Five ways to reduce weight stigma, improve care for patients with overweight, obesity

Almost 70% of patients with overweight or obesity report feeling stigmatized by physicians, which could cause them to delay seeking health care, according to a paper published in Family Practice Management.

Experts said that clinicians can improve communication as well as health outcomes among these individuals by using a holistic approach to care.

Cardiorespiratory fitness is a strong predictor for morbidity and mortality among all patients, according to Ann Blair Kennedy, BCTMB, DrPH, an assistant professor of biomedical sciences and family medicine at the University of South Carolina School of Medicine Greenville, and colleagues. Yet, clinicians often focus on weight and BMI as reflectors of health rather than nutrition and physical activity.

“Focusing too much on weight rather than taking a more holistic approach can be detrimental to the care of all patients, whether overweight or not,” Kennedy and colleagues wrote. “Prioritizing a number on a scale over patients’ individual characteristics and concerns increases the risk of ‘false negatives’ (failing to diagnose a problem, such as type 2 diabetes, because the patient is not overweight) or ‘false positives’ (incorrectly diagnosing a healthy person as unhealthy due to a higher weight.”

Kennedy and colleagues compiled five steps that clinicians can take to lessen weight stigma and improve health outcomes.

See, acknowledge and treat the whole person

Focusing on holistic well-being involves considering a patient’s emotional, physical, nutritional, social and spiritual health while aiming to develop a sustainable, healthy lifestyle compared with a weight-loss end goal. Such an approach may incorporate screening for eating disorders and connecting the patient with mental health resources, according to Kennedy and colleagues.

Moreover, accounting for a patient’s social determinants of health may reveal risk factors for overweight or obesity.

“Socioeconomic factors can account for up to 80% of health outcomes,” the researchers wrote.

Identify bias and assumptions

Research indicates that long-term weight is unsustainable for most patients. Meanwhile, the long-term health risks of weight bias are “staggering,” according to Kennedy and colleagues.

Weight bias can prompt unhealthy eating behaviors, physiological reactions, reduced engagement with health care, psychological distress and a lower quality of life.

The researchers recommended that clinicians examine and address their own biases as weight bias contributes to health disparities. Clinicians can ask themselves if they automatically assume patients with overweight or obesity are inactive, have a poor diet or are uneducated. These assumptions may jeopardize the physician-patient relationship, the researchers wrote.

Practice patient-centered communication

Moving forward, clinicians can use motivational interviewing techniques to communicate health risks. Any conversations about weight should begin with the clinician asking the patient for permission to discuss the topic, Kennedy and colleagues wrote.

Clinicians should be more mindful of their word choice by replacing terms like “diet” or “exercise” with more positive synonyms like “nutritious food choices” and “physical activity,” according to the researchers.

Create a welcoming environment

A curated health care environment can signal that a patient’s health needs will be met without shame or discrimination. For example, ensuring that the waiting and exam rooms are comfortable, appropriately sized equipment is available and reading materials feature average bodies and healthy lifestyles can make patients with overweight or obesity more comfortable.

Moreover, all staff should undergo sensitivity training focused on obesity, weight management and weight loss, Kennedy and colleagues said.

Pursue lifelong learning

In addition to sensitivity training, further education and knowledge about obesity and treatment may be appropriate.

Overall, a compassionate approach to caring for patients with overweight or obesity “may be able to reduce weight stigma and the shame it provokes in patients” while ensuring that they continue to seek out care in the future, the researchers wrote.