'People First' -- Ending Weight Bias in Diabetes Care

Rebecca M. Puhl, PhD


July 21, 2016

In This Article

Stigmatizing Obesity

Several decades of research have documented persistent societal stigma and discrimination toward individuals with obesity. Unfair treatment or prejudice because of body weight, often referred to as "weight bias," can produce a range of negative consequences for psychological well-being and physical health. In addition to heightened vulnerability to depression, anxiety, and other psychological disorders, experiencing weight bias can lead to unhealthy eating behaviors, increased calorie intake, binge eating, reduced physical activity, and heightened physiologic stress.[1,2] Weight bias has even been shown to predict future weight gain and obesity, even after accounting for baseline body mass index (BMI) and sociodemographic factors.[3]

This issue becomes increasingly complex in light of weight bias that is present in the healthcare setting. Consistent evidence has documented weight bias from healthcare providers (HCPs) toward patients with obesity, including stereotypes that these patients lack self-control and discipline, and are unmotivated to improve health, noncompliant with treatment, and personally to blame for their weight.[4,5,6] Recent studies have found that levels of weight bias are as pervasive among physicians as the general population,[7] and that in some cases this bias among health professionals has worsened over time.[8] These findings underscore the fact that HCPs are not immune to broader, negative societal attitudes about people who have obesity.

The impact of provider weight bias on patient outcomes has also received research attention, showing that patients with obesity who perceive bias from providers have less trust in their providers and more difficulty losing weight. They are more likely to avoid preventive health services and future medical appointments because of these experiences.[9,10,11] Evidence also indicates that doctors may spend less time in appointments, provide less health education, build less rapport, have lower expectations for medication adherence, and have less desire to help patients with obesity compared with thinner patients.[12,13,14,15]


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