Weight Stigma in Healthcare

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Dr. Lesley Williams

Many healthcare providers struggle with how or why weight stigma is a public health concern.  The truth is, if you care about health, you should care about weight stigma.  The two issues are not mutually exclusive. For years, I have taken care of patients of various ages who struggle with eating disorders. More frequently than not, the onset of their eating disorder is linked to experiencing some form of weight stigma. So many children and adolescents and adults share stories with me of comments that medical professionals, friends, family members, and classmates have made about their bodies, and how those comments immediately shifted the way they saw themselves. Regardless of their prior state of mental and physical health, one negative comment regarding their weight immediately changed them from being a happy kid enjoying life, to being worried about size, weight, and how others perceive them.  One of the most concerning side effects of experiencing weight stigmatization is that it cultivates shame around food and puts the stigmatized person at increased risk for developing an eating disorder. I have never had a child tell me, “I really appreciate how harshly my doctor spoke to me regarding my weight. It really encouraged me to join the soccer team and eat more fruits and vegetables!”

Children who feel stigmatized because of their size don’t magically lose weight. Instead, they have increased levels of social isolation. depression, anxiety, and disordered eating. If we are endeavoring to end eating disorders, we must focus on where they start. By stopping weight stigma, we work towards creating a world where all children feel included and valued, regardless of their size. Children who feel comfortable with their size and how others view them  are much more likely to be happy and active and open to learning more about how to best fuel their unique body. Weight Stigma Awareness Week provides an opportunity to highlight how supporting size diversity in children and adults is a great tool for eating disorder prevention.

Physicians are notorious for perpetuating weight bias. I am often challenged by my colleagues about my Health At Every Size (HAES) approach to patient care. They feel strongly that I should be joining them in the “war against obesity” instead of embracing HAES. They share the common misperception that almost every health issue is associated with higher weight, and if we just focus on getting people to lose weight the world will be a healthier place. We have been doing this for years and it is not working. The bottom line is that there are many factors that influence an indivual’s body size and  weight.  We are doing our patients a disservice by using archaic information to address these multi-faceted issues. The topic is complex, and there are many unanswered questions about all of the factors involved. One thing we do know for sure is that being stigmatized negatively impacts health. If we are advocates for eating disorder prevention and public health equity, ending weight stigma in medicine is a great place to start. Teaching healthcare professionals how to acknowledge and address weight bias can be a helpful tool.

Patients who avoid healthcare because they are afraid of how they will be treated regarding their weight will get sicker and die quicker than those who don’t have to worry about this stigmatization. Using a weight inclusive/HAES approach to care is a great example of how we as medical professionals can come together to make a necessary paradigm shift in the field.  We should feel empowered to move away from singular focus on weight loss and compassionately treat all patients as we help them reach THEIR health goals, regardless of their size.

Dr. Lesley Williams is a Certified Eating Disorder Specialist and Family Medicine Physician practicing in Phoenix, Arizona where she owns a consultative private practice, Williams Wellness. She has worked with patients with eating disorders for over 15 years. Her areas of special interest and expertise include Health Equity and Size Diversity Advocacy. Dr. Williams currently serves on the Academy of Eating Disorder’s Diversity Equity and Inclusion Advisory Council.