In our just released 2020 Canadian Adult Obesity Clinical Practice Guidelines, you’ll see that one of the first chapters is about reducing weight bias and discrimination. There is a serious and severe bias against people with obesity in our society, and it sadly worst amongst health care providers, family members, and friends of people with obesity. This chapter is placed first in the guidelines because the health care profession needs to get past obesity stigma first, if there is any hope of addressing and treating obesity well. People living with overweight or obesity are also unlikely to feel comfortable to talk to their health care provider about weight management if they feel like their health care provider is judgmental or stigmatizing against obesity. Thus, we need to eliminate weight bias and stigma in order to help people be able to access quality weight management care in an open and welcoming environment.
Recommendations from the chapter, with some of my thoughts/examples on why they matter:
- Health care providers should assess their own attitudes and beliefs regarding obesity and consider how their attitudes and beliefs may influence care delivery. (Level 1a, Grade A)
Note that stigma can be seemingly subtle and even unintended. If a doctor’s office has narrow chairs with armrests in the waiting room, fashion magazines full of skinny people on the table, blood pressure cuffs that aren’t big enough, or scales that don’t go high enough, this will likely not feel like a welcoming place for patients to discuss their weight. - Health care providers should recognize that internalized weight bias (bias towards oneself) in people living with obesity can affect behavioural and health outcomes. (Level 2a, Grade B)
Many people with obesity struggle with internalized weight bias (eg feeling negatively about themselves because of their weight, or feeling that they are to blame for their weight issue). Helping people address any negative attitudes towards themselves is important in improving success with weight management and quality of life/wellbeing.
- Health care providers should avoid using judgmental words, images, and practices when working with patients living with obesity.
If a doctor says to their patient: ‘You are obese’, this is perceived as very judgmental by the person with this disease. Remember that obesity is a diagnosis, not a description of a person. The term ‘obese’ should be eliminated from the English language in my opinion. And this is one of the milder examples of judgmental words – often it is much worse.
- We recommend that health care providers avoid making assumptions that an ailment or complaint that a patient presents with is related to their body weight. (Level 3, Grade C)
If a patient complains of shortness of breath while walking their new puppy, don’t assume this is due to obesity or being ‘out of shape’ – could this actually be an undiagnosed heart condition?
Swelling in legs/ankles is often automatically attributed to obesity. Could this be undiagnosed congestive heart failure?
Key messages in this chapter for people living with obesity:
- Weight bias may affect the quality of healthcare that you receive.
- Experiences of weight bias can harm your health and well being. Talk to your healthcare provider about your experiences with weight bias.
- Talk to your healthcare provider about addressing and getting help for internalized weight bias (self-stigma, self-blame).
- Try focusing on improving healthy habits and quality of life rather than weight loss.
Policy makers: be sure to check out the Key Messages for healthcare policy makers in this chapter.
NOTE: This blog is not intended to be a full synopsis of the chapter. There is a wealth of information in this chapter that is beyond the scope of one blog post. I encourage everyone to read the recommendations and key messages in full, and to read the entire chapter!
Stay tuned for much more on the Obesity Guidelines in coming weeks!
Share this blog post using your favorite social media link below!
Follow me on twitter! @drsuepedersen
www.drsue.ca © 2020
