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How We Talk About Weight Matters

The words doctors use around weight impact a patient's success at losing weight—and may even save lives. So says a provocative new review of studies.

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You wouldn’t say that someone was a thyroid person, or a diabetes person – you would say they are a person with diabetes, or a person with a thyroid disorder. Why should conversations around excess weight be any different? One important lesson from Obesity Care Week is that people-first language helps patients achieve medically-advised health goals.

"Particularly in medical settings, we found that people preferred neutral terms. So, not being called fat or obese, but just talking plainly about body weight or weight," says obesity specialist and review author Rebecca Puhl, PhD of the Rudd Center for Food Policy and Obesity at the University of Connecticut.

93 million Americans are considered medically obese, while more than a third are affected by excess weight. Obesity Care Week was created to end bias in healthcare, raise awareness, and train healthcare professionals to provide more compassionate and science-based care in the treatment of health conditions related to obesity, as well as to increase shared decision making between patients and physicians, so that they can play an active role in their own health outcomes. One simple way to make that change is how we talk about people who are struggling to lose weight for health reasons.

Putting patients before their diagnoses

Putting people first is a critical change in the way we talk about patients diagnosed with medical obesity or excess weight. It can make all the difference toward helping them make sustained and healthy lifestyle changes. Discussing a person before their health condition is a reminder for healthcare professionals to see them as a human who happens to be struggling with a health issue stemming from their weight, not a weight-related health issue first and a human being second.

As with other medical conditions and disabilities where people-first language has been adapted, the way we talk about excess weight can make the person who has the medical issue feel either cared for or ashamed. Studies show that patients who feel seen as more than just their weight feel understood and respected in medical offices, and therefore are more likely to receive life-saving preventative scans and services than those who are too afraid to be shamed by their doctor about their size to make an appointment.

According to Puhl, multiple studies in the review showed that people with higher weight are subject to weight based-stigma, prejudice, and discrimination in medical settings. Healthcare providers use of stigmatizing communication exacerbates the problem and undermines the delivery of essential healthcare services for patients with high body weight.

Impact of bias on quality of care

Another recent review of studies published in the journal Obesity Reviews on the impact of weight bias and stigma on the quality of medical care for patients with obesity found:

  • Stigma against patients with high body weight reduces the quality of care for patients considered obese regardless of intention
  • Previous experiences of poor treatment by medical professionals causes people with high body weight to avoid care, mistrust doctors for fear of being mistreated, and miss follow-up appointments for related health issues
  • Increased focus on body weight in medicine causes alienation and humiliation of patients dealing with health issues stemming from excess weight
  • Physicians and other medical professionals hold strong negative opinions about people with obesity, causing them to feel disrespected, inadequate, and unwelcome in medical settings, which affects their willingness to subject themselves to those settings even when they need care
  • Stigma against people with obesity reduces both the quality and quantity of patient care, which affects their ability to follow through with recommendations
  • Negative attitudes toward people with obesity cause worse outcomes for weight loss and mental health
  • Providers who evaluated patients as obese spent 28% less time with them than patients evaluated as being of normal weight
  • Physicians over attribute symptoms to obesity alone and fail to refer patients with high body weight for diagnostic testing or to consider treatment options other than advising the patient to lose weight, even for symptoms that may be unrelated to weight
  • In order to avoid embarrassment in a clinical setting, women who are obese are less likely to seek recommended cancer screenings
  • Patients who feel judged by their primary care provider are less likely to seek or achieve successful weight loss

Compassionate communication toward equality in care

The problem is so pervasive that the American Medical Association and the American Academy of Pediatrics both recently issued statements emphasizing the importance of compassionate communication around the topic of weight to ensure that people with high body weight are not stigmatized or shamed when seeking treatment for health issues related to their weight, in order to ensure that this significant portion of the population receive the same quality medical care as their lower-weight peers.

People-first communication is the new standard that these organizations, as well as The Obesity Society, recommend to ensure that patients dealing with high body weight stop being discriminated against based on their health issues, and start having access to the same services and care as any other person seeking treatment.

"It does seem common sense to put a person before their weight, but assumptions and stigma are so strong around obesity, that this is a slow process," says Puhl.

"Body weight is a very emotionally charged topic because it still remains highly stigmatized in our culture, which has created a barrier to supportive and respectful language. We found that the more neutral conversations can be around it in medical settings, the better."


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Anti-Obesity Bias