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 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?

Sorry to burst you bubble, but the other poster was correct. I know this on a personal level and I watched a TV show this summer where part of the therapy is to put the entire days food that the particular obese person they are working with would eat throughout the day and compare it to a regular real life average weight person. The amount of food was astounding, even to the obese person, who had been diluting themselves about how much they ate.

I am considering obese by the BMI scale, and I can tell you my husband would bring home a pizze and I could eat the entire thing exept for maybe one or two slices, which I would eat later when I got hungry again, oh like an hour later. I wouldn't sit and eat one slice of cake, I would have three, because it tasted soooo good. I could not only kill a bag of chips, I could kill a bag of chips with half a thing of ranch dip, then have dinner, desert and then several cups of coffee full of cream and sugar; I could eat a large big mac meal and barely feel full.

It would take more of this type of crappy food that I ate to fill me up and this food never filled me up for very long because it was nothing but quick burning carbs. I would eat all day, like 6 meals or more a day like this. I was always hungry, sometimes I ate because I was bored, or depressed and sometimes I ate when I wasn't hungry just because the food was so yummy.

You may never see this yourself because many overweight people hide their eating. I did, and often. I would eat at burger king on the way to school, then get there and get a meal from the cafeteria to take to class. I would wait til my family went to bed, then root around in the fridge to eat.

People feel very quilty about this behavior...many know it's wrong and feel horrible that they seem helpless to stop it.

Also, I can imagine that many obese people become easily offended because what you are telling them is something that they have already heard twenty times that day, from TV, to their family to some random person on the street.

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?

It is not ignorant and I do not care if it is insulting. It is not meant to be that way. And yes the morbidly obese do eat alot, if they are bags or half bags of chips or something else. you do not get to 500lbs on a 1200 calorie a day diet.

Sorry to burst you bubble, but the other poster was correct. I know this on a personal level and I watched a TV show this summer where part of the therapy is to put the entire days food that the particular obese person they are working with would eat throughout the day and compare it to a regular real life average weight person. The amount of food was astounding, even to the obese person, who had been diluting themselves about how much they ate.

I am considering obese by the BMI scale, and I can tell you my husband would bring home a pizze and I could eat the entire thing exept for maybe one or two slices, which I would eat later when I got hungry again, oh like an hour later. I wouldn't sit and eat one slice of cake, I would have three, because it tasted soooo good. I could not only kill a bag of chips, I could kill a bag of chips with half a thing of ranch dip, then have dinner, desert and then several cups of coffee full of cream and sugar; I could eat a large big mac meal and barely feel full.

It would take more of this type of crappy food that I ate to fill me up and this food never filled me up for very long because it was nothing but quick burning carbs. I would eat all day, like 6 meals or more a day like this. I was always hungry, sometimes I ate because I was bored, or depressed and sometimes I ate when I wasn't hungry just because the food was so yummy.

You may never see this yourself because many overweight people hide their eating. I did, and often. I would eat at burger king on the way to school, then get there and get a meal from the cafeteria to take to class. I would wait til my family went to bed, then root around in the fridge to eat.

People feel very quilty about this behavior...many know it's wrong and feel horrible that they seem helpless to stop it.

Also, I can imagine that many obese people become easily offended because what you are telling them is something that they have already heard twenty times that day, from TV, to their family to some random person on the street.

Thank you for your post.

Specializes in Hospice / Ambulatory Clinic.

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?

sorry to burst you bubble, but the other poster was correct. i know this on a personal level and i watched a tv show this summer where part of the therapy is to put the entire days food that the particular obese person they are working with would eat throughout the day and compare it to a regular real life average weight person. the amount of food was astounding, even to the obese person, who had been diluting themselves about how much they ate.

exactly my point. information gotten from a tv show. so accurate :no: . a friend of my is a reality tv show producer with her own production company. trust me nothing she produces is remote real. it just involves real people. reality tv is not a reliable source.

it doesn't take a large calorie deficit. if you took in a surplus of 350 calories each day for 1000 days (about 3 years or so) you would be 100lbs overweight. i will restate i have never eaten an entire pizza or bag of chips and i would think most overweight people don't but hey this just illustrates that people do think overweight people sit around eating chips while rolling around on the floor eating hoho's

It doesn't take a large calorie deficit. If you took in a surplus of 350 calories each day for 1000 days (about 3 years or so) you would be 100lbs overweight. I will restate I have never eaten an ENTIRE pizza or bag of chips and I would think most overweight people don't But hey this just illustrates that people DO think overweight people sit around eating chips while rolling around on the floor eating hoho's

I believe you mean calorie excess, not deficit. And yes, I understand that TV is not a reliable source, which is why I backed up what was said with personal experience. Heck, even scientific research studies performed by Ph.d's are not always reliable sources.

What you explain is another example of what can lead to a persons weight gain, certainly, and overeating the way the other poster mentioned is also another way. We can also include steroids and other meds, hypothyroidism, cushings, etc.

Let's not forget the basic rules of metabolism. If you eat 350 extra calories a day for so many days, as you say, yes you will gain weight but as time goes on and you gain more weight, you must eat calories in addition to that 350 a day simply to maintain your current body weight.

And no, a person doesn't have to roll around on the floor in a pile of hoho's in order to gain weight, they can in fact be very active, work all day, go to the gym, etc and still gain weight (or maintained their excess weight) if they are ingesting a bad diet or have other issues as I mentioned above. And by bad diet I do not necessarily mean an excess of calories. Weight loss and gain is 80% diet and 20% excercise. No one can out train a bad diet.

We can all agree that no one can say exactly what causes weight gain or exactly the best way to loose weight, but we can agree that what we are trying currently is certainly not working.

And also as far as judgement of overweight people is concerned, I doubt that will ever end. It is human nature, sucky as it is, and til the end of time people will judge other people, either by the clothes they wear, the food they eat, the way they look, who they are seen with or whatever other silly reason they can come up with. Course I do not mean everyone does this...wait, yes I do! Face it, you are lying to yourself if you say you have never caught yourself judging someone for something. Sometimes I catch myself doing it and sometimes I don't. When I do, I think to myself, "well that was crappy, I'm sure as heck not perfect myself".

Specializes in Oncology/hematology.

Exactly my point. Information gotten from a TV show. So accurate :no: . A friend of my is a reality TV show producer with her own production company. Trust me nothing she produces is remote real. It just involves real people. Reality TV is not a reliable source.

It doesn't take a large calorie deficit. If you took in a surplus of 350 calories each day for 1000 days (about 3 years or so) you would be 100lbs overweight. I will restate I have never eaten an ENTIRE pizza or bag of chips and I would think most overweight people don't But hey this just illustrates that people DO think overweight people sit around eating chips while rolling around on the floor eating hoho's

The poster was also giving their personal experiences, so I would think he/she knows that these are true.

I've eaten an entire large pizza by myself and I weigh 135 pounds, so it absolutely can be done. I have watched my morbidly obese relatives eat a HUGE dinner and then eat an entire pie.

Specializes in ICU.

Weight needs to be addressed by a physician. I think that the physician wouldn't be doing their job if they didn't speak of modifying risk factors that affect health. of course there is a tactful way to do this, but it needs to be addressed.

My dad's wife has a niece who is 8 now I believe.... she is morbidly obese. She has been quite heavy most of her child hood. Has asthma. According to her mother, the pediatrician never said anything about the child's weight. So she was assuming in her world of denial there was nothing wrong. That pediatrician should have explained how reduction in weight can improve the asthma symptoms. Not to mention how she is at risk for diabetes amongst other things.

Doctors are too worried about "insulting" people these days. Well, it's more like saving lives to me, if done the right way.

I don't think that nurses are predjudiced against obese people as a whole. Yes, there are people no matter what occupation they ahve that are, but I think nurses problems lie in the fact they it is stressful when they have to physically care for such overweight people. I have hurt myself before on obese patients in the ICU before. And yes, call me what you will but the thought has ran through my head that if they took better care of themselves and lost some weight, BOTH of us wouldn't be in this position. (and yes, the obese people I have said this about had modifiable means to their obesity. It had nothing to do with thyroid disorders or what not. It had to do with an unhealthy diet and no exercise)

Mperhaps some education to the MD's on how to approach the subject of obesity and weight loss to their patients would be helpful.

Specializes in Emergency, ICU.

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?

I think you need to educate yourself more. Food is absolutely an addiction whether you eats lots of it or the wrong kinds of it. Obesity is not normal. Stop defending it as it only hurts people suffering from unhealthy habits more.

I would never say it is easy to loose weight. I personally have been trying to loose 40 lbs for 3 years and the truth is that I am not yet obese and I have not reached the point where I'm willing to stop using food as comfort and escape. I'm getting there as I see how terrible I look all the time. I look tired, my clothes don't fit and I'm not willing to buy size 14.

So, I'm getting there. But I am definitely addicted to carbs -- and I know because when I've attempted to stop using carbs, I withdraw. I'm a nurse, I can recognize the symptoms of malaise, headache, intense cravings, talking myself out of not eating processed foods (oh, it's just a few chips with this healthy homemade salsa...), yet in the end, I go back and actually feel worse. Grains make me bloated, my bowel movements change, my skin reacts with rashes, mucous production increases in my body, but hey, I fed the monkey.

Food addiction is real.

Modern humans are all addicted to some type of food not meant for our body to process in some way or another. No matter how much you weigh.

For now I'm starting slow by sticking to whole foods. Basically if I can't envision humans eating it or growing it thousands of years ago, I don't ingest it. And I'm weaning off grains to not crash and burn.

Sent from my iPhone using allnurses.com

Specializes in Emergency, ICU.

Sorry to burst you bubble, but the other poster was correct. I know this on a personal level and I watched a TV show this summer where part of the therapy is to put the entire days food that the particular obese person they are working with would eat throughout the day and compare it to a regular real life average weight person. The amount of food was astounding, even to the obese person, who had been diluting themselves about how much they ate.

I am considering obese by the BMI scale, and I can tell you my husband would bring home a pizze and I could eat the entire thing exept for maybe one or two slices, which I would eat later when I got hungry again, oh like an hour later. I wouldn't sit and eat one slice of cake, I would have three, because it tasted soooo good. I could not only kill a bag of chips, I could kill a bag of chips with half a thing of ranch dip, then have dinner, desert and then several cups of coffee full of cream and sugar; I could eat a large big mac meal and barely feel full.

It would take more of this type of crappy food that I ate to fill me up and this food never filled me up for very long because it was nothing but quick burning carbs. I would eat all day, like 6 meals or more a day like this. I was always hungry, sometimes I ate because I was bored, or depressed and sometimes I ate when I wasn't hungry just because the food was so yummy.

You may never see this yourself because many overweight people hide their eating. I did, and often. I would eat at burger king on the way to school, then get there and get a meal from the cafeteria to take to class. I would wait til my family went to bed, then root around in the fridge to eat.

People feel very quilty about this behavior...many know it's wrong and feel horrible that they seem helpless to stop it.

Also, I can imagine that many obese people become easily offended because what you are telling them is something that they have already heard twenty times that day, from TV, to their family to some random person on the street.

Thank you for sharing this.

Sent from my iPhone using allnurses.com

Specializes in OB.

What I am seeing on this thread is something that is very common in my experience with health care providers and exactly the kind of prejudice that affects their healthcare: someone tells you what the eat, their level of activity, their experience with various diets and the immediate reactions is "Yeah, right....". The assumption is always that they are lying, that they couldn't possibly be doing all that and still be overweight.

I've given up discussing this with providers as it is of no help to me to be told "You must not really...be doing as you say" rather than having someone accept it as the truth and help me explore other options. It's really counterproductive as it causes overweight individuals to avoid healthcare rather than deal with the comments we all have heard and know are being said about us as well.

Specializes in Hospice / Ambulatory Clinic.
I think you need to educate yourself more. Food is absolutely an addiction whether you eats lots of it or the wrong kinds of it. Obesity is not normal. Stop defending it as it only hurts people suffering from unhealthy habits more.

Oh get real. Stating that many/most obese are addicted to food like a crack addict is to crack is ok but defending that personal experience plus what you see on tv is not absolute fact is "hurtful" and I need "education"

Food addiction is not in the DSM IV but cocaine addiction is 304.20

There's many pathways to being obese but to say many people are x and many people are y without reliable data to back it up is incorrect. Observation is the least reliable scientific method.

It sounds like you have an intolerance to carbs not an addiction. I have a significant background in nutrition because thats what I was studying to be before I switched to being a nurse. The basic fundamental is you need to met people where they are at and not making sweeping assumptions and judgements which is the entire point of this thread.

And yes I accidently switched my verbs around on the excess/deficit but missed the edit deadline.

Specializes in Hospice / Ambulatory Clinic.
What I am seeing on this thread is something that is very common in my experience with health care providers and exactly the kind of prejudice that affects their healthcare: someone tells you what the eat, their level of activity, their experience with various diets and the immediate reactions is "Yeah, right....". The assumption is always that they are lying, that they couldn't possibly be doing all that and still be overweight.

Fat discrimination is the one last politically acceptable forms of discrimination left. If you substituted obese out for black, white, blonde or blue there would be an uproar. But use a disease label like obesity and its ok.

And its not. Regardless of what you see on TV. Regardless of your personal experiences. It's just wrong and to think otherwise is a big FAT lie.