How Weight Bias Makes It Harder to Fight Obesity | Healthiest Communities


HOUSTON – Among the biggest hurdles obese children face are the negative stereotypes about their condition: that they’re lazy, undisciplined and don’t care about their own well-being.

Those assumptions, however, sometimes come from the same doctors, nurses and health care professionals that treat obese patients.

Stigma and bias against overweight children, and often their parents, is “very pervasive” in the health care industry, Dr. Fatima Cody Stanford, an obesity specialist at Massachusetts General Hospital in Boston, told a gathering of medical specialists on obesity Thursday.

She said those attitudes — expressed through a doctor’s careless remark, insensitive question or negative assumption about a patient’s family — can have a physical as well as psychological impact: Studies show that bias against obese young people can trigger release of stress hormones, further impeding weight loss.

That stress can have a long-term, negative effect. Patients tend to take that discomfort into adulthood, says Stanford, and the mindset can determine “whether they’re going to avoid care, whether they’re going to be reluctant to take advice.”

The event convened top medical experts, hospital executives, pediatricians, community health leaders, advocates to exchange ideas and share practices that are helping to fight the nationwide obesity epidemic.

Stanford and her copanelist, Dr. Ihuoma Eneli, director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital, agreed that obesity is usually seen as a moral failing. Too often, Eneli says, physicians don’t understand that patients who are obese have a disease that needs medical intervention, and scolding patients exacerbates the problem.

Surveys show that two out of three health care providers “have very low expectations of their patients in managing their weight. That in itself is a bias,” Eneli says. “We think it’s all about will power. We think it’s about self-control” while ignoring underlying issues like genetics, socioeconomic status and family dynamics.

Some patients “say the reason we’re struggling with weight is that we’re big-boned. The first thing (caregivers should) say is, ‘I agree with you,'” Eneli says. “You must affirm and you must hear. The key is to be humble enough to be able to listen to find that area of affirmation” that puts the patient at ease.

Stanford put a finer point on it, recalling a friend who remembered that — decades earlier, when they were both children — Stanford once told her she was fat.

“She was telling me that story for the first time,” Stanford says. As doctors, she says, “what we’re saying to kids — the language that we’re using with them (can) really set them up for failure.”

There are solutions, she adds: Massachusetts recently passed a law requiring physicians to ask about a patient’s food insecurity, a way to determine whether to direct him or her to agencies that can help. But Eneli says “you don’t have to wait for a law” to ask.

The bottom line is childhood obesity “is indeed a disease,” Eneli says, and the medical community should treat it as such. “There is (usually) something underlying it.”

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