On weight stigma in healthcare
I got some good feedback on my last, somewhat salty post, and since I’m still feeling feisty, thought I’d tackle another topic that gets me pretty fired up. And that is: weight stigma in healthcare. Weight stigma can be defined as discriminatory acts and stereotyping because of one’s weight. For example, a patient in a larger body receiving poorer care because of their size, shamed because of their size when visiting the doctor, assuming a patient in a larger body must want to lose weight and pushing weight loss on them when it’s unrelated to the reason of their visit, etc.
How I got here
I worked clinically in healthcare for about 10 years (though the pandemic years should count as double if you ask me), and when I first started back in 2012 I was one of the majority who perpetuated weight stigma in the hospitals/clinics. To me that was assuming patients in larger bodies wanted and needed to change them to become smaller, and to do that my job was to help them cut calories and “diet.” It pains me to think about it now, but back then a lot less people knew better, and we certainly were only taught through a very weight normative, diet culture-filled lens. It took probably about half my career as a dietitian to realize not only the error in my ways, but the error in the system’s ways. And then I started seeing it everywhere. The patient who was told their weight was the sole cause of their cancer (no!) and felt deep despair, the patient who gained 10 pounds during perimenopause and was told to try a medical weight management program (these are ALWAYS a terrible idea), the patient who didn’t follow up with her physician due to fear of weight shaming found to have late stage cancer that could have been caught much earlier, the patient with knee pain told to lose weight (when a thin person would have been given a referral to PT), the patient seeing the PCP for cold symptoms leaving their appointment with a list of weight loss medications, a woman in a larger body with severely disordered eating encouraged to diet. The list could go on and on, and these are all real examples I’ve seen first-hand. And they all enraged me.
Weight stigma harms health
The fact of the matter is, weight stigma is harmful to health, longevity, and even the obesity epidemic. A recent review found that weight stigma can trigger physiological and behavioral changes linked to poor metabolic health and increased weight gain. This study also supports that, and links weight stigma to increased alcohol intake and poor sleep. Another study found physicians show strong anti-fat bias in healthcare situations. This absolutely impacts care! I can’t tell you how many patients I saw at the hospital who were absolutely terrified to meet with me, the dietitian, because of what they thought that entailed – the food police, feeling like they did something wrong, diets, sad salads forever, and so much shame. I hate that it took me so long to get here, and that even though I worked in healthcare so long I was unable to move the needle in a positive direction (I really tried).
Here’s what I think needs to happen
I definitely don’t have all the answers, but to start, there needs to be a collective realization that weight does not equal health. There also needs to be a collective recognition that weight stigma in healthcare exists, and healthcare workers should take several beats and check their own individual biases that come into play when seeing patients. There also needs to be more emphasis on healthy behavior change for health, and referrals to the appropriate professionals who have the time and expertise to help implement these changes taking into account the unique individual. For example, a referral to a dietitian for healthy behavior change can result in the patient eating more vegetables, not skipping breakfast anymore and cooking more meals at home. Is this amazing for long-term health? YES! Weight changes may simply be a side effect (or not! It’s just not the focus!).
Here’s what I do differently in my practice
I spoke a bit about my philosophy and my approach in this post, and that still rings true. And like I stated above, addressing the individual by using a weight neutral approach and focusing on healthy behavior change that is meaningful to them and their long-term health is so much more effective and health-promoting than having weight loss as a primary goal (and there’s research to back that up!).
For more information on working with me, please visit my website to schedule a free discovery call!