The Weight of Stigma: Heavier Patients Confront the Burden of Bias

Melissa Krechmer, a social worker in Philadelphia, grew tired of hearing the same refrain from each of her doctors. “I’d go to my allergist, and they would [say], ‘You need to take your Zyrtec, but you also need to lose weight,’” Krechmer says. “It’d be every time, no matter what type of visit.” This went on for years, even as her repeated attempts to lose weight only led her to disordered eating. It made Krechmer stop seeking care altogether.

Krechmer’s story is not uncommon. Many heavier patients report avoiding medical care for fear of mistreatment because of their size—just one of myriad ways weight stigma, or anti-fat bias, manifests in health care. In this short documentary, Scientific American partners with Retro Report to dive deeper into common misconceptions about weight and to examine how weight bias impacts heavier patients.

Weight stigma shows up in health care in many ways, from the size of blood pressure cuffs or hospital gowns to the amount of time doctors spend with their higher-weight patients. Studies dating back to the 1980s have documented provider bias, including how doctors more often describe heavier patients with negative terms such as “weak-willed,” “lazy” and “noncompliant.” Many patients have reported being misdiagnosed, with their symptoms being blamed on their weight.

Experiencing stigma alone is bad for a person’s health. It can contribute to anxiety, depression, and disordered eating and has direct physiological effects by increasing blood pressure, cortisol levels, inflammation, and fat deposition. Studies have shown that, ironically, people who experience anti-fat bias tend to gain more weight over time. And a 2016 study of more than 21,000 people found that, even after controlling for weight, physical activity, and socioeconomic status, experiencing weight discrimination was associated with increased risk for conditions such as heart disease, high cholesterol and diabetes.

In general, doctors want to give all of their patients high-quality care. But they are no more immune to implicit biases than anyone else, and the prevalence of implicit anti-fat bias has only increased in recent years (the sole form of implicit bias to do so). Plus, doctors often aren’t educated about stigma or the complexity of weight. “People know as much about obesity when they finish medical school as they did when they started,” says Fatima Cody Stanford, an obesity medicine specialist at Massachusetts General Hospital. An overburdened health care system only heightens the problem, adds Vicky Borgia, a Philadelphia-based primary care physician. She says that rushed appointments can force doctors to lean on their biases instead of taking time to consider each individual’s needs.

Slowly, Stanford says, people are starting to recognize the importance of this issue. In 2020 more than 100 medical and scientific organizations around the world came together to endorse a pledge to combat weight bias in health care. But she says there’s still a long way to go.

“Addressing weight stigma as a public health issue is extremely important,” Stanford says. “It needs to be picked up as a major threat to the health of our public.”

Want to learn more? Check out the previous short documentary of this series to find out how weight bias impacts scientific research and influences what information people accept as true.

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