Obesity Stigma

Obesity is a commonly stigmatised condition that is frequently reported to elicit emotions such as disgust, anger and blame.

To stigmatise an individual is to mark the bearer with a perceived lower social value based on their physical appearance or an unfavourable character trait. The common perception is that stigmatisation is justifiable because it may motivate an individual to adopt healthier behaviours. However, prejudice against people with obesity will often just result in adverse consequences for their psychological and physical health.

Research has shown that in a clinical setting there is often a strong stigmatisation by healthcare providers towards overweight and obese patients (Puhl et al. 2010). Here, primary care providers, nurses and medical trainees were shown to hold explicit and implicit negative opinions about people with obesity. This is supported by substantial evidence that overweight and obese patients often feel disrespected, inadequate, and unwelcome when in the presence of many healthcare professionals (Phelan et al. 2015).

Overweight Healthcare Professionals

Healthcare professionals, however, are as human and flawed as everyone else and so are just as vulnerable to weight bias from their patients. If a patient stigmatises their healthcare professional with weight bias, this will affect patient trust and willingness to follow medical advice. Interestingly, many patients are also likely to change physicians after just one visit because of this stigmatisation.

Doctors and nurses are expected to be experts in nutrition and healthy living with knowledge and understanding in obesity and its co-morbidities. Clearly, being overweight is detrimental to health, with obesity and its co-morbidities being leading causes of morbidity and mortality. Therefore, patients tend to hold doctors and nurses to a stricter standard and believe they should not have the same weight management issues that they as patients may have.

Effect on Duty of Care

Overweight and obesity are leading healthcare concerns in Australia, and primary healthcare providers are in a unique position to advise and empower their patients. Health professionals are required to educate patients regarding weight management strategies, as well as health-promoting lifestyle and behavioural changes, and to be able to communicate obesity-related health implications. However, if they are perceived to be overweight or obese, then the message of weight management is often seen as hypocritical and disingenuous.

Research has shown that obese healthcare professionals are also less likely to talk to patients about weight management compared to those who are of a ‘normal’ weight. Furthermore, this study showed that overweight and obese healthcare professionals were also less likely to diagnose for obesity compared to those of a ‘normal’ weight (Bleich et al. 2012).

An interesting editorial in the BMJ challenged its readers that medical students who smoked should be channelled away from working as general practitioners (Chapman 1995). If obesity is the equivalent to smoking as the current epidemic behaviour, should overweight medical or nursing students be channelled away from primary care? Intriguing as it may be, there is of course the suggestion that this is merely just another form of obesity stigmatisation.

Barriers Against Change

It is important to note that there are many barriers against weight management in healthcare professionals. Work schedules are long and often involve prolonged sitting times. Prolonged sitting time is well documented to have numerous negative consequences for health, including proper weight management. Work routines can also mean a lack of time and willpower, which may limit efficacy of any lifestyle and behavioural changes an individual wishes to make.

Also, it must be pointed out that the increased availability of energy-dense foods, better public transport, and jobs that require less manual labour, means more calories in and fewer calories out. Here, hospital cafes have often come into criticism for serving or supplying unhealthy food choices, and this is certainly an area that should be improved to aid doctors and nurses in maintaining an ideal weight.

Summary

Obese and overweight individuals are vulnerable to biased attitudes that will affect professional credibility, trust and inclination to follow medical advice. As a profession, all healthcare individuals have a duty to combat obesity, and so encouragement for regular exercise and healthier diets should be promoted amongst all healthcare professionals.

References

Bleich, SN, Bennett, WL, Cooper, LA & Gudzune, KA 2012, ‘Impact of Physician BMI on Obesity Care and Beliefs’, Obesity (Silver Spring), vol. 20, no. 5, pp. 999-1005, viewed 16 September 2016, http://www.ncbi.nlm.nih.gov/pubmed/22262162
Chapman, S 1995, ‘Doctors Who Smoke’, BMJ: British Medical Journal, vol. 311, no. 6998, pp. 142-143.
Phelan, SM, Burgess, DJ, Griffin, JM, Hellerstedt, WL, Van Ryn, M & Yeazel, MW 2015, ‘Impact of Weight Bias and Stigma on Quality of Care and Outcomes for Patients with Obesity’, Obesity Reviews, vol. 16, no. 4, pp. 319-26, viewed 16 September 2016, http://www.ncbi.nlm.nih.gov/pubmed/25752756
Puhl, RM & Heuer CA 2010, ‘Obesity Stigma: Important Considerations for Public Health’, American Journal of Public Health, vol. 100, no. 6, pp. 1019-28, viewed 16 September 2016, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866597/

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