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.
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.Last edit by Joe V on Jun 24, '12
About TheCommuter, BSN, RN Moderator
TheCommuter is a moderator of allnurses.com and has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a registered nurse.
TheCommuter has '11' year(s) of experience and specializes in 'Case mgmt., rehab, (CRRN), LTC & psych'. From 'Fort Worth, Texas, USA'; 36 Years Old; Joined Feb '05; Posts: 38,035; Likes: 69,187.Jun 21, '12Issues, Issues. Now a doctor telling a patient it would be good for her to loose weight is discriminating against that person. OR is he addressing an issue in addition to the issue the patient presented for. I read somewhere that a lot of obese patients say they have NEVER had their weight addressed by a physician or nurse. If medical professionals don't address this issue who will?Jun 21, '12It's one thing to address someone's weight and another to treat them disrespectfully or disparagingly becasue of their weight is another.Jun 21, '12It really is a catch 22. For many obese patients, to mention weight at all, even therapeutically, brings on such guilt, shame and defensiveness that the healthcare worker cannot win. It is percieved as negative almost no matter what. But to ignore it is to not do our jobs. I'd like to believe there is a "right" way to talk about it, but obesity is such a fragile topic that it seems impossible. Damned if you do, damned if you don't.Jun 21, '12There is a way to approach us. It's called "respect". Why do so many healthcare providers seem to think that just because we're fat, we don't have ears to hear with, or feelings that are pretty sensitive given the crap we put up with every day? It's not like we don't KNOW we're fat.....after all, we do live in these imperfect bodies. But a doctor will get a lot farther with me if s/he broaches the topic of obesity withOUT the sledgehammer....in fact, I may even listen if I don't feel judged. =)Jun 21, '12Quote from not.done.yetI've had my weight addressed by the family practice PA I used to go to, the NP that replaced her, and my GYN. I think they all did a great job.It really is a catch 22. For many obese patients, to mention weight at all, even therapeutically, brings on such guilt, shame and defensiveness that the healthcare worker cannot win. It is percieved as negative almost no matter what. But to ignore it is to not do our jobs. I'd like to believe there is a "right" way to talk about it, but obesity is such a fragile topic that it seems impossible. Damned if you do, damned if you don't.
I always hear at AN from people that say nurses have to be role models. The PA and NP are both women that have struggled with their weight and are still struggling with getting it down. Probably both would still qualify as BMI obese, but were smaller than they'd been in the past and know what it's like. They were able to empathize with the struggle while still giving me good advice. The PA even used her struggle as a warning, she pointed out the crepitus that I'm starting to get in my knees, and she'd recently had to get knee surgery. The NP made the very good point that weight loss won't happen until I'm ready to make it happen. She shared what had worked for her, and what's worked for other patients. Although I feel that my GYN addressed the subject in a very nonjudgmental manner, gave me some good advice, the fact that she's never "been there" and only has experience with maintaining a healthy weight or losing the occasional 5-10 pounds, it didn't have the effect on me that someone who really knows what a struggle it is to lose a significant amount of weight had in being able to say, "I know it's hard. But when you reach the point where it becomes important enough TO YOU to address it, what information and support can I provide?"
I've got a couple of problems that would probably be significantly better without the weight. My NP has said, "You know that losing weight will make a difference, but until then, here's what we can do." There's no blowing off my concerns just because I "brought them on myself."
It is a sensitive subject. (And this isn't aimed at you ndy, but a general rant about some of the things said in our regular fat nurse threads.) But I think fat people being over-sensitive is an excuse some people use to just be rude about it. "Well even if I said it in a non-judgmental way, she'd still be offended." I think some healthcare workers think that maybe fat people don't realize they're fat. Or that it's a problem. We do. There's no reason to say, "Well you realize your overweight." We still need healthcare though until we can make those changes. Until we get to a point psychologically where we can make the changes needed.Jun 21, '12I have lost over 100 lbs myself, so I definitely understand the struggle with obesity. My BMI is still not ideal and probably never will be because BMI is a crap tool. But that's a whole different topic.
I have had both types to be honest. Those who appreciate the gentle handed approach and respond well to it and those who no matter how gently approached act as if you just slapped them.Jun 21, '12Quote from rita359But the advice to lose weight has no direct relation on the problem they went to see the doctor for. If the doctor said losing weight would help x condition or prevent y condition then that would be fineIssues, Issues. Now a doctor telling a patient it would be good for her to loose weight is discriminating against that person. OR is he addressing an issue in addition to the issue the patient presented for. I read somewhere that a lot of obese patients say they have NEVER had their weight addressed by a physician or nurse. If medical professionals don't address this issue who will?
But simply saying losing weight would make "life" easier is not. Life as in people liking you as in finding clothes. What? Non specific and non helpful. Btw 279lb was my exact weight this morning and my "life" is fine. My health is good and all that other good stuff.
And the "for the good of their health" is not a good reason to discriminate. People usually pay in some form or another for the Dr so it's a service its not a invitation to run their lives.Jun 21, '12I have struggled with obesity and have lost a significant amount of weight. It is good for doctors to speak about weight but not to dwell on it. Like another poster said, we know we are fat and know the risks. I had one gyn who brought up my weight EVERY single time I went there. It seemed to be her solution to all my problems even though some of my problems I had when I was a more normal weight. Needless to say I do not go there anymore.Jun 21, '12In nursing school, an instructor told me to include a psych eval in my care plan for an obese patient because, "nobody gets that fat without mental problems." The patient weighed less than me.
Yes. Prejudice against overweight patients exists in the nursing profession. I wonder if this would help.Jun 21, '12in 20 years people will being saying why didnt we do more to stop obesity . People dont realize in 20 years 50 percent of tghe population wil be obese , not overweight.... obese , im making it my own personal responsibly now to not be apart of that stat