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

Rebecca M. Puhl, PhD


July 21, 2016

In This Article

'People First' and Other Implications for Clinical Practice

With increasing recognition that weight bias is present in healthcare, efforts have shifted to the identification of strategies that can help reduce bias in the clinical care setting and improve healthcare delivery to patients with obesity.[20] Provider communication approaches that promote respectful and supportive dialogue when discussing weight-related health with patients have also received more attention. Suggestions for clinical practice resulting from these efforts are briefly summarized below and are applicable to providers involved in diabetes management and care.

Increasing awareness of personal attitudes about body weight. Although weight bias can be expressed overtly, quite often it is also conveyed in more subtle ways through one's tone of voice, nonverbal behaviors, physically distancing oneself from the patient, and relying on weight-based stereotypes when counseling patients.

Providers may be unaware of these subtle forms of bias or their potential impact on the quality of care. Increased awareness of personal attitudes about body weight and how bias can affect patients is an important first step of stigma-reduction efforts.

Rather than relying on societal stereotypes about obesity when counseling patients, providers can reduce bias by consciously challenging weight-based stereotypes in their clinical practice (eg, challenging the assumption that a patient with obesity is unmotivated or noncompliant with treatment, and instead considering other barriers that may affect patient outcomes). Providers can also take note of examples of individuals who counter common weight-based stereotypes, both with their own patients and more broadly with examples of public figures who have a higher body weight (eg, musicians, actors, athletes, and government officials) who display counter-stereotypical traits such as success, ambition, discipline, and intelligence.

Recognition and appreciation of the complex etiology of obesity. Studies with medical students have demonstrated reductions in weight bias following education about the complex causes of obesity that are outside personal control, such as genetic, biological, and environmental contributors.[21,22] These findings highlight the importance of causal attributions of obesity, as well as the need for providers to understand and acknowledge the multifaceted causes and solutions for obesity and body weight regulation that go well beyond personal behaviors.

Practice patient-centered communication about weight-related health. Increased training and use of patient-centered communication strategies like motivational interviewing can help reduce weight bias that might otherwise be communicated to patients in conversations about weight-related health behaviors. Counselling skills of medical trainees can improve with training in communication skills and awareness of stigma.[23]

Use respectful language about weight and obesity. Studies show that the words that providers use to discuss a patient's body weight can have implications for future healthcare utilization. Using such words as "high BMI" or "unhealthy weight" is viewed by patients as less stigmatizing and more motivating for weight loss than using such words as "fat" or "obese."[24] In recent years there has also been an increasing movement in the obesity field to use "people-first language" in the context of obesity.[25] People-first language has been used as part of stigma-reduction efforts related to other illnesses and diseases, and involves referring to a person first ("a patient with obesity") rather than labeling the patient by his or her disease ("an obese patient").

Reduce barriers in the clinical care setting. Patients with obesity have reported bias-related barriers in the clinical care setting, such as patient gowns and blood pressure cuffs that are too small for their body size, scales that do not accommodate patients of high body weight and/or are not located in private areas, and seats in waiting room areas that are too small. Checklists are available with suggestions for changes that can create a medical environment that is welcoming to patients of diverse body sizes and conducive to optimal care for patients with obesity and diabetes.

Evidence-based training opportunities. Brief educational videos have been found to effectively reduce weight bias among medical students. These videos describe weight bias and its consequences for patients, and summarize clinical strategies that providers can implement to help reduce bias in their practices. An evidence-based and newly created online continuing medical education course on weight bias is also available for healthcare providers.


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