New Standards Are Clear: Weight Stigma Has No Place in Healthcare
Key takeaways
- Many people experience weight stigma, which can lead to negative mental and physical health outcomes, lower quality care, and reduced use of healthcare services.
- The ADA’s Obesity Association recently developed a new set of guidelines around overweight and obesity that aim to empower healthcare professionals to recognize and address weight bias and stigma in their care.
- These guidelines, which include recommendations for healthcare professionals around education and training, clinical environment and practice, and communication and collaboration, aim to improve obesity care for all.
For Tara Eacobacci, an executive assistant and office manager living in New York with her husband and daughter, managing her health and weight has been an uphill journey.
Having been diagnosed with three metabolic conditions and three autoimmune conditions – one of which may be linked to weight gain – Eacobacci went to her healthcare team looking for answers, support, and symptom relief. Instead, she was met with assumptions and preconceived notions about her weight and health behaviors.
“I went to my internist and was frustrated because everyone on my mother’s side of the family had been diagnosed with diabetes around the time they were going through menopause. At the time, I was starting to notice my A1C was increasing even though I was eating healthy and exercising,” said Eacobacci.
“The doctor told me the same thing I would hear over and over: That I needed to stop eating cake and candy, and I should pay attention to calories in, calories out,” she said. “The worst part was when my blood test came back confirming my A1C was increasing, he wrote in the notes the stuff about cakes and candy and calories. It was so deflating.”
As these types of interactions add up, they have a real effect on people. “All my life, I’ve felt so guilty…I get really emotional because I just wish the doctor had listened to me. I've done research, I know what I'm talking about. Don't just push me aside and say the same cliche that everyone's saying to people who look overweight,” Eacobacci said.
What is weight stigma and how does it affect people?
Weight stigma refers to the social rejection, exclusion, and mistreatment of people based on weight or size. This form of stigma stems from weight bias or negative attitudes, stereotypes, and blame that people assign to those living with obesity.
Weight stigma has consistently been shown to negatively impact mental and physical health in countless ways.
“I feel like the question is, how does weight stigma not impact people?” said James Zervios, COO of the Obesity Action Coalition (OAC). The OAC is an organization dedicated to giving a voice to people affected by obesity and helping them toward better health through education, advocacy, and support. “It impacts their interpersonal relationships, employment, and education opportunities, and contributes to internalized weight bias and stigma.”
“The number one place that we see weight stigma is healthcare,” said Zervios. “A place where somebody should be able to be vulnerable and have a conversation about their weight is one of the places where people say that they experience weight bias the most.”
The reality is that in many cases, the biases that healthcare professionals have around weight and size are unconscious, meaning they may not even be aware (or willing to admit) that they hold them.
“I think most of the healthcare professionals that I've interacted with throughout my career feel somewhat ill-equipped to deal with obesity, because it's not just about somebody gaining weight,” said Zervios. “There's a lot more to it. There’s a mental health aspect to it, and a social one as well.”
Zervios explained that this is why it’s so important to empower all healthcare teams to recognize and find ways to reduce weight stigma in their practices. Thankfully, a new set of guidelines created by the American Diabetes Association’s Obesity Association takes a crucial first step in doing just that.
What are the new standards of care?
The new standards of care for overweight and obesity acknowledge that stigma is a significant barrier to effective weight management. The document also provides guidance for healthcare professionals on how to recognize and address weight bias.
“Addressing weight stigma really starts from the moment that somebody walks into a healthcare provider’s office,” said Zervios.
For example, there should be adequate seating to accommodate anyone living with overweight and obesity, as well as necessary equipment for them. How healthcare providers interact with their patients is also critical: “Are they being told that obesity is their fault? That they should simply eat less and move more?” Zervios added.
The new recommendations are grouped into three crucial areas designed to help promote more supportive, inclusive, and compassionate care for people living with obesity:
- Healthcare professional education and training: All clinicians and staff should be trained on weight bias and stigma, which includes greater education around obesity itself, and continuous training around delivering compassionate and person-centered care.
- The physical clinical environment and practice: Healthcare teams should have protocols to minimize weight bias and stigma. This includes making sure medical equipment (scales, blood pressure cuffs, gowns, etc.) and furniture (examination tables, waiting room chairs, etc.) are suitable for everyone, regardless of weight or size. This also includes ensuring privacy when people are having their health measurements, like weight, taken in the office.
- Healthcare communication and collaboration: Healthcare teams should use person-centered, non-judgmental, and collaborative language that emphasizes shared decision-making between healthcare professionals and people living with obesity. Healthcare teams should ask permission before discussing weight, and they should ask people what their preferred words or terms are.
“Healthcare professionals have to believe that obesity is a disease, not just in their brain, but in their heart,” said Eacobacci.
“If they have empathy for us and try to really relate to what's going on, then the interactions become so much more authentic. I shouldn't have to ask every single time for a large enough blood pressure cuff. As my doctor, I shouldn’t have to educate you on how to treat me,” she said.
What do these recommendations mean for people with diabetes or obesity?
Although these recommendations were created for healthcare professionals, there is hope that they will lead to positive changes outside of the healthcare system – like creating a more empowering, respectful, and compassionate world for people living with obesity.
“I think we're hoping that if we all take this on and have a unified front saying, ‘Patients deserve better. People with obesity and diabetes deserve to be treated with dignity and respect,’ then we’re putting out this mandate saying enough is enough and we need to change things,” said Zervios.
If you are someone who has experienced weight stigma in a healthcare setting, there are things you can do. Zervios suggested pointing people to resources, like those included in OAC’s campaign Stop Weight Bias, that people can take to their healthcare provider’s office to help educate them and their staff around weight bias and how to address it.
Eacobacci has similar advice for people experiencing weight stigma. “Once you believe that you deserve better, then you have the confidence to go into the doctor’s office and say, ‘Hold up, this is actually what I need,’ or ‘You're not meeting my needs.’”
If things still aren’t changing, people should also feel empowered to find a new healthcare team, if possible, that aligns with their health goals and the type of support and treatment they want.
“I myself changed healthcare providers at a certain point. I just said, ‘This is not working anymore. We are not seeing eye to eye on how to treat this,’” said Zervios.
The bottom line
Each person living with diabetes or obesity deserves access to a supportive, empowering, and respectful healthcare team. With these new standards of care for overweight and obesity, there is hope that we will start to see progress being made.
“It’s our hope that when you go in to have that conversation [about weight] with your healthcare team, you're having a more positive experience from start to finish,” said Zervios.
Learn more about how to reduce stigma here: