Asking your patients to lose weight may do more harm than good. Here’s why.

By Jules Murtha
Published January 31, 2022

Key Takeaways

  • Weight bias consists of negative attitudes and assumptions about people who are considered overweight.

  • Patients who experience weight bias from clinicians may be less inclined to seek medical attention, potentially compounding existing health issues due to lack of medical intervention. 

  • Instead of pushing diets that don’t work, patients may benefit from incorporating intuitive eating practices into their lifestyle.

Although studies show a correlation between excess weight and higher risk of illnesses like cardiovascular disease and cancer, doctors may be doing a disservice to their patients by encouraging weight loss as a universal solution. To mitigate harm, clinicians can address their communication skills and implicit weight biases.

What is weight bias?

Weight bias encapsulates the negative beliefs or attitudes held about those living in larger bodies. According to a review published by Current Obesity Reports, people perceived as overweight are often thought to be unattractive, lazy, undisciplined, unintelligent, and a handful of other demeaning qualities.[]

Those affected by weight bias may experience it from several sources. On a personal level, people in larger bodies could be targeted by colleagues, family, friends, strangers, and peers. On an institutional level, weight bias manifests in the lack of legal protections for those who face discrimination and bullying based on weight.

Some internalize external bias. For example, a person deemed overweight may take on the attitudes of people or cultural norms that devalue them based on their size. Negative messaging regarding weight starts on the outside and seeps in, reinforcing harmful stereotypes in those with larger bodies.

The harmful effects of weight bias don’t stop at personal relationships or legislative barriers, though. In fact, weight bias permeates other institutions—including healthcare.

How weight bias harms patients

Despite efforts to improve the health of patients living in larger bodies, physicians who exhibit weight bias and stigma may contribute to overall poorer health outcomes in patients.

In a review published by Obesity, studies show that those considered overweight live with chronic life stressors associated with a 207% increased risk of high levels of allostatic load.[] Additionally, patients who encounter weight-based discrimination are at a 60% increased risk of death, regardless of BMI.

Weight bias in clinical practice

The harms of weight bias and stigma are often traced to healthcare professionals and medical settings. Since health improvements in patients rely on a trusting and supportive patient-doctor relationship, physicians who hold negative attitudes toward patients with larger bodies could harm the relational dynamic by engaging in unintentional discrimination.

For example, evidence shows that healthcare professionals may exhibit contemptuous, disrespectful, and patronizing treatment toward patients of larger body sizes—even if they don’t mean to. Sometimes, HCPs attribute all patient health concerns to obesity. What follows is unfavorable to all parties: Patients avoid and cancel appointments. 

The authors of the Obesity review emphasize the statistical significance behind this finding. 

"Up to 55% of women living with obesity report delaying or canceling an appointment if they anticipated needing to be weighed during the consultation."

Researchers publishing in Obesity

“Up to 55% of women living with obesity report delaying or canceling an appointment if they anticipated needing to be weighed during the consultation, and evidence shows that women with overweight or obesity admit to delaying or avoiding pelvic and breast examinations because of fears of judgment when needing to expose their bodies,” the authors wrote. 

“Therefore, weight bias in HCPs may prevent active participation in the healthcare system by individuals with obesity who are likely most at risk of comorbidities associated with their weight.”

Physicians aren’t the only figures in healthcare who perpetuate weight bias, either. Nurses, dietitians, psychologists, exercise professionals, and others are reported to have exhibited weight bias during appointments or sessions, contributing to the widespread effects of weight stigma in medicine.

Related: What to do when your patient doesn't trust you

Intuitive eating as the answer

Intuitive eating (IE) involves using internal hunger and satiety cues to drive what we eat. A 2020 Eating and Weight Disorders study suggests that IE "predicts better psychological and behavioral health across a range of outcomes."[]

Where there is weight bias, there are diets. But the millions of people who pursue diets with the intention of slimming down largely fail to sustain the weight loss, calling into question the efficacy of diets—and the psychological costs of dieting.

A wide range of diets center on macronutrients. In a review published by the British Medical Journal, participants of at least 18 years of age living with overweight were assigned popular diets and weight loss programs, including Atkins, Jenny Craig, Weight Watchers, and others.[] Researchers examined changes in participants’ health based on weight loss and macronutrient intake.

Transient benefits

While some diets led to short-term weight loss and reductions in blood pressure and HDL cholesterol, by the 12-month marker, almost all benefits vanished. The same goes for diets that reduced cardiovascular risk factors: Statistically significant changes disappeared after a year. The only exception was the Mediterranean diet, which was associated with long-term health benefits in participants.

Diets, as a result, are largely ineffective for most people in the long-term. For patients with overweight who may suffer from disordered eating in their attempts to lose weight, intuitive eating (IE) could be a safer option.

IE encourages patients to “eat according to internal hunger and satiety cues,” according to an article published by Eating and Weight Disorders.[] Those who eat intuitively are less likely to engage in extreme weight loss behaviors—binging, purging, or taking pills—as well as exhibit lower rates of depression.

At an 8-year follow up, participants using IE had a reduced risk of binge eating by 74%. Longitudinally, studies show that those who implement IE in their lifestyles exhibit better psychological and behavioral health—which offers more than most diets can.

What this means for you

Weight bias is prevalent in healthcare. Clinicians may inadvertently harm their patients living in larger bodies by dismissing health concerns or attributing them to excess weight. As a result, patients avoid or cancel appointments. Diets may also prove ineffective for most patients living with overweight. Addressing weight bias in clinical settings requires clinicians to learn more about the nature and nuance of obesity and sensitive communication training, as well as embrace virtual reality applications that could support future weight bias interventions in healthcare professionals.

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