Weight Bias in Medicine

 

 

For one of my first patient encounters while on my elective I was waiting for her in the hallway as her vitals were recorded. We quietly moved through blood pressure, oxygen saturation, height, and then it became time to record her weight. As she stepped on the scale she playfully joked that she was going to close her eyes. She said “I’ve already had a bad day as it is, I don’t want this to make it worse”. We all agreed with her that being weighed at the doctor is one of the worst parts. Needless to say we went on our way with the visit and I didn’t think much about it.

It wasn’t until I noticed a trend, where when those patients who would be considered overweight or obese would step onto the scale they would often times close their eyes or appear visibly upset at the number on the scale. This typically only occurred with women and rarely if ever occurred with men. I started to think, was it something we as health care providers were doing to make these women feel so uncomfortable? At first I thought it was their own insecurities but then I soon realized that maybe the place where they were going for their health check-up was also adding to their feelings of dread when stepping on the scale.

I recently read an article about obesity bias in medical training. The article was eye opening while also being somewhat discouraging. It discussed how those in training for health care professions had witnessed bias against patients who were considered obese and overweight, but what I thought was most salient was that it looked into how your own self- worth influenced how you felt that others perceived you. Overall, the article found that individuals who scored higher on feelings of low self-esteem perceived greater bias towards obese patients.

I realized that how we view ourselves as health care providers and our own self esteem can greatly impact how we treat patients, even if we are doing so subconsciously. Women are particularly vulnerable to societal pressures of what is considered “normal” and “beautiful”. It’s easy to let our internal negative voice cloud how we see one another but I never realized how much it has been engrained into patient care, a place where there should be no bias when caring for individuals.

It’s impossible to eliminate bias in one fell swoop, but I feel that by acknowledging that bias against weight in medicine exists that the hardest part is now over. We can all do our part to ensure that we are not letting our own self-worth cloud the judgment of how we view others, especially patients. It’s important to empower patients and encourage them, not make them feel targeted or ashamed at their doctor’s appointments, even if it is unconscious bias that is occurring. Now that we are aware of the systemic bias that can exist around weight in medicine, we can consciously do our part to hopefully eliminate that bias for good.

 

Stephanie Tzarnas      DUCOM 2019

 

Swami V, Pietschnig J, Stieger S, et al. An investigation of weight bias against women and its associations with individual difference factors. Body Image 2010;7:194-199.