Just like the rest of Americans, healthcare providers carry weight biases. That means that your physician, nurse, dietician, psychologist, and fitness professional may hold discriminatory attitudes about fat people. Studies consistently document weight bias in healthcare providers, including the tendency to view obese* patients as lazy, lacking in self-control, undisciplined, and noncompliant with treatment. Furthermore, they believe that these traits are the causes of obesity.
So, why should you care about your doctor’s beliefs? Because they effect your treatment. Studies reliably find an inverse relationship between body mass index (BMI) and providers’ respect for a patient; this means that the more you weigh, the less respect your doctor has for you. Less respect means worse care. Studies show that providers spend less time with obese patients. Many obese patients have stories of incorrect diagnoses in which the doctor was so focused on the patient’s weight that the doctor failed to identify the real cause of the patient’s ailment. These anecdotes include joint pain that was attributed to excess weight rather than a broken bone, shortness of breath attributed to excess weight rather than asthma, severe back pain attributed to excess weight rather than a pinched nerve from a car accident, and even missed cancer diagnoses. Most fat patients have experienced being diagnosed as “obese” at their doctor’s office, while the ailments that brought them in for treatment remain undiagnosed and untreated.
These experiences lead to perhaps an even bigger problem; when you are confronted with a judgmental shame-inducing environment every time you go to your doctor’s office, you are likely to avoid going to your doctor. Obese patients are less likely to go to the doctor for preventative care and non-emergency issues. When you do finally get to the doctor’s office, things usually have gotten pretty bad.
Weight bias contributes to obese patients being:
Less likely to seek preventative medical treatment
More likely to wait until medical problems have progressed to seek treatment
More likely to receive inadequate medical care when they finally do seek treatment
I wonder how these factors influence the poor health outcomes that are so commonly attributed to obesity?
In writing this article, I am reminded of the following quotes:
“First, do no harm” –Hippocrates
“The unexamined life is not worth living” –Socrates
We are all bombarded with fat-hating mesages every day. Medical providers are no more immune than anyone else to internalizing these messages and acting on these beliefs, whether they are conscious or not, intentional or not. We all need to examine our biases to avoid doing harm.
Are providers who specialize in eating disorders any less fat-phobic than other medical professionals? For the answer, read my next post: “Is my therapist fat-phobic?”
*I use the terms “obese” and “obesity” in this post to correspond with the language used by the authors of the study. For a discussion of language to describe weight, please read my post “Is Fat the New F-Word?”
Reference: Puhl R., & Heuer C. (2009). The stigma of obesity: A review and update. Obesity, 17: 941-64.