Office Environment Strategies to Reduce Weight Bias

Rebecca M. Puhl, PhD


September 30, 2010

In This Article

Weight Bias in Healthcare

With two-thirds of Americans now overweight or obese, many people could be encountering negative healthcare situations or avoiding needed healthcare services. Decisions to avoid or delay care can stem from personal shame related to weight gain or failure of weight loss, negative provider attitudes toward obese patients, inappropriate communication by staff performing medical procedures, or previous experiences of feeling stigmatized in healthcare settings. It can also stem from the medical office environment.

Many aspects of the medical office environment create obstacles and barriers to quality care for obese patients. Instead of experiencing an atmosphere of support, tolerance, and accessibility, many obese patients are left feeling uncomfortable, stigmatized, and embarrassed.

A group of researchers surveyed 498 overweight and obese women about their healthcare experiences.[1] In line with previous research, obese women reported delaying healthcare services, such as preventive cancer screening. When asked why they avoided healthcare, 46% of obese women reported that small patient gowns, narrow exam tables, and inappropriately sized equipment were barriers to seeking healthcare. Moreover, 35% reported that embarrassment about being weighed was a barrier to care. The percentage of women who reported these barriers increased significantly as body mass index increased, showing a pronounced effect on the heaviest women.

The same investigators interviewed 129 healthcare providers about their education and practices in providing care to obese patients. Interviews revealed that only 1 in 11 clinicians had scales that can be used for patients who weigh more than 350 pounds, and that many healthcare settings did not have appropriate medical equipment to accommodate obese patients. The Table highlights these findings, showing the percentage of healthcare providers who reported that their medical office settings provided medical equipment to accommodate large patients.

Table. Availability of Healthcare Equipment Suitable for Larger Patients

Healthcare Equipment Reporting Availability
Scales for patients > 350 lbs 9%
Gowns for very large patients 21%
Armless waiting room chairs 46%
Longer speculums for pelvic exams 80%
Extra large blood pressure cuffs 83%

According to these findings, many healthcare settings do not have adequate equipment to accommodate obese patients. When patients have difficulty sitting comfortably in waiting room chairs, are asked to change into patient gowns that are too small, are weighed on scales that don't accommodate their size or is located in a hallway or office with little privacy, or cannot receive needed medical services because appropriately-sized equipment to perform them is lacking, it becomes easy to see why many of these patients are reluctant to return for future healthcare services. Well-intentioned efforts of skilled, compassionate providers can be quickly erased by these negative aspects of the medical office setting.


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