Weight Bias

Weight bias is pervasive in medicine and is unfortunately influenced by outside forces. Addressing weight bias early in the medical education of learners can be key to avoiding damage to the therapeutic relationship associated with carrying that bias into interactions with patients. 

What addressing weight stigma is NOT

Addressing weight bias is NOT ignoring weight as a factor that influences health and outcomes. 

An effective way to talk about weight bias with learners: 

Addressing weight bias in medicine means not allowing it to have an inordinate influence on clinical decision-making such that symptoms are explained away by BMI or body-surface area. Medicine is not that simple. It also means taking the time to listen to your patients. Many patients report having their symptoms dismissed or ignored by their practitioners due to their weight (Phelan et al. , 2015). 

Delving into the specific physiological mechanisms (if known) that inform approaches to patients with higher weight can help contextualize this information and also avoid making historical health claims that relate to weight but lack clinical evidence.

What addressing weight stigma can look like

1. Definition: Weight Stigma (Sizeism)

• Weight stigma: Bias against individuals due to their body size

• Other names: Sizeism

2. Impacts of Weight Stigma (Zhu et al., 2022)

• Psychological Health: Linked to emotional suffering, psychological distress, and internalized self-stigma

• Physical Health: Leads to poorer physical health outcomes, delayed healthcare, and avoidance of health providers

• Overall Well-being: Causes stress, worsens health outcomes, and increases the burden of intersecting forms of oppression

3. Best Practices for Respectful Language (Meadows & Daníelsdóttir, 2016)

• Neutral Terms: Use "weight," "lower weight," and "higher weight"

• Avoid: Terms like "underweight," "fat," "obese," "morbidly obese"

• Person-first Language: Ask individuals their preferred terms, use "person-first" or "identity-first" language

• Community Preferences: Some individuals in the fat-acceptance community prefer terms like "fat" or "plus-sized" to reclaim and neutralize the word "fat" (Saguy & Ward, 2011).

4. Critique of BMI

• Limitations of BMI: Body Mass Index is a crude measure, failing to consider muscle mass, bone density, overall body composition, and differences across race and sex. It is based on measurements solely from non-Hispanic, White populations (Nordqvist, 2022).

• Recommendation: BMI should not be the sole measure of body fat or health.

5. Intersectionality

• Weight stigma often intersects with other forms of oppression, such as sexism, ageism, racism, classism, transphobia, and xenophobia. Multiple forms of oppression create a greater cumulative burden and stress, damaging overall health (Abrams, 2022; Chrisler & Barney, 2017).

Based on American Psychological Association (APA) Inclusive Language Guide

References

1. Abrams, Z. (2022, March 1). The burden of weight stigma. Monitor on Psychology, 53(2).  https://www.apa.org/monitor/2022/03/news-weight-stigma 
2. Chrisler, J. C., & Barney, A. (2017). Sizeism is a health hazard. Fat Studies, 6(1), 38–53. https://doi.org/10.1080/21604851.2016.1213066
3. Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M. & Ryn, M. van. (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

4. Meadows, A., & Daníelsdóttir, S. (2016). What's in a word? On weight stigma and terminology. Frontiers in Psychology, 7, Article 1527. https://doi.org/10.3389/fpsyg.2016.01527

5. Nordqvist, C. (2022, January 19). Why BMI is inaccurate and misleading. Medical News Today. https://www.medicalnewstoday.com/articles/265215

6. Zhu, X., Smith, R. A., & Buteau, E. (2022). A meta-analysis of weight stigma and health behaviors. Stigma and Health, 7(1), 1–13.  https://doi.org/10.1037/sah0000352