pt. They think a pt will take what a nurse tells them, adhere to it religiously, and live to be 110. s

Well of course newbies are idealistic! It's in our job description! I wouldn't be so quick to roll your eyes at the useful enthusiasm...it serves an important purpose in the field :)

When school districts in our fair state started hiring freezes and handing out pink slips, older, more experienced teachers were the only ones finding work (much like nursing at the moment). One of the surprising outcomes of that was people started noticing something was missing: the fresh energy, the idealism, the excitement for new and innovative ideas and methods, all brought to you by brand new, know-nothing new grads.

Anyway, yes, you're right. We cannot actually force anyone to not get sick. If anyone actually does believe that, it'll be a lesson hard learned. Newbie naivety aside, I altruistically hold myself and people I care about to a very high standard. It's just who I am. Fortunately for the world at large, I do believe you can tell the difference between someone who actually cares and wants to help and a bully.