Why it’s time to address weight bias in health care

Have you ever avoided seeking medical care because you worried the health-care provider would judge your weight? Has a health-care provider ignored your concerns or denied you treatment because they were only focused on your weight? If so, you’ve experienced medical weight bias.“Weight bias cuts across all areas of health care from a misunderstanding of the nature of obesity,” says Dr. Michael Mindrum, an internal medicine physician in Kentville. His clinical practice initially focused on caring for patients living with diabetes, which led to an interest in obesity medicine. The more he learned, the more he began to recognize his own bias. He now believes all health-care providers need to identify and remedy weight bias in their patient care.

Medical weight bias or obesity bias includes implicit negative thoughts or beliefs held by health-care providers about people who live with weight, as well as explicit bias – poor or negligent treatment toward them. It has been clinically proven to cause patients harm.

“It’s not just having kindness and compassion toward patients with weight,” Dr. Mindrum explains, “but understanding the factors that may lead to obesity, such as genetics, brain biology and the social determinants of health.”

“Most important, physicians need to understand how harmful it is if they believe the condition of obesity is the patient’s fault. Health-care settings should be safe places where patients can come for understanding and receive education, and where effective treatment is offered,” he says. “But when patients living with weight experience bias, stigma and discrimination from their health-care providers, they can end up avoiding health care.”

“Patients living with obesity are frequently embarrassed, they feel like they’re failing and they feel like their weight is completely up to them. And the [providers] they interact with also feel that way – that it’s completely up to the patient.”

According to a recent Public Health Agency of Canada report, people living with obesity report higher incidences of discrimination in health-care settings. This can lead to negative health outcomes: distrust of health-care providers, not taking medications, disordered eating, physical inactivity and poorer mental health.

The Canadian Medical Association Journal notes that the bias and stigma faced by patients with weight can contribute to increased morbidity and mortality independent of weight or body mass index. Other harmful effects of weight bias include less time spent between doctor and patient and less patient-centred communication.

Weight bias remains prevalent in Nova Scotia, Dr. Mindrum notes, for a variety of reasons. Health-care policies are often directed toward individual behaviours, many barriers prevent patients from accessing appropriate care (such as the nearly decade-long wait list for bariatric surgery) and there is currently no provincial framework for approaching obesity care.

One way all health-care providers can work toward systemic change is to examine their own medical weight bias.

“That’s when the bias starts to break down and that’s what gets us to a place where we’re not causing harm to patients,” Dr. Mindrum says. “To do no harm would be a great first step.”

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