Reducing Weight Bias in Obesity Management, Practice, & Policy
Key messages for healthcare policy makers
- Policy makers developing obesity policies should assess and reflect on their own attitudes and beliefs related to obesity1.
- Public health policy makers should avoid using stigmatising language and images. It is well established that shaming does not change behaviours. In fact, shaming can increase the likelihood of individuals pursuing unhealthy behaviours and has no place in an evidence- based approach to obesity management 2, 3.
- Avoid making assumptions in population health policies that healthy behaviours will or should result in weight change. Weight is not a behaviour and should not be a target for behaviour change. Avoid evaluating healthy eating and physical activity policies, programmes, and campaigns in terms of population-level weight or body mass index outcomes. Instead, emphasise health and quality of life for people of all sizes. As weight bias contributes to health and social inequalities, advocate for and support people living with obesity. This includes supporting policy action to prevent weight bias and weight-based discrimination 2-8.
- Policy makers should know that most people living with obesity have experienced weight bias or some form of weight-based discrimination. Public health policy makers should consider weight bias and obesity stigma as added burdens on population health outcomes and develop interventions to address them. To avoid compounding the problem, we encourage policy makers to do no harm, to develop people-centred policies that move beyond personal responsibility, recognise the complexity of obesity, and promote health, dignity and respect, regardless of body weight or shape.
Key messages for healthcare professionals
- Weight stigma amongst healthcare professionals (HCPs) can lead to non-supportive, judgemental encounters with individuals affected by obesity and this may discourage these individuals from seeking help, and the care that they are entitled to and require.
- Weight stigma in healthcare can result in delayed diagnosis, the development and increased severity of obesity complications, reduced treatment efficacy and reduced quality of life for individuals with obesity.
- HCPs should ensure their clinical environment is accessible, safe and respectful for all patients regardless of their weight or size. They should make efforts to improve health and quality of life rather than solely focusing on weight loss. HCPs should ask permission before weighing someone, and never weigh people in front of others. Weighing scales should be placed in private areas. HCPs should consider how their office physical space accommodates people of all sizes and ensure they have properly sized equipment (e.g., blood pressure cuffs, gowns, chairs, beds) ready in clinical rooms prior to patients arriving.
- Weight bias impacts morbidity and mortality. It follows that advocacy and support for people living with obesity is a part of the HCP duty of care. This includes action to create supportive healthcare environments and policies for people of all sizes8.
- Healthcare professionals (HCPs) should assess their own attitudes and beliefs regarding obesity and consider how their attitudes and beliefs may influence care delivery (Level1a, Grade A)1.
- HCPs should recognise that internalised weight bias (bias towards oneself) in people living with obesity can affect behavioural and health outcomes (Level 2a, Grade B) 9-12.
- HCPs should avoid using judgemental words (Level 1a, Grade A)2, images (Level 2b, Grade B)2 and practices (Level 2a, Grade B)13 when working with patients living with obesity.
- We recommend that HCPs avoid making assumptions that an ailment or complaint a patient presents with is related to their body weight (Level 3, Grade C)13,14.
- We recommend that all professional health disciplines include training on weight bias, stigma, and discrimination in their curricula (Level 4, Grade D, consensus).
- We recommend that formal teaching on the uncontrollable and non-modifiable causes of obesity, and the management of obesity as a chronic disease, should be incorporated into training programmes for healthcare professionals (adapted from Primary Care recommendations, Level 1, Grade A).
Key messages for people living with obesity
- Weight bias affects the quality of healthcare for individuals with obesity. For example, weight bias may negatively affect healthcare professionals’ (HCPs) attitudes and behaviours towards individuals living with obesity8,13.
- Experience of weight bias harms your health and wellbeing. Experiencing unequal treatment because of your size or weight, for example, is not acceptable. Talk to your healthcare professional about your experiences with weight bias. By sharing these experiences, you can support action to stop weight-based discrimination15-17. Talking to your HCP about your experiences with weight bias will help stop weight-based discrimination directed towards you, and others. The Irish Coalition for People living with Obesity (ICPO) have template letters that patients can use to send to HCPs explaining how experiencing weight bias has made them feel. They can be contacted at icpobesity.org for further details15-17.
- Talk to your HCP about addressing internalised weight bias. Bias can unconsciously impact your choices and your health. Self-stigma and self-blame can be addressed through behavioural interventions, consistent with the principles of cognitive therapy and acceptance and commitment therapy9,18-22 (see Chapter 10 Effective Psychological and Behavioural Interventions in Obesity Management chapter for more information on these therapies).
- Try focusing on improving healthy habits and quality of life rather than weight loss. Weight is not a behaviour and should not be a target for behaviour change23, 24.
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