Clinicians must advocate, take action to eliminate weight stigma
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Health care professionals must be advocates for reducing weight stigma by helping to develop policies and to eliminate weight discrimination in their clinics, according to a speaker at ObesityWeek 2021.
“Health professionals, including researchers and clinicians, must become versed in the methods of strategic science and policies to reduce weight stigma,” S. Bryn Austin, ScD, professor in the department of social behavior sciences and founding director of the Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED) at the Harvard Chan School of Public Health, and a research faculty member in the division of adolescent and young adult medicine at Boston Children’s Hospital, said during a presentation. “Diverse stakeholders, which can include researchers, clinicians and advocates with lived experience, all have unique and essential roles for success.”
The mission of STRIPED is to train health care professionals to use the power of public health to prevent eating disorders and related problems with food, weight and appearance as well as create a society where people of all genders can grow up at home in their own bodies.
STRIPED used the Kumanyika Equity-Oriented Prevention Framework to identify several deterrents to healthy behaviors, including the promotion of unhealthy products, threats to personal safety, and discrimination and social exclusion. Using strategic science and a policy translation arc, Austin said, health care professionals can accrue evidence and generate policies to energize political will and reduce weight stigma.
Combatting weight discrimination
One way discrimination and social exclusion can be dealt with is through government legislation. Austin said multiple studies have associated weight discrimination with lower earnings and lower likelihood to be hired or promoted in the workplace, lower ratings from teachers or college admissions in education, inaccessibility in public settings, social isolation, depression, anxiety, eating disorders and harmful physiological impacts of stress.
To root out weight discrimination, Austin said, legislation similar to U.S. age discrimination laws could be enacted, or weight discrimination protections could be added to existing civil rights or anti-discrimination laws. Multiple public opinion surveys have revealed about 79% of Americans support protections in employment law and civil rights protections against weight discrimination.
“Some progress has happened already,” Austin said. “In the U.S., 12.3 million people live in areas where there are weight anti-discrimination laws. An additional 1.9 million people are living in areas where they are protected by a court ruling. However, that still leaves us with a lot of work to do. Over 95% of people in the U.S. live in areas where they have absolutely no protection against weight discrimination.”
To get more legislation passed, coalitions of lawmakers, researchers, clinicians and advocates with lived experience are working to advise on legislation and appeal to government officials. Austin said finding advocates with lived experiences to tell their story is important as constituent stories are always more motivating than research data.
Advocating against weight-loss supplements
Another area of focus is weight-loss and dietary supplements, which Austin described as products that are dangerous and can worsen health inequities, as they are more likely to be used by women, Black and Latinx adults, and people living in homes with an annual income of less than $40,000.
“Almost all over-the-counter diet pills on the market today are dietary supplements,” Austin said. “These products can be deceptive, dangerous, and they also can include promises of weight loss, or you may have seen more recently, cleanse and detox. These products are predatory, and they profit from weight stigma.”
Multiple studies have shown many products marketed as weight-loss supplements are not effective and have no medical evidence to support their use, have been prospectively associated with eating disorders and can cause a wide range of health problems, including some life-threatening ones.
STRIPED partnered with public health law scholar Jennifer Pomeranz to lead a legal research team that published several articles on the dangers of weight-loss supplements. The team determined that weight-loss supplements are similar to tobacco from a public health point of view and should be treated similarly.
“Like with tobacco, U.S. cities and states have legal authority to act,” Austin said. “We can ban the sale to minors like tobacco, we can move the products behind the counter in stores like pseudoephedrine, we can increase taxes on the products to drive down teen use, because we know teens are very price sensitive.”
Austin said coalitions are needed to drive legislation on weight-loss supplements.
Weighing as a potential barrier to care
Another problem with weight stigma is barriers it may present in the health care system. Austin said while its easy for providers to say they want to eliminate barriers to care, it is not always easy to agree on what the barriers are and how to mitigate them.
One barrier may be routine weighing and BMI surveillance during primary care visits. Austin noted weight and BMI are included in electronic health records, school health screening, health promotion interventions, and clinical and public health research studies. She noted weight is sometimes needed for dose medication, tracking a child’s growth and targeting equity efforts. Universal weighing also alerts providers to health impacts and allows the community to monitor societal and inequity trends.
However, Austin said, there are also problems with weight, such as BMI used as a proxy for health and the time and resources it takes to perform the measurements. Universal weighing also perpetuates weight stigma, leading to avoidance of care, subpar care and shame.
Austin suggested health care providers consider asking where, how and why they conduct routing weighing by conducting a strengths, weaknesses, threats and opportunities analysis and determine whether weighing is a barrier to care or stigmatizing.
“Where, how and why do you do routine weighing?” Austin said. “Could this be a barrier to care, or could it be stigmatizing for the people who are being weighed or their BMI is being assessed?”
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Austin SB. Taking action against weight stigma – recent policy initiatives and next steps. Presented at: ObesityWeek 2021; Nov. 1-5, 2021 (virtual meeting).
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