written by: Jessica Mueller
The culture here in the
United States is obsessed with the topic of weight. How often do you hear your
family members and friends commenting on “how good” someone looks during your
holiday gatherings because they shaved off a few pounds? Vice versa, how often
do you hear gossip about an old acquaintance of yours that has gained a
noticeable amount of weight? These comments are often seen as “normal”
topics of conversation, and, in the case of weight loss, complimentary, the
subject of weight may seem completely harmless.
The emphasis and
lack of sensitivity towards weight continues in the healthcare setting. Earlier
this year at one of my clinical rotations at a residential eating disorder clinic,
one of the clients was sent out to a cardiology appointment due to heart
complications related to prolonged, severe restriction of food intake. Per
usual eating disorder (ED) protocol, the patient was weighed backwards so they
did not see their weight. When meeting with the doctor, he told his patient
that they did not need to gain any more weight or be at an eating disorder
clinic because while their BMI was on the lower side, it fell within the normal
range. This patient returned to the residential eating disorder clinic
extremely confused. They had been restricting food for so long that their heart
did not work properly and other complications were present; however, her doctor
just told her that her weight was normal and not to worry. The eating disorder
clinic RD explained that even though their doctor told them that their weight
appeared fine on paper, the phycological strain her ED was putting on her in
addition to the physical complications of prolonged, severe food restriction
called for their body to be at a higher weight. What was supposed to be a
cardiology appointment that lead towards a safe and successful recovery of an
ED, turned into an additional road block and source of confusion for this
patient.
Stories like the previous one are not uncommon. Whether
intended or unintended, many healthcare professionals (and Americans in
general) show weight bias. Weight bias is when a person has negative,
prejudiced attitudes towards an individual perceived to have an excess amount
of weight. These attitudes often manifest into weight stigma and/or
discrimination (Puhl and Brownwell, 2001; Dennet, 2019).
Weight
bias leads to many people in bigger bodies to have decreased quality of
healthcare for a myriad of reasons. Healthcare practitioners spend 28% less
time with patients who are obese than patients at a normal body weight (Phelan
et al, 2015) and 40% of these professionals are reported to have negative
reactions to patients with obesity (Fruh et al, 016). Additionally, healthcare
providers are more likely to suggest weight loss and “lifestyle changes” to
people in larger bodies as a treatment option while choosing to delay
diagnostic testing and/or treatment for symptoms (Phelan et al, 2015). Both
direct and indirect weight bias from healthcare professionals contributes to
anxiety, depression, disordered eating, medical non-adherence, antisocial
behavior, reduced patient satisfaction, and reduced self-esteem in patients who
have fallen victum to weight bias and discrimination (Dennett, 2019; Papadopoulos
and Brennan 2015; Phelan et al, 2105). These negative interactions related to
weight status in the healthcare setting sometimes cause people to delay or
avoid seeking treatment for illness or preventative care (Fruh et al, 2016).
Discussing
weight status with patients and peers is difficult. After all, ample evidence
connects obesity with cancer development, insulin resistance, and high blood
pressure, and more. What’s an effective and sensitive way to portray this
information to patients and peers? When is the correct time to bring up the
conversation of weight? During my clinical rotations, my weight-inclusive
preceptors have shared their own strategies on tackling this difficult topic. I
have also received resources from the Health at Every Size approach to
healthcare, the Obesity Action Coalition, weight- inclusive articles on the
Harvard Health and Cleveland Clinic websites, as well as listened to many personal
testimonies from the creators, Aubrey Gordan and Michael Hobbes, and the fans
of my favorite podcast, Maintenance Phase. Below are some ways to
approach weight in a sensitive manner as a healthcare professional and peer.
How to discuss weight
with patients as a healthcare professionals:
Treat
the patient.
If
a patient arrives to an appointment complaining of ear pain, treat the ear
infection. It does not make sense to bring up their weight in an appointment
unrelated to their weight. Always ask yourself if weight status if relevant to
the conversation you are having with your patient.
Provide
the same care for all patients.
This
recommendation should seem like a no-brainer, but according to the evidence
stated above, patients in larger bodies often have decreased quality of
healthcare because of their weight status. Spend the same amount of time with
patients with obesity as you would with patients at a normal body weight. Order
the same tests and procedures as you would for a patient at a normal body
weight at the same point in treatment as you would for a person at a normal
body weight.
Keep numbers out of the conversation
surrounding weight and weight status.
Using
numbers and categories can be really triggering for a person with an eating
disorder or disordered eating. Stay away from mentioning numbers in order to
prevent avoidable triggers that can lead to or worsen eating disorders. As a
side note, make sure to scour a chart for previous evidence or note of
disordered eating before discussing weight.
Build rapport.
Before
discussing weight with your patient, you want to build rapport. Trust is
essential for discussing weight in a sensitive manner.
Focus
on the mental health of a patient.
Eating
disorders, disordered eating, and obesity all have phycological components.
Before congratulating a patient on their weight loss or condemning a patient
for weight gain address their mental health status. Ask questions in a
sensitive manner and search for patterns of disordered eating such as fad
dieting, restrictive eating practices,
fear of gaining weight, negative attitude towards weight gain or people
in larger bodies, bingeing, depression, anxiety, or other conditions related to
altered patterns in diet. Treating the root cause of weight gain or loss can
help healthcare professional more effectively treat the whole patient at one time.
Refer
patients looking for nutrition advice to Registered Dietitians- they are the
experts!
Registered
Dietitians complete a 4 year undergraduate degree in nutrition as well as an
internship with 1200 supervised clinical, food service, and community nutrition
hours. All of the training and education dietitians go through make them the
experts on food and nutrition. If a patient is seeking medical nutrition advice
related to their weight status or simply wants more information on eating
healthy, a Registered Dietitian can provide personalized information and
counseling that benefits the patient and can be extremely effective to their
overall health.
How to Discuss weight
with your peers and family members:
Don’t.
Discussing
weight often encourages people to want to lose weight. It is important to
remember that a weight loss technique that might have worked for you, or your
cousin, or your cousin’s hairdresser’s, next-door-neighbor might not be the
tactic that works for everyone. Vice versa, if you comment on “how good” a
person looks since you last saw them, you could be unintentionally encouraging
disordered eating habbits. When complimenting or critiquing another person,
it’s best to stick to the “5 Minute Rule”. Unless a person change some the
aspect you are commenting on in 5 or less minutes, do not comment on it.
But
what if they bring it up?
Weight
loss, dieting, and nutrition are common hot topics and themes of gossip
sessions. If someone brings up their recent weight loss efforts or unexpected
weight gain, change the subject or refer them to healthcare professionals
trained to teach on the subject area. Adding to weight-related gossip fuels
Weight Bias and Weight Stigma.
But
what if I’m really concerned about someone and their weight status?
If you
have a rapport with a person you feel needs an intervention related to their
weight status, go about it in an extremely sensitive manner. Focus on their
mental health and make observations about their attitudes and behaviors instead
of their appearances. Always encourage them to get help from a trained
professional if you believe their habits and emotional state are harmful to
themselves.
By approaching weight in a
sensitive manner in the healthcare setting and with our friends and family, we
can create a more inclusive environment for people of all body types. Improving
attitudes around weight and reducing weight stigma, patients can have improved
satisfaction in their appointments and procedures, healthcare professionals can
improve their quality of care, and patients and healthcare professionals can
have better, more meaningful relationships with one another.
Resources:
Implicit weight bias test: https://implicit.harvard.edu/implicit/selectatest.html
Health at Every Size: https://haescommunity.com and https://www.sizediversityandhealth.org/health-at-every-size-haes-approach/
Maintenance Phase Podcast: https://www.maintenancephase.com
Discussing Weight in the
Healthcare Setting:
https://health.clevelandclinic.org/weight-bias-in-healthcare-can-it-be-prevented/
https://www.health.harvard.edu/blog/addressing-weight-bias-in-medicine-2019040316319
https://www.obesityaction.org
Citations:
Dennett, C. (2019, May). Weight Bias in Dietetics
Education. Today's Dietitian, 21(3), 36.
Fruh, S. M., Nadglowski, J., Hall, H. R., Davis, S. L., Crook, E.
D., & Zlomke, K. (2016). Obesity stigma and Bias. The Journal for
Nurse Practitioners, 12(7), 425–432.
https://doi.org/10.1016/j.nurpra.2016.05.013
Papadopoulos, S., & Brennan, L. (2015). Correlates of weight
stigma in adults with overweight and obesity: A systematic literature
review. Obesity, 23(9), 1743–1760.
https://doi.org/10.1002/oby.21187
Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L.,
Griffin, J. M., & Ryn, M. (2015). Impact of weight bias and stigma on
quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4),
319–326. https://doi.org/10.1111/obr.12266
