Weight Bias in Healthcare: An Important Clinical Concern

Rebecca M. Puhl, PhD


May 11, 2009

Despite increased attention to the obesity epidemic, little has been done to address the bias, prejudice, and discrimination that obese children and adults face every day. Weight bias is prevalent in our society, but it often goes unnoticed and ignored. As a result, overweight and obese individuals face discrimination in employment, barriers in education, stereotypes in the media, stigma in interpersonal relationships, and even bias from healthcare providers. This unfair treatment reduces quality of life for obese persons and jeopardizes their emotional and physical health.[1,2]

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At the Rudd Center for Food Policy and Obesity at Yale University, one of the primary aims is to reduce weight bias through research, education, and advocacy. The Center is working to draw attention to weight bias and develop evidence-based strategies to address this problem with young people, families, teachers, employers, and healthcare professionals.

In the past several years, the Rudd Center has been contacted by health professionals across North America who want to learn more about weight bias and what steps they can take to inform and educate others about this problem. Often, health professionals say that they have observed weight bias among their colleagues and have witnessed negative treatment toward overweight and obese patients. Indeed, these comments are consistent with several decades of empirical research[1,3] demonstrating negative attitudes among providers toward obese patients and reports by overweight and obese patients who frequently feel stigmatized in healthcare settings.

As the majority of Americans are now overweight or obese, weight bias is an important clinical concern, one that no provider can afford to ignore. Patients who feel stigmatized about their weight are more likely to avoid routine preventive care, and when they do seek health services, they may receive compromised care.[4] When patients feel stigmatized, they are vulnerable to depression and low self-esteem, they are less likely to feel motivated to adopt lifestyle changes, and they are more likely to turn to unhealthy eating patterns for solace.[5,6]

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Healthcare providers face a complex challenge in helping overweight and obese patients lose weight and adopt healthier lifestyle behaviors. Providers are faced with the challenge of deciphering the merits of existing weight loss strategies to recommend to their patients, even though many programs have limited success. Although the challenges of treating obesity may continue, it is critical for providers to avoid stigma in their interactions with obese patients and to help encourage healthy behavior changes.

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In response to many requests for resources on this issue, the Rudd Center has created a free educational video about weight bias in healthcare. This video, hosted by celebrity and activist Emme, uses expert commentary from Rudd Center faculty and dramatic representation to increase awareness of bias and stigma that overweight and obese patients encounter in healthcare. The video is also designed to help clinicians across a variety of practice settings find strategies to improve delivery of care for overweight and obese patients. These strategies range from simple ideas to improve provider-patient communication and ways to make positive changes in the office environment, to profound changes, including self-examination of personal biases. These strategies can significantly reduce bias in clinical practice and optimize the healthcare experience for overweight and obese patients.

These videos are available online without charge, and can be downloaded here on Medscape, on the Rudd Center Web site, or on You Tube. The video is an ideal educational tool for medical staff training, medical school or nursing school curricula, and healthcare continuing education. There is also a free video discussion guide (see Appendix) to facilitate important discussions about weight bias among medical professionals and students. The response to the video from medical professionals and healthcare facilities has been favorable. A free DVD of the video is available by sending an email to rudd.center@yale.edu

It is hoped that this resource will increase attention to weight bias in healthcare and stimulate needed discussion among providers about weight bias and its consequences for patients who are affected.

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