This resource provides practical tips for all health care providers on how to reduce harm and support patients of all body sizes with respect, compassion, and equitable care.
What’s the Issue?
Weight stigma refers to the negative beliefs, stereotypes and discriminatory practices that devalue, oppress, and exclude people in larger bodies. Weight stigma is widespread in our society. Our current societal norms perpetuate weight stigma by equating thinness with virtue, health and beauty, and de-valuing bodies that do not conform to the ‘ideal’ image of health. Weight stigma has detrimental impacts on an individual’s social, psychological and physical health and can result in discrimination against people in larger bodies in all aspects of life, including healthcare. Weight stigma can unknowingly affect our personal and professional well being, beliefs, clinical judgment, practices, and interactions with patients.
What are the impacts of weight stigma on patients?
Many negative outcomes commonly associated with weight (e.g., heart disease, high hemoglobin A1C levels) may be partially attributed to the emotional, psychological, and behavioural effects of weight stigma.1 Failure to address weight stigma and its impacts perpetuates negative health outcomes as described in the “stigma cycle” (Mercedes & Kriete)2 below.
What are the impacts of weight stigma on patients?
- A chair or gown at the doctor’s office that doesn’t fit their body
- Being denied knee surgery to improve quality of life until weight loss
- Having symptoms attributed to weight without exploring other possible causes
- Assumptions being made about eating or activity levels based on weight
- Delayed cancer diagnosis and treatment due to symptoms being blamed on weight
- Delaying visits or screenings because they feel unheard or disrespected
- Having your body mass index (BMI) used as a sole measure of your health risk
What can you do?
A weight-inclusive approach recognizes that body size diversity is a natural part of being human. It rejects the idealization and pathologization of specific weights and acknowledges that BMI and weight are unreliable measures of health. Overall, a weight-inclusive approach in healthcare aims to consider how all aspects of a patient’s life impact their health and provides compassionate, non-judgmental and equitable care for all humans.
Reflect on your own attitudes, beliefs and biases
- We live in a weight centric culture and we all have conscious and unconscious weight bias. When caring for a patient in a larger body, ask yourself – what care would I provide if a smaller bodied person presented with this same health concern?
Consider the impact of your language
- Terms like “overweight” and “obese” pathologize larger bodies and increase stigma. Use neutral terms that are non-stigmatizing such as higher weight or larger body.
Recognize the limitations of BMI and challenge it’s widespread use
- The use of BMI to assess individual health should be reconsidered and replaced by more accurate indicators of health status or risk (e.g., biochemical markers of disease, health behaviours).
- If BMI is used, consider using a numerical BMI value rather than BMI category labels (e.g., patient has a BMI of 60kg/m2, rather than “morbidly obese”).
Learn about weight science
- An understanding of weight science is crucial to reduce weight stigma and provide equitable care. Learn more here.
Ensure access to treatment is not dependent on body size
- Care should always be provided to a patient regardless of their body size.
- Reconsider recommending weight loss before treatment. Recognize that dieting can cause harm (i.e. malnutrition, muscle mass loss, eating disorders) and its impact on treatment outcomes.
- Challenge BMI guidelines that restrict access to treatment based on weight and consider whether these guidelines are appropriate and truly evidence-based.
Reconsider when and how you weigh patients
- Weigh only when medically necessary (e.g., medication dosing). Weights may not need to be taken at every visit.
- Ask for patients’ consent before weighing them. Provide a private space for taking weights of patients. Turn the scale display around or ask patients to turn sideways or face forward on the scale so they don’t have to see the number.
- Do not make comments about a patient’s weight when weighing.
Help create size-friendly spaces
- Champion the need for improved accessibility of your facilities and equipment for all body sizes (i.e., chairs, exam tables, toilets, blood pressure cuffs, gowns). Use this checklist as a guide.
- Talk to your team about removing materials that promote thin ideals (i.e., magazines, weight loss/diet advertisements) and replacing them with ones that feature positive portrayals of a diverse group of individuals in different bodies.
Consider how systems and structures create health inequities
- Recognize the impact of the social determinants of health on your patients’ circumstances (e.g., income, education, safe communities).
- Reflect on structural barriers to healthcare for larger bodied patients (i.e., MRI machines that are not accessible).
- Advance your skills in doing procedures and providing support for patients in larger bodies.
Support individual health behaviours
- Ask about lifestyle in all patients as activity, diet, smoking, alcohol, sleep, etc. impact health of people of all sizes.
- Given the patient’s circumstance and readiness for change, ask about health promoting changes in the past, what they are willing to try, discuss realistic and achievable health promoting behaviours such as eating a variety of foods, adequate sleep and finding enjoyable ways to move their body rather than the goal of weight loss.
- Consider the impact of a patient’s circumstances, for example whether they are experiencing food insecurity, on their ability to make health behaviour changes. Refer clients to call 2-1-1 for local community resources.
Be eating disorder aware
- Eating disorders and disordered eating do not “look” a certain way. People of all body sizes, ages, genders, socioeconomic classes, racial backgrounds, ethnicities, and abilities can have eating disorders. (NEDIC)
- The Canadian Pediatric Society recommends that all teens, regardless of their body size, be screened for eating disorders. (CPS)
How to support patients who want to lose weight
- Validate their desire to lose weight and all the factors that contribute to that desire. Ask: “What are you hoping will be better when you lose weight?”. Patients often expect weight loss to be the answer to their health problems. As healthcare providers we may feel pressured to meet those expectations.
- Consider patient goals. Is weight loss truly necessary to meet these goals? Is the person’s desire to lose weight driven by external or internalized weight bias (for example, being told by a specialist that they need to lose weight to receive care or believing they would be happier if they were thinner)?
- Consider sharing information about weight science and the benefits of lifestyle changes regardless of weight outcomes. For example, say “when you start engaging in health behaviours, your weight may go up, it may go down or it may stay the same”.
- Ask: “What do you think would make the biggest difference in your health and wellbeing right now aside from weight loss?” or “What are some things that you could do for your health that will make you feel better?”
Recommended resources and tools
- Association for Weight and Size Inclusive Medicine: https://weightinclusivemedicine.org/
- Medical Students for Size Inclusivity: https://sizeinclusivemedicine.org/
- Association for Size Diversity and Health (ASDAH) Framework of Care: The Health at Every Size® (HAES®) Principles – ASDAH
- Weight and Healthcare Newsletter Ragen Chastain: https://weightandhealthcare.substack.com/
- Towards a Weight Inclusive Approach in Public Health: A Position Statement by the Ontario Dietitians in Public Health. Ontario Dietitians in Public Health (ODPH). Available from: https://www.odph.ca/addressing-weight-bias-resources
ODPH would like to thank academic and clinical colleagues for their helpful input.
References
- Ontario Agency for Health Protection and Promotion (Public Health Ontario). Synopsis. Review of “Weight bias: a narrative review of the evidence, assumptions, assessment, and recommendations for weight bias in health care.” Toronto, ON: Public Health Ontario;2024. https://www.publichealthontario.ca/-/media/Documents/W/24/weight-bias-narrative-review.pdf
- Mercedes M & Kriete M. Anti-fatness and public health: reconsidering “obesity” and its “prevention.” [Webinar]. New England Public Health Training Center. https://www.nephtc.org/enrol/index.php?id=336 Accessed: Nov 22, 2024.
