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Weight stigma: Why everybody needs to act

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It is estimated that 19–42% of adults living with obesity experience stigma.
 
Weight stigma has been well documented in a large variety of societal domains, such as education, the workplace, healthcare, and the media.
 
According to the literature but also clinical experience, women experience: 

• higher prevalence of stigma
• higher levels of mental health effects associated with stigma
• an increased risk of internalising weight bias compared with men.

What does weight stigma look like?
Weight stigma can be implicit, such as unsolicited suggestions to an individual to exercise or subtle weight loss advice, but it can also be displays of micro-aggressions, such as eye rolling, tutting etcetera.
 
From a healthcare perspective it can manifest in subtle ways, such as equipment which is inadequate for the patient’s needs (eg scales that do not measure beyond 150 kg), or an inappropriate, ill-fitting blood pressure cuff.
 
These send a subliminal message to the patient that they’re ‘too big’. However, if the patients are ‘blamed’ for equipment/clothing malfunction then this is obviously explicit weight stigma.



Why should we care?
Firstly, as healthcare professionals we have an ethical duty ‘to do no harm’. As such, we must remember that our words, actions, and even inactions can do just that.
 
We have already reported on the fact that there is a mean delay of almost nine years from when a person with obesity first starts to struggle with their weight and when they first seek medical advice.
During this time, such patients develop more severe obesity and/or develop weight-related complications and/or comorbidities.
 
The consequences of weight stigma are serious and far reaching.
 
Psychological sequelae include low self-esteem due to body image, which may lead to or worsen existing mental illness such as depression and anxiety.
 
Meanwhile, fear of discrimination is a major factor in patients’ avoidance of treatment. This can impact the frequency of healthcare screening services, and result in delays in the detection of conditions such as cancer and other non-communicable diseases.
 
As a result, people with obesity have poorer treatment outcomes.
 
This World Obesity Day, what can we do?
There are several immediate actions we can take to reduce the stigma experienced by people with obesity.
 
These include:
 

• obesity-focused training/upskilling for healthcare professionals to better understand the physiology of obesity and its drivers
• additional training on weight stigma and weight bias for healthcare professionals, which includes discussing weight with patients in an empathetic and non-judgemental manner
• ensure the appropriate tools/equipment are available to treat people with overweight/obesity in healthcare settings
• developing guidance to support healthcare professionals in diagnosing and treating individuals with obesity
• supporting people with obesity to focus on gains in health, function and wellness – not just focusing on weight loss
• providing equitable access to effective anti-obesity treatment therapies within policies and government-funded treatment pathways
• changing the narrative from one of individual responsibility to one of shared responsibility.

Given this year’s World Obesity Day theme − ‘Everybody needs to act’ − what else can we do? I suggest we:
 

• use people-first language, ie people living with obesity
• use non-stigmatising images
• remember that language matters, both tone and content
• stick to the scientific facts: obesity is a chronic progressive condition; people don’t choose to have obesity
• focus on gain in health, not just weight loss.

At an individual level, now is the time to:
 

• audit your life, ie go over what you’re watching, reading, clicking on. Then ‘unfollow’ or dial back on those things which may bias or prejudice your attitude towards people living with obesity, while focusing on what lifts you up
• talk back to yourself, so that when you catch yourself speaking unkindly to yourself – ‘This outfit makes me look big’ – you can literally tell yourself something positive, like ‘My body deserves respect. It is beautiful, functional and capable’
• speak up against weight stigma if you can and consider calling it out or otherwise offering your support to the person being harmed, ie if the person speaking says they’re ‘just trying to help’, it’s okay to say, ‘Those comments are not helpful’.

What does the RACGP Red Book recommend?
The Red Book recommends that GPs measure waist circumference and calculate BMI every two years in all patients, and annually for adults with diabetes, CVD, stroke, gout, liver disease, or those who are in high-risk groups, such as people from Aboriginal and Torres Strait Islander ancestry, and people with Pacific Island heritage.
 
For people already living with overweight or obesity, it is recommended that these anthropometric measures be performed every six months.
 
When raising the issue of weight with a patient, it is important to: 
 

• seek permission to discuss obesity and its impact on their health/function
• open the discussion in a respectful, sensitive non-judgemental way
• avoid words such as ‘fat’ and ‘obese’; instead use ‘excess weight’ or ‘BMI of …’

There is no better time for all of us to take stock and consider the way we approach overweight and obesity. Anyone, including GPs, seeking additional help on this issue should visit the Obesity Action Coalition website.
 
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obesity overweight stigma World Obesity Day

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