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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I've spoken about this issue too many times to count now, but in short, stop judging fat people. Stop judging gay people. Stop judging people with tattoos. Stop judging people with red hair. Stop judging people who watch Dancing with the stars. Stop judging Muslims. Stop judging people of different races. Stop judging teen mothers.

Just stop judging people, and treat them like someone you love.

Why is this hard?

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.

The amount of misinformation being spoken on here is disheartening, especially coming from the people who's responsibility it is to educate pt's on health and weight loss.

A person gains weight because they are eating more and moving less but also because they are overeating carbs, this leads to huge spikes and drops in insulin which over time leads to insulin sensitivity. This means our cells cannot get the energy they require no matter how much insulin they produce, so since the insulin cannot put the carbs into a cell they store it as fat. The cells still never recieve the energy they asked for so they ask for more, so you are always hungry.

No matter how much you excercise, if you are a carb burning person, and you will limit the calories you eat with the less calories in more calories out theory you are starving your body even more. You are telling your body to burn fat yet you are a carb burning person. THIS IS WHY you burn very little fat if any even if you are busting your butt in the gym. You are telling your body to perform KETOSIS yet you have not transitioned into ketosis (takes about 14 days). THIS IS WHY the general advice the majority of people get for weight loss never works! You can't expect someone to try and lose weight over a period of a year and be STARVING the entire time, how in the world could that ever possibly work?

Your quoting of an Atkins research study is rediculous, you have to back up what you say. Who did this study, has it been re-created, how did they prove they cheated on the diet and with what, has anyone refuted it successfully and so on. That is why we have so much misinformation passed around and everyone is confused and no one gets better. When you read a study it takes ALOT of time to look into it, you have to take all studies with a grain of salt, as in they are usually bogus and self serving.

And to which Atkins do you refer, the original or the new? The original had a few flaws, including allowing too many bad fats in addition to good ones and the original did not allow for calories, they allowed you to eat as much as possible.

And many people can't stick to fad diets because of the very nature of fad diets and human nature. Even the definition of the word "diet" has gotten so confused. When you go on a diet it should be a lifelong change. So you need to find a diet you can stick with for the rest of your life, and what works best for you.

I think that one of the problems with judgement and becoming rude when a pt does not seem to adhere to our advice is that we caught up in thinking that everyone has to be like us and think like us and that our advice is gold. We can simply present our ideas (well researched, thought out, adjusted to a particular person, backed up with facts and so on) to someone and leave it up to them to accept them. "There is nothing so powerful as an idea who's time has come" -Victor Hugo. If a person is not ready to accept this new idea, they will NEVER accept it. Just think of the other posts you have seen on AN where a nurse can give their family advice, they know their stuff, can even show them a medical dictionary but they just REFUSE to see what you are trying to show them? I had a friend who swore that blood was blue before it came out of the body and when it hit the air it would become red, some conclusion she came to from taking a biology class or something, and we went back and forth and I could explain down to the molecule what was going on and show her textbook evidence but she absolutely refused to believe me.

So basically don't get upset when they don't listen to you, even if you know what you are telling them is good info (and many people give out horrible info and think it's gold but they are still passionate about it)...if it's good info and correct info, they will hear it over and over and one day, BAM! they just might get it.

The first person to say the world was round (some dispute as to who this really was) was called a total quack, despite the evidence he presented. It was a thought of the few against the masses (just like the whole fats are bad for you thing) and the masses won despite their ignorance, considering that we know the earth is round as a fact today.

Specializes in Trauma.
The amount of misinformation being spoken on here is disheartening, especially coming from the people who's responsibility it is to educate pt's on health and weight loss.

A person gains weight because they are eating more and moving less but also because they are overeating carbs, this leads to huge spikes and drops in insulin which over time leads to insulin sensitivity. This means our cells cannot get the energy they require no matter how much insulin they produce, so since the insulin cannot put the carbs into a cell they store it as fat. The cells still never recieve the energy they asked for so they ask for more, so you are always hungry.

No matter how much you excercise, if you are a carb burning person, and you will limit the calories you eat with the less calories in more calories out theory you are starving your body even more. You are telling your body to burn fat yet you are a carb burning person. THIS IS WHY you burn very little fat if any even if you are busting your butt in the gym. You are telling your body to perform KETOSIS yet you have not transitioned into ketosis (takes about 14 days). THIS IS WHY the general advice the majority of people get for weight loss never works! You can't expect someone to try and lose weight over a period of a year and be STARVING the entire time, how in the world could that ever possibly work?

Your quoting of an Atkins research study is rediculous, you have to back up what you say. Who did this study, has it been re-created, how did they prove they cheated on the diet and with what, has anyone refuted it successfully and so on. That is why we have so much misinformation passed around and everyone is confused and no one gets better. When you read a study it takes ALOT of time to look into it, you have to take all studies with a grain of salt, as in they are usually bogus and self serving.

And to which Atkins do you refer, the original or the new? The original had a few flaws, including allowing too many bad fats in addition to good ones and the original did not allow for calories, they allowed you to eat as much as possible.

And many people can't stick to fad diets because of the very nature of fad diets and human nature. Even the definition of the word "diet" has gotten so confused. When you go on a diet it should be a lifelong change. So you need to find a diet you can stick with for the rest of your life, and what works best for you.

You are correct, you must take what you read with a grain of salt. Including claims made by someone that is trying to sell you a book based on a research paper the author read.

I cannot recall the name of the study. We discussed it in my nutrition class where my professor holds a PhD in Nutritional Science. I think she may be slightly more informed than some random person on an internet website. I was able to locate a couple of reputable websites that address the Adkins diet.

What Is the Atkins Diet? Expert Review of This Diet Plan

The Atkins Paradox: What Diet Studies Don't Reveal | LiveScience

I would have a doubt about any diet that suggested I remove all fruits and vegetables from my diet and replace them with bacon and pork chops.

I have a really good friend that swears by the Atkins diet. He dropped a lot of weight fast. The diet has to work for some or it would never have become popular. I just don't see it as a viable option for most people.

Specializes in Hospice / Ambulatory Clinic.

I have a really good friend that swears by the Atkins diet. He dropped a lot of weight fast. The diet has to work for some or it would never have become popular. I just don't see it as a viable option for most people.

It's not viable because of our food environment. Eating out and buying prepared food on Atkins is difficult and lets face it many of us may not have been overweight if we liked to cook. We just aren't as skilled at getting a lot of fat / carbs /salt into a dish as commercial chefs.

It's not viable because of our food environment. Eating out and buying prepared food on Atkins is difficult and lets face it many of us may not have been overweight if we liked to cook. We just aren't as skilled at getting a lot of fat / carbs /salt into a dish as commercial chefs.

I hear you on this, we are usually so busy and rarely have time to prepare meals or even sit down with our family to eat. The sitting down with our family is as vital for the health of our family as is preparing meals.

When we prepare meals we take control of our lives and skip all the hype and processed foods. I thought homemaking foods would take so much of my time but I was totally wrong! It takes no more time than preparing a meal from a box and is much more satisfying. So the time issue has just become a big excuse. And stopping at a drive thru and eating on the run...well that can be easily skipped with a lunch box, what is hard is to skip with the excuses.

I prepare all my meals now, breakfast, lunch and dinner. They all include lean meats, healthy fats, veggies and sometimes fruit. All my meat is frozen, I pick what I will eat the next day and stick in the fridge the night before so it can be pulled from the fridge and defrosted quick. Toss my meat on the stove, while it's cooking I chop up a few veggies and toss them in the pan when the meat is just about cooked, toss a lid on top and viola! Dinner ready in like 20 minutes.

It's fun to experiment with adding flavors like garlic cloves, rosemary, paprika, etc. I am even growing some herbs in my kitchen window.

School is the hard part. I am often gone all day and have a long commute. So I pack around a big lunch box on my rollie backpack. I get plenty of looks, let me tell ya, as people scarf on their vending machine lunches, eat the horrible cafeteria food or take off in groups to spend hard earned money to eat out. I learned the hard way that glass tupperware makes food taste so much better! My lunch is often leftovers, nuts, tuna with veggies, a piece of fruit, etc. I take as much food as I think I will need so that I will not get stuck with nothing and a growling stomach then have to resort to vending machine crap.

i fully believe the word "diet" is detrimental to the goal of losing weight.

any permanent weight loss, has to be the result of a lifestyle change.

this is why family/friends are crucial in becoming triumphant.

for those who are able to do so, get that referral from your dr, to consult with dietitian.

find out exactly what your insurance will cover.

find support groups with folks trying to achieve like goals.

eliminate the no-brainers in promoting wt loss, i.e., candy/cakes/chips/etc.

find/create inspiration in your daily life, as there are many blessings around us - we just need to be cognizant of them.

i am not trying to sound simplistic, as i am very aware of the complexities involved in changing one's lifestyle.

it is a major and permanent commitment.

but my main point is, one's mindset/attitude can be instrumental in feeling positive and hopeful.

do not try and change if you are doing so for the wrong reasons, e.g., "because i should".

it needs to happen "because i want to"...and not a day before.

there IS lots of support around us all...

we just need to ask.:)

leslie

You are correct, you must take what you read with a grain of salt. Including claims made by someone that is trying to sell you a book based on a research paper the author read.

I cannot recall the name of the study. We discussed it in my nutrition class where my professor holds a PhD in Nutritional Science. I think she may be slightly more informed than some random person on an internet website. I was able to locate a couple of reputable websites that address the Adkins diet.

What Is the Atkins Diet? Expert Review of This Diet Plan

The Atkins Paradox: What Diet Studies Don't Reveal | LiveScience

I would have a doubt about any diet that suggested I remove all fruits and vegetables from my diet and replace them with bacon and pork chops.

I have a really good friend that swears by the Atkins diet. He dropped a lot of weight fast. The diet has to work for some or it would never have become popular. I just don't see it as a viable option for most people.

We have to always keep in mind that no matter the level of education of the person delivering the info that person may still have personal opinions that cloud the information they share, which they often are completely unaware of. There are M.D's, Ph.d's, research scientists of all types who for over a hundred years have been unable to agree on diets and weight loss.

I have not looked much at Atkins but it is similar to Paleo. I don't see many reasons (never forget the many factors each individual person brings to the table) why a person would be unable to maintain this diet long term. There are many different types of Paleo, as I've found, but the one that is a high fat, mod protein, low carb one seems ideal. Plenty of lean meats, healthy fats, veggies and some fruit. No processed food, keep it all natural and made from scratch as possible, still get plenty of nutrients, will need to add calcium and vit D due to no diary (lots of issues behind cows milk as well, goats milk would be good as does not cause the problems that can come from cows milk like lactose intolerance). And let's not forget that cows milk is pastuerized which destroys many of the nutrients, so the calcium and vit d are added back in, that's not very natural. No legumes or grains...I've looked into that a little bit and it's amazing the links to inflammation, immune issues, GI issues and allergies that come with these products and there is plenty of science behind it.

The 14 day transition is only a challenge as you are not actually hungry as with other diets but you still have to fight those cravings for carbs. Then once you get going, I have heard that your cravings for the food you grew up with diminish over time and loose their appeal as you replace them with new comfort foods.

I've spoken about this issue too many times to count now, but in short, stop judging fat people. Stop judging gay people. Stop judging people with tattoos. Stop judging people with red hair. Stop judging people who watch Dancing with the stars. Stop judging Muslims. Stop judging people of different races. Stop judging teen mothers.

Just stop judging people, and treat them like someone you love.

Why is this hard?

:bow:

Overweight people are seen as unattractive ( in the eye of the beholder and maybe they are) by many in society and I do not think we can control who were are attracted to ., overweight people are seen as noncomplient, for the most part that is true with regards to diet and exercise. I have seen many 450lbs pts and no one anywhere wants to address the huge elephant in the room. seriously. i find that they tend to become more defensive then even some of the drug addicts when any mention of their eating habits is discusssed. GUess what if you are that big and need to be boosted up in bed, turned repo- we are gonna need more people whether that upsets you or not. I would also like to add I have been fat and thin. The thin part is NOT easy, IT IS a struggle and I do not always enjoy hours at the gym or not eating what I want for days on end and resented those implications. The fat part had much or everything to do with non compliance to healthy living.

I sometimes think, many obese people are addicted to food. addicted like an alcoholic or crack addicts. etc. I think because of that and the feelings of loss of self control that come with an addiction some people get defensive/angry when it is mentioned. just like in that CAGE acronym. how else can we explain the eating a whole bag of chips that don't taste that great, eating a whole pizza, etc. Not every obese/overweight person is addicted to food, i am not saying that, but I think some are. just like one can be addicted to anything.

Specializes in Hospice / Ambulatory Clinic.
I sometimes think, many obese people are addicted to food. addicted like an alcoholic or crack addicts. etc. I think because of that and the feelings of loss of self control that come with an addiction some people get defensive/angry when it is mentioned. just like in that CAGE acronym. how else can we explain the eating a whole bag of chips that don't taste that great, eating a whole pizza, etc. Not every obese/overweight person is addicted to food, i am not saying that, but I think some are. just like one can be addicted to anything.

I think you need to stop thinking because what is coming out of your head is ignorant and insulting.

Most obese people DO NOT eat entire bags of chips or whole pizzas. Are you kidding me? Where do you get your information from? TV?