Prejudice Against Overweight Patients: An Issue To Ponder

[TheCommuter]

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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[wooh, BSN, RN]

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.

Ahhh yes. Because anorexia and bulimia are MUCH healthier than obesity.

And why is it only fat young girls we're worried about? Shouldn't we be shaming young boys as well?

[Esme12, ASN, BSN, RN]

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.

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

I agree 100% ....most are great but those few who are insensitive are growing.

[jadelpn, LPN, EMT-B]

This is an interesting debate. I am one of the ones who was literally 115 pounds soaking wet (

Then had my last child at age 37, couldn't figure out how to lose the baby weight. (Never been an issue before). Then whatever I put in my mouth went straight to my waistline. I needed education--I had not a clue in the world what I needed to be eating nor about portion control. All foriegn concepts. I got a lot of "wowwww you used to be sooooo skinny". I will never be 115 pounds again (by the grace of God) nor do I think I should be. However, being overweight is not about being lazy or unmotivated. It is often because one is so used to one way of eating or exercising, that when our bodies change--be it stress, hormones, lack of sleep--a lot of us are at a loss. And I have to add that most people's concepts of weight are way off base. It is NOT healthy or realistic for most people to be 115 pounds and be 5 foot 7. But there are many, many outlets that tell you that this is perfectly acceptable. I would rather have a patient who has a realistic view of healthy weight, then a patient who is so caught up in a diet roller coaster that they are constantly ill. And it is up to us as nurses, doctors, along with many other referrals to make it possible for a patient to feel better without the ridicule and stereotyping.

[HM-8404, BSN, RN]

Ahhh yes. Because anorexia and bulimia are MUCH healthier than obesity.

And why is it only fat young girls we're worried about? Shouldn't we be shaming young boys as well?

I didn't mention anorexia, bulimia, race, or age, etc because obesity is the topic of the thread. I chose to use girls because they are typically the ones that have the most social problems, as adolescents and teens, if they are overweight.

Your last sentence points out the problem with obesity and health care workers. (Shouldn't we be "shaming" young boys as well?) You equate educating someone with shaming them. My point was there needs to be a balance when addressing young people.

Why is it that "tough love" is not always considered a bad thing when dealing with an addict but would usually be considered a terrible thing to do to someone that is obese? They are both killing themselves by their life choices. I have heard many overweight people talk about foods being like a drug, it is a craving, it is comforting, but afterward they feel guilty and shameful. This is the same way I hear addicts describe their addiction.

[malamud69, BSN, RN]

Wow so many ideas to ponder. Her are some of mine. The BMI is outdated and unrealistic...it does not take into account body size, shape,ethnicity,athletics etc...Its like relating the american household to leave it to beaver!!! ( I am of sound square Russian stock)If I was supposed to be the "correct" weight for my height I would be like some little skinny high school kid...give me a break! That would have really helped me all those years doing construction..or now- moving patients as a CNA...but alas the BMI and my overweight doc say so...so I must be "too" overweight approaching obesity...funny how I can and do go to the gym 5-7x a week and can out sweat my doc and most of my "skinny" co-workers that eat nothing but sugar and mcdonalds 3x a day! Now... I do not judge anybody by there weight. I have had that issue my whole life..borderline body dimorphism if you will...but...I am a new nursing student and I still have a hard time taking advice from extremely overweight nurses that are constantly downing mcdonalds and mountain dews and smoking trying to tell me about good health! Health(for the most part sans genetics) is a choice and until this country starts with prevention we are going to have a long road of "sick" care ahead of us.

[brandy1017, ASN, RN]

So there's nothing to be said for "preventative

health?"

The truth is once you gain the weight your body metabolism changes and you are screwed! It is next to impossible to get back to a normal weight unless you are on extreme makeover, professionally starved and exercised to death or get gastric bypass surgery. Other than that forget it! If you somehow miraculously are able to lose weight you will most likely regain it!

As far as your life would be better if you didn't weigh 270 or whatever. No kidding! Of course life would be better, you would look good and be treated a hell of a lot better by most people and of course you could buy tons of great clothes, etc.

What is ridiculous is all the hype over the few diet pills available and most people lose only a few pounds maybe 10% if their lucky. Stupid articles telling you how 10% will really improve your health and life! Are they for real! Give me break!

[tothepointeLVN, LVN]

As far as your life would be better if you didn't weigh 270 or whatever. No kidding! Of course life would be better, you would look good and be treated a hell of a lot better by most people and of course you could buy tons of great clothes, etc.

I call BS on that in a BIG way. I STILL look good thank you very much. I get treated wonderfully by most people and I can still buy a bunch of great clothes. It's only a few jerks who think my life would be better that think that.

I used to work in the fashion industry before nursing. All the stuff we feed you about looking good is to make you buy crap you don't need. Clothes are sold on hangers so they need to look good on a hanger so runway models need to be shaped like hangers. It's really that simple.

[wooh, BSN, RN]

(Shouldn't we be "shaming" young boys as well?) You equate educating someone with shaming them.

No, I equate telling someone that they're only beautiful if they're skinny as shaming them. Teen girls already equate beauty with unrealistic photoshopped models. Telling someone they're only beautiful if they lose weight is COUNTERPRODUCTIVE. If you think a lack of self esteem helps healthy weight loss in any way, then you're sadly mistaken. The only time it helps is if it drives someone to an eating disorder.

[HM-8404, BSN, RN]

The truth is once you gain the weight your body metabolism changes and you are screwed! It is next to impossible to get back to a normal weight unless you are on extreme makeover, professionally starved and exercised to death or get gastric bypass surgery. Other than that forget it! If you somehow miraculously are able to lose weight you will most likely regain it!

This is incorrect. Metabolism does not change as one gains weight. It often does as we age. Just like yo-yo dieting does not cause someone to weigh more than they did at the beginning. The main way to lose weight is to burn more than 500 calories than taken in on a daily basis. Weight loss is like everything else in our society, we want it and we want it now. Someone that is 120lbs overweight that loses 4-5 lbs in a month is not happy and will get frustrated. They don't stop to consider that at that rate they will lose 48-60 lbs in a year. Instead they jump on some crazy fad diet and feel like crap after a week or two. Long term studies have been done with the Atkins diet. One group was on Atkins the other met with a Nutritionist and ate a sensible diet. At first the Atkins group dropped weight much faster. After 18 months both groups weighed the same. After 24 months the non-Atkins people weighed less. This is because most people cheated on the Atkins diet. Most people cannot completely adhere to a diet that removes so much everyday items from a persons diet.

[HM-8404, BSN, RN]

No, I equate telling someone that they're only beautiful if they're skinny as shaming them. Teen girls already equate beauty with unrealistic photoshopped models. Telling someone they're only beautiful if they lose weight is COUNTERPRODUCTIVE. If you think a lack of self esteem helps healthy weight loss in any way, then you're sadly mistaken. The only time it helps is if it drives someone to an eating disorder.

I would bet you are an English Lit major. You read stuff in that is not actually there.

I really like how you left out the very next sentence of what I posted too.

[wooh, BSN, RN]

No, I just think through the results of putting really bad ideas into practice.

But thankfully, you're not king of the world, so it's doubtful you'll be able to affect too many people with your simplistic ideas on metabolism and child psychology.

[tothepointeLVN, LVN]

You know when it comes down to it the problem is many people don't know the difference between patient education and advocacy and being rude. Being rude is something most of us myself included are very good it. Education and advocacy that gets the message through and helps not so much.