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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[beast master RN]

in 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

[Stephalump]

But 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 fine

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.

So there's nothing to be said for "preventative health?"

[wooh, BSN, RN]

I think it it comes up in the context of overall wellness, good. "How are things in general? Energy? Sleep? How have you been eating? Getting any exercise? Stress?"

When it's the ONLY piece of wellness information offered, or it comes in the context of: Patient: "I have a headache." Provider: "You should lose weight." Not good.

Especially since I think all of the other wellness things have a huge impact on weight. If you aren't sleeping well, your raising your stress hormones which increases weight, and you're going to look to food to supply the energy you lack from lack of sleep. If you're under stress, stress hormones.

If you're lacking energy, you can't exercise. Now part of the lack of energy may be from a lack of exercise. But I had a while that I could not get through a workout. Finally realized that I was really anemic. If my healthcare provider just told me to exercise, it would have been just another frustration. I was trying to workout. I couldn't do things that I could do just a few months prior. It took one of my coworkers pointing out to me how pale I was for it to finally click that I'd been eating ice and having restless legs like crazy. All signs of iron deficient anemia. Once I took a couple weeks off from trying to workout, focused on my diet and getting more iron, I was actually able to workout. If I'd kept up just trying to workout, exhausting myself even more, I wouldn't have accomplished much, because as little as I could do wasn't giving much in the way of results. I got that taken care of and now that I can work out, I don't dread it as the most frustrating time of day. Which means I stick with it.

"Just lose weight" isn't helpful. Looking at creating an overall wellness plan that will help someone lose weight is.

[Double-Helix, BSN, RN]

Phrasing is everything. You can address a weight issue without saying, "You're fat." Addressing the reasons for the increased weight is different and more effective then just addressing the weight itself.

It's the difference between:

Patient: "My back has been hurting me."

Doctor: "I think you would feel better if you exercised and didn't weigh so much."

And:

Patient: "My back has been hurting me."

Doctor: "Lets talk about your daily routine and exercise habits. Maybe we can identify a few lifestyle changes that might help with this pain."

In the first example, the doctor is making the patient's weight the issue. It comes across are more judgmental, because it doesn't really offer any practical help for the problem. It also doesn't involve the patient in the discussion, but is simply the doctor giving their opinion.

In the second example, the doctor involves the patient in the discussion and makes the focus about lifestyle factors that an be adjusted in order to help with the problem and make the patient healthier overall. It's much less likely to come across as judgmental and biased.

I think this philosophy of phrasing can be applied to many situations when discussing weight, such as when discussing health with teenagers. Many teenage girls feel an obligation to be skinny, like the magazine models and are afraid of gaining weight. When our educational sessions with these girls, focusing on weight, BMI and obesity can further reinforce the idea that gaining weight is bad and they need to be skinny. If we focused on the lifestyle choices that result in better health (balanced diet, regular exercise) instead of on the weight, I think our teaching could be more effective.

[Thujone]

overweight patients do tend to be non-compliant with some physician orders. if they complied with an order like "exercise 5 days a week and eat this diet" then they would most likely lose weight. however, i do think that most people, whether they are overweight or not do comply with taking medications. most people in america view overweight and obese people as unattractive, not just in the health care setting, the cause of this is out of the hands of us healthcare workers, and more up to the zeitgeist of the time which, in today's time, is highly influenced by the media. the awkwardness of someone is totally subjective. many people say that physicians are some of the most socially awkward people out there, so what right do they have judging that trait in others? in the end though, it is common courtesy to not say offensive things like that. you can think it all you want, but when you speak it out loud, you run risk of not only offending someone, but also lowering their self-esteem which may cause some people to eat excessively and put on even more weight!

[2BRN123]

Exercising 5 days a week and changing your diet are not enough. The patient needs to be educated.

If nutrition and human exercise physiology were such simple concepts to understand and execute, then obesity wouldn't be the problem that it is. If they were things that people could just read a pamphlet about and simply integrate into their lives, then personal trainers wouldn't need licenses to practice and colleges wouldn't offer bachelors and masters degrees in the topics to prepare people to do the job.

The reality is:

Many people who struggle with weight, do work hard and do not experience results. I see this every day where I work. Months and months on end coming into the gym to put in the work and experience marginal or non existent results.

Anecdotally and in my personal experience, those who experience significant and meaningful results are those that see personal trainers, nutritionists and physical therapists. Not to say that obseity cannot be challenged without professional help, because it can, but long term results typically aren't anticipated without some kind of guidance.

The problem herein lies, while health professionals may be able to identify that a person has issues with weight, there is little they can do about it aside from alert the patient to the fact and give them basic counseling. In my experience many health insurance companies, despite the recommendation or order of a Dr, get combative when a patient tries to control their weight with methods that the health insurance company would have to contribute to, regardless of the fact that it may help control the patients other healthcare costs.

The burdon of one of our most basic but most difficult to manage health care practices has been placed solely on the patient both financially and in access to care.

The exercise routines of MANY individuals, not just overweight people are hopelessly flawed. Incorrect form, in conjunction with incorrect diet execution or ideas is a hindrance to millions of people who are trying to change their lives.

Honestly, there is little that a PCP can do to legitimately counsel a patient as to how they can experience significant weight loss, without the participation of other entities to help get the job done.

[Multicollinearity, BSN, RN]

Overweight patients need to be addressed with respect, and healthcare providers DO need to be aware of their prejudices and bias. That said, I fear we are getting to a point of overly-politically correct enabling approaches where the issue will not be able to be addressed with overweight patients without "bias!" and "over-weight prejudice" being called.

[Pets to People]

Issues, 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?

I understand what you are saying, but the way he addressed it was unprofessional...I can just imagine the tone it was said in. That approach does not address the pt's issue in any way.

[2BRN123]

Overweight patients need to be addressed with respect, and healthcare providers DO need to be aware of their prejudices and bias. That said, I fear we are getting to a point of overly-politically correct enabling approaches where the issue will not be able to be addressed with overweight patients without "bias!" and "over-weight prejudice" being called.

There is "prejudice" and "bias" though. Not necessarily on a patient care level but on a level of access to general services. It is ridiculous that as health care providers that we can sit here and call overweight people "non-compliant" when many of them have been given no legitimate materials or instructions to comply with!

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.

[Multicollinearity, BSN, RN]

overweight patients do tend to be non-compliant with some physician orders. if they complied with an order like "exercise 5 days a week and eat this diet" then they would most likely lose weight. however, i do think that most people, whether they are overweight or not do comply with taking medications. most people in america view overweight and obese people as unattractive, not just in the health care setting, the cause of this is out of the hands of us healthcare workers, and more up to the zeitgeist of the time which, in today's time, is highly influenced by the media. the awkwardness of someone is totally subjective. many people say that physicians are some of the most socially awkward people out there, so what right do they have judging that trait in others? in the end though, it is common courtesy to not say offensive things like that. you can think it all you want, but when you speak it out loud, you run risk of not only offending someone, but also lowering their self-esteem which may cause some people to eat excessively and put on even more weight!

i think we have shifted from a culture of doctors orders, and patients' compliance. that reflected prior generations' vested authority in physicians that no longer exists. now physicians and other healthcare providers are partners in creating and maintaining health. truly.

i prefer educating and coaching from healthcare providers and patients' adherence or non-adherence, which is their choice.

[Multicollinearity, BSN, RN]

There is "prejudice" and "bias" though. Not necessarily on a patient care level but on a level of access to general services. It is ridiculous that as health care providers that we can sit here and call overweight people "non-compliant" when many of them have been given no legitimate materials or instructions to comply with!

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.

Leo, I deleted my prior post as it was rambling and long. I described a scenario where a physician claimed many overweight people will be overweight no matter what they do.

I agree there is prejudice and bias. I'm afraid, though, that fear of claims of bias will tie healthcare providers' hands when it comes to addressing the issue honestly and kindly.

[2BRN123]

I agree there is prejudice and bias. I'm afraid, though, that fear of claims of bias will tie healthcare providers' hands when it comes to addressing the issue honestly and kindly.

Their (and our) hands are already tied, unfortunately.

Another poster previously said that a Dr. shouldn't constantly harp on someone about their weight. I think they should BUT they need to be able to refer them to someone or something or some way that the problem can actually be controlled. *sigh*

sorry I'm posting so much, I just work in the health and fitness field currently and believe very strongly about these issues.

Its just so hard to bear witness to the whole thing. Seeing Client A with adequate financial resources or agreeable health insurance be able to participate in our program and SERIOUSLY change their lives and then have to watch client B without those resources struggle on the eliptical reading health magazines every day not knowing if they will ever be able to turn themselves around.