Weight bias in healthcare: ubiquitous, damaging, and needs addressing

“You know, you really should think about losing weight”—If you’ve ever heard those words from a healthcare provider when consulting them about something completely unrelated to your weight, you’ve experienced weight bias. 

You might have faced weight bias in the workplace, in school, on an airplane, or at the grocery store, in the form of comments or treatment related to your weight. 

Weight bias is everywhere, and it’s highly damaging—both to individuals and to our society. 

Nearly 74% of US adults have overweight, according to the Centers for Disease Control and Prevention (CDC). So, we’re in a lot of trouble as a society if we can’t learn to address and reduce weight bias. 

Keep reading to understand what weight bias is, its effects, and how we can work to reduce it. 

Weight bias is when people have certain attitudes or assumptions about others based on their weight. Often, these attitudes can lead to treating those with excess weight differently—simply because of their weight. 

We all have biases—it’s one of the many flawed parts of being human. Simply having biases (of any kind, including weight bias) doesn’t make a person bad or wrong. The key is to be aware of your biases and work to reduce their harmful effects.

Weight bias shows up in many settings, and healthcare is one of the most egregious. 

There are a few key ways that weight bias shows up in healthcare, according to Dr. Tzvi Doron, an obesity medicine specialist. 

Patient blaming

“Healthcare providers often will blame their patients for their weight,” says Dr. Doron. “Patients shouldn’t be blamed for having obesity, any more than they should be blamed for having cancer, asthma, or psoriasis”—in other words, not at all. 

We know now that obesity is a complex disease and should be treated as such. Just like other chronic conditions (including those mentioned), treating obesity usually needs a multi-pronged approach, including behavioral modification. But acknowledging a patient’s role in treating their condition shouldn’t in any way come from a place of blame, but rather partnership. 

When healthcare providers start interacting with patients assuming they’re to blame for their condition, it colors the whole exchange negatively. They’re less likely to see everything that’s going on, and certainly less likely to be able to speak to their patient in an effective and helpful manner. 

Missed diagnoses

Dr. Doron points to one of the most dangerous ways weight bias can show up, “when healthcare providers automatically assume that every symptom or issue in a patient with obesity comes from their weight, without doing a real evaluation of what’s really going on. This can cause delayed or missed diagnoses, which can be very dangerous.”

If someone with obesity goes to their provider complaining of fatigue, for example, only to get sent home with the unhelpful directive to “lose some weight,” that provider has failed their patient. 

“Excess body fat is linked to a wide range of health conditions, so many providers assume everything comes from weight. Not everything comes from weight,” says Dr. Doron unequivocally. 

Obesity can indeed cause fatigue, among many other health conditions, but fatigue can also come from depression, sleep disorders, or even severe health conditions (like cancer, kidney, liver, or heart disease) in some cases. Without a full work-up, there’s no way to know what’s really going on. Assuming weight is the primary culprit comes from a place of bias, resulting in bad medicine. 

Poor coverage

Beyond individual healthcare providers, many people face weight bias on a systemic level within the healthcare system. “One of the main manifestations of this,” adds Dr. Doron, “is many treatments are not covered by insurance.” 

If you’ve ever tried to get coverage for weight loss medications, behavioral treatments (like a dietitian), or even surgery, you know how challenging this can be. While some insurance companies are starting to cover certain treatments, the hoops people have to jump through points to the severity of systemic weight bias that exists.   

“In short,” says Dr. Doron, “obesity and overweight being treated differently than other diseases is weight bias. Plain and simple.” 

Weight bias and weight stigma have far reaching effects. 

As we’ve already discussed, people with obesity can be misdiagnosed due to a provider’s implicit or explicit weight bias. This can prevent them from getting early treatment for conditions not necessarily related to obesity. 

Another effect of people regularly facing weight bias in healthcare settings is they’re less likely to seek care when they need it. That includes recommended cancer screenings, which are essential for catching cancer early, when it’s easier to treat. 

Outside of healthcare, people with obesity also face discrimination in the workplace, including hiring, performance reviews, and promotions. In educational settings, students with obesity get lower grades for the same quality of work (in a study setting, when teachers evaluated the quality of a student essay accompanied by photographs that portrayed the student as either not overweight or overweight). Weight discrimination can start as early as kindergarten. 

Clearly, weight bias is far from benign and needs to be addressed. 

There are many related terms you might encounter when it comes to weight bias. Some of these include weight discrimination, weight stigma, fat shaming, and body shaming. In general, according to Dr. Doron, “Weight bias is the broadest term,” with multiple manifestations. In other words, all fat shaming is a type of weight bias, but not all weight bias shows up in the form of fat shaming. 

While weight bias could be implicit—meaning it’s not necessarily even known by the person holding that bias—fat shaming is the most explicit manifestation of weight bias. Fat shaming, says Dr. Doron, “is when someone deliberately makes someone feel bad about their weight.” 

Fat shaming and body shaming are forms of bullying, which people with obesity may encounter in a wide range of settings. In some ways, it’s easier to address these explicit forms of discrimination than biases that often exist on a subconscious level, but still, it’s worthwhile to address this issue from all possible angles. 

Before we get into ways to address weight bias, it’s important to reiterate that simply having biases does not make you (or anyone else) bad, and it’s not something we should feel defensive about. We all have biases, which may come from the environment we grew up in, our culture of origin, messages we’ve gotten through the media, a lack of education about particular issues or groups, or any number of other contributing factors.

But our implicit and explicit biases tend to cause harm, so it’s essential to address them. On an individual level, Dr. Doron says the most important things are to “know this bias exists, acknowledge it, examine your biases, try to remain aware of them, and not give into them.”

We can all acknowledge we have biases, but staying vigilant about our own biases is key. What’s not helpful is shaming others for the biases they have—which is just another form of bias and shame. Instead, we can be aware of our own biases and work to overcome (or mitigate) them. 

What about on a societal or systemic level? “Some things require policy changes,” says Dr. Doron. “For instance, making sure treatments for obesity are covered, so that obesity is treated no differently from other diseases.”  

“Even if you maintain your internal bias,” he adds, “if you start covering treatments, that’s already a step in the right direction.”

Another area that needs to be addressed on a systemic level is how medical students are being prepared to treat patients with obesity. As of now, frankly, they’re not. One survey showed that very few medical schools self-report as adequately preparing their students on how to treat patients with obesity. 

“It’s a travesty,” Dr. Doron says. “Obesity is literally the most prevalent disease in the US. In medical school, we learn about these super rare genetic diseases that most doctors will never see even once, but the disease literally everyone will encounter is barely talked about in school.”

So, in short: 

• We all need to be aware of our biases and fight against them.

• The medical system needs to start treating obesity like any other disease. 

• Medical schools need to educate their students on how to treat patients with obesity, and specifically on how to recognize and resist weight bias. 

Yes, when done appropriately and in the right context, your healthcare provider not only can bring up your weight but should. After all, your provider’s job (especially in a primary care setting) is to flag any health concerns you should be aware of, then work with you to address those.

However, there’s a right way and a wrong way for your provider to address this with you. 

As we’ve mentioned, if they continually bring up your weight completely out of context and dismiss your symptoms or concerns, do yourself a favor and find a new healthcare provider. 

When the context is appropriate (for example, if you’re at your annual checkup and your weight has increased dramatically since your last visit), your provider can bring this up by asking you if you’re comfortable discussing your weight. They should get your permission to broach the topic before delving into a discussion about your treatment options. 

If you’re open to a discussion, it should start from a place of your provider trying to understand your feelings about your weight. If you understand the potential health risks of obesity and you’re happy with your weight, your provider should respect that and leave the door open for you to bring it up with them at a later date if you decide to do that. 

No one with obesity should have to deal with weight bias and its consequences in their daily lives. We can—and must—address it on an individual and systemic level.

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Current version

May 24, 2023

Written by

Rachel Honeyman

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.