By Denise Williams | News & Views
Healthcare is harboring a bad habit.
It’s probably safe to assume that the industry’s well-meaning professionals have an inherent desire to help – not hurt – people. But according to experts, some of them judge, stereotype and even discriminate against patients viewed as overweight or obese. Wait, WHAT?!
It’s true, affirms Callan Wall, RD, pointing to ample published evidence demonstrating the different ways this mindset insinuates itself into modern society. The good news, according to the body image coach – who works at the cardiopulmonary rehabilitation facility at New Hanover Regional Medical Center in Wilmington, North Carolina, and is the founder/owner of Tula Wellness – is that “weight stigma” is a mostly unconscious bias within the healthcare community. There’s no malicious intent, she reassures; many may not even have heard of the term before, and most likely aren’t even aware when they’ve inadvertently crossed into that touchy territory. By the same token, meanwhile, they also probably don’t realize the potential damage these ideals can cause.
Ramifications of Size Discrimination
In CR/PR and other medical settings, Wall offers examples of direct, indirect and environmental elements of weight bias, including:
- Recommending weight loss as the first or only line of defense instead of exploring all options for improved health
- Blaming a patient’s medical condition on his or her weight, and assuming that weight loss will resolve the problem
- Not accepting a patient’s claim of healthy diet and/or regular exercise simply because of his or her larger body size
- Having equipment, such as blood pressure cuffs and chairs with arm rests, that does not accommodate a range of body types
- Conducting patient weigh-ins multiple times during the week, when that cadence isn’t medically necessary
- Staging weight-loss challenges
- Stocking the wait room with magazines that reinforce the weight stigma mentality
These infractions, whether subtle or not so subtle, can have disastrous consequences for affected patients, Wall warns. “What’s important for us to take into consideration,” she advises, “is the level of stress that experiencing weight stigma can introduce into someone’s life – specifically, how their body and behaviors respond to that stress.” Some of the unfavorable possibilities include psychological impacts such as low self-esteem, depression and anxiety, poor body image, substance abuse and/or suicidality. Exposure to weight stigma can also trigger physiological impacts, with Wall naming elevated blood pressure and higher blood glucose levels as examples. Additionally, these patients may be less motivated to take up positive health behaviors – but may be more vulnerable to binge eating, disordered eating, weight gain and weight cycling (repeated weight gain and loss). Moreover, they may be less likely to stick to treatment regimens, lose faith in healthcare providers, avoid follow-up care and put off preventative health checks – all of which could prove detrimental to their health and management of medical conditions.
Such scenarios certainly aren’t what healthcare professionals want for patients. However, medical training often teaches that weight and body size are inextricably linked to health outcomes – a relationship that Wall says isn’t necessarily supported by the literature. “This information can be difficult to face, especially when it challenges an entire paradigm that we may have been taught from the moment we started our careers,” she admits. But if the prevailing assumption were true, she reasons, “we wouldn’t have people across the size spectrum (in small bodies, medium bodies and large bodies) all with similar medical issues like hypertension or high cholesterol.” It’s important, the non-diet registered dietician argues, for providers to start walking back some of the ideas that they’ve always accepted as fact. “We need to critically analyze the research and stay up to date, since we now know that associations are not causations and that randomized controlled trials [which are lacking on this subject] are the gold standard,” Wall declares. “We also need to critically think about confounding factors that are not controlled for in these studies.”
Unlearning What You’ve Unconsciously Learned
In the meantime, she suggests several steps that PR/CR professionals can take to chip away at weight stigma and embrace a weight-normative or weight-inclusive approach to health:
- Help patients set non-weight-centered goals, focusing instead on healthy behaviors.
- Approach health from a holistic angle that incorporates nourishment, sleep, physical activity, stress management, positive reinforcement and other aspects rather than just body size.
- Encourage variety, balance and sufficient nutrition over restrictive behaviors or diets.
- Recognize the social determinants of health and how they may impact a patient’s health.
- Cover the scale’s display screen or weigh patients with their back to the display to shield them from unnecessary embarrassment.
- Avoid weighing patients at every single visit, unless their medical condition (chronic kidney disease, chronic heart failure, gastrointestinal distress, malnutrition etc.) demands it.
To be sure, Wallen emphasizes, weight stigma is not a problem exclusive to healthcare. It’s present all around us – in the workplace, on public transportation, at clothing stores, within the fitness industry, on social media and elsewhere. It can manifest directly, for example, through ridicule when exercising or eating in public; or indirectly, such as when a person in a larger body is excluded during social interactions or ignored by customer service personnel. Inadequately sized airline seating and gym equipment are additional examples, at the environmental level. While weight stigma is omnipresent, the healthcare profession – populated by so many people with a passion for helping others – seems like a great starting point to break down the fallacies and misinformation associated with it.
- Intuitive Eating, by Evelyn Tribole and Elyse Resch
- Health at Every Size, by Linda/Lindo Bacon
- Anti-Diet, by Christy Harrison
- Body Respect, by Linda/Lindo Bacon and Lucy Aphramor
The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss