Fighting Weight Bias: Help Overweight and Obese Patients Feel Comfortable at Your Practice

On any given day, you interact with people from a wide range of social classes and cultural backgrounds, and with many different diagnoses. This interaction includes people who have wide-ranging weights.

All patients come to you for one main reason: to get or stay well. Unfortunately, overweight and obese patients often feel uncomfortable visiting physicians. Just a quick Google search brings up many personal experiences of overweight individuals who felt their medical concerns were being dismissed or disregarded; a physician either shamed them for being overweight or suggested weight loss as the only possible solution to their ailments.

The Prevalence and Effects of Weight Bias

A significant amount of research shows that many health care providers indeed have negative opinions about their overweight patients -- and not always intentionally. After all, weight bias is just as prevalent for the people who are struggling with their weight: A study from the Rudd Center for Food Policy & Obesity found that female patients begin to feel a negative weight bias at a body mass index of 27, while men start to feel it at a BMI of 35. This can reveal itself through verbal and nonverbal communication, further highlighting the need for support.

And if overweight patients can't get that support from their doctor, where can they get it? Unfortunately, weight bias does creep into practices: An article from Obesity Reviews highlights how negative attitudes still persist toward obese patients and suggests that this may harm overall quality of care. Providers -- whether physicians, trainees, nurses, or advanced care practitioners -- with a bias tend to use less patient-centered communication and instead typically assume that the patient will not adhere to a treatment regimen.

This widespread attitude is quite shameful, as our understanding of obesity is actually rapidly growing. Various research has shown that several circumstances contribute to obesity, including medications, the makeup of gut bacteria, hormone imbalances, certain illnesses, and genetics. The big picture is much more complicated than a simple formula of calories in versus calories out -- and yet, societal attitudes continue to stigmatize obesity and promote simple fixes.

Tips to Avoid the Pitfalls of Bias

One way to avoid falling into the trap of weight bias as a provider is to keep the focus on being healthy -- that's what your patients are coming to you for anyway. Remind yourself (and your patients) that good health encompasses so much more than a BMI. You can follow these tips to help overweight patients feel more comfortable:

• Make sure the waiting room furniture is accommodating. It's embarrassing for someone to not be able to fit in a waiting room chair. Make sure you have seating options for patients of all sizes.
• Focus on the patient's primary concern first. If your patient is coming in because of a common cold, there's no need to discuss weight. Likewise, if you're managing a chronic condition for the patient, focus on treating the condition and how healthy habits are part of the treatment plan. Even when you feel confident that losing weight would help the patient's symptoms, be sure to evaluate all possible causes. Physicians with a bias may assume too often that a problem is caused by obesity and fail to refer the patient for further evaluation.
• Skip the weigh-in sometimes. When weight has no bearing on the patient's complaint, just bypass the scale. You'll help your patient feel more at ease and be able to focus on the ailment that brought them to your office.
• Concentrate on screenings. Rather than talking about losing weight with your patient, particularly if you have someone who doesn't want to hear that advice, focus on screenings. Stay on top of early detection for obesity-related illnesses, and talk to your patients about those problems, their causes, and prevention. Emphasize an overall healthy lifestyle above meeting a target weight.
• Let your patients initiate the weight discussion, or ask them if it's OK to talk about it. Many patients want to lose weight, but they may be uncomfortable bringing it up. If you have patients who seem open, ask them if they would like to talk about a plan to lose weight. Most often, obese patients want their physicians to act as a partner, helping to set goals and encouraging them to stick to a plan.
• Learn more about obesity. Reasons behind weight loss and weight gain are extremely complex and personal. New obesity research comes out all the time, and having a deeper understanding will lead to increased empathy, as well as more solutions that you can recommend to patients. Advocacy organizations and websites that provide free online courses are a great place to begin upping your knowledge.

You may find that overweight and obese patients are wary about visiting your office if they've had a previous bad experience with a physician, so maintain compassionate language and respect their feelings about discussing weight when it's not directly relevant to the visit.