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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Addressing Weight Bias and Stigma in Health Care

Kiera Ishmael, MPH and Kimberley Korf-Uzan, MPH

Reprinted from the "Culture" issue of Visions Journal, 2014, 9 (4), p. 18

In our society, it’s considered important to be thin and fit. Have you ever noticed that people worry and talk a lot about their weight and appearance? Have you heard people comment on others’ bodies, or even their own, in a negative way? In a society that values thinness, negative attitudes toward larger bodies can be common. Weight bias and stigma exists in employment, education and health care.

What is weight bias and stigma?

Weight bias refers to negative attitudes, beliefs, assumptions and judgments toward people who have larger body sizes.1,2 These attitudes can often lead to negative stereotypes, which cause people to wrongly assume that people who are heavier have a number of negative qualities. Examples include the false belief that larger people are physically unattractive, incompetent, lazy, unmotivated, lacking self-discipline and sloppy.3,4

A person may experience stigma when they have a characteristic (such as being heavy) that is not valued by the society they live in.5 When someone is stigmatized because of their weight, it means that the way others react to them or treat them can make them feel like a less important or less valuable member of society.6

What are the impacts of weight bias and stigma?

Research has shown that weight bias has an impact on both physical and mental health, regardless of a person’s weight. This means that weight bias itself can cause harm to health. Examples of these harms include poor body image, low self-esteem, low self-confidence, loneliness, depression, anxiety, disordered eating, stress and avoidance of physical activity.3

Patients who experience weight bias in health care settings may avoid or delay seeking health care. This can lead to health risks, including failure to diagnose and treat illnesses—which can be life-threatening. Research has shown that individuals who have a larger body size are less likely to be screened regularly for things like breast, cervical or colorectal cancer.

Reasons patients may avoid health care include feeling a lack of respect while being treated, having negative interactions with health care providers, being embarrassed about being weighed and receiving advice about losing weight, or encountering medical equipment that is too small for larger bodies.3

The harms to health that can be caused by weight bias and stigma make it an important issue to address.7 BC Mental Health and Substance Use Services (BCMHSUS) is an example of one organization which is working towards reducing weight bias and stigma in health care settings in BC.

What is BalancedView?

BalancedView is an online, interactive module being developed by BCMHSUS, an agency of the Provincial Health Services Authority. The resource is being developed in collaboration with experts and health care providers from around the province. BalancedView is expected to be available in the fall of 2014.

The goal of this resource is to decrease weight bias and stigma among health care professionals in British Columbia. Examples of health care providers include doctors, nurses, psychologists and psychiatrists, social workers and physiotherapists, among others.

BalancedView will educate health care providers about the meaning of weight bias and stigma, how it happens in health care, and the negative effect it can have on a patient’s health and overall well-being. For example, patients have described two ways that weight discrimination can happen in the health care system. The first occurs when a health professional focuses on a patient’s weight, even though the patient is looking for help for another issue. The second occurs when a health professional avoids talking about weight with their patient because they don’t feel well-prepared to address weight-related issues. Each situation can lead to frustration for both patients and health care providers.

The online module will also introduce health care providers to practical tips and tools for making changes in their practice. For example, health care providers can use the following strategies to guide their conversations with patients:

  • Initiate any conversation about weight
  • Respectfully listen to and try to understand the context of people’s lives
  • Work collaboratively with patients to meet their health goals understand food as more than “fuel”
  • Understand a person’s beliefs about their own weight

A main focus of the resource will be on helping health care providers to promote the overall health and well-being of their patients, rather than focusing on a person’s weight as the only measure of their health. For example, health care providers can encourage healthy behaviours, such as eating a balanced diet and enjoying physical activity, rather than promoting weight loss as a way to improve health.

BalancedView will also contain information, videos, quizzes and activities that will encourage health care providers to explore their own thoughts, feelings and attitudes about weight and the relationship between weight and health. The goal of this education and self-reflection is to allow health care providers to build better relationships with patients who are experiencing weight-related issues. In some cases, they may also make changes to their practice, which will result in better health outcomes for their patients.

BalancedView is just one piece of a bigger movement toward promoting a focus on health rather than weight. Changing social norms related to body weight is a big task. But people in BC are being encouraged to challenge some of their attitudes and assumptions about weight, and are learning to appreciate the fact that healthy bodies can come in different shapes and sizes. By shifting the focus from weight to well-being, together we can promote better overall health for all British Columbians.

For more information about BalancedView, contact Kiera Ishmael at 604-875-2866 or [email protected]

About the author

Kiera is a Project Manager with the BC Mental Health and Substance Use Services (BCMHSUS) Health Literacy Team. Her work involves leading health literacy initiatives that focus on eating disorders. Kiera is passionate about prevention and is co-leading the creation of BalancedView—an online resource for addressing weight bias and stigma in the health care setting

Kimberley is also a Project Manager with the BCMHSUS Health Literacy Team. She is involved in a number of initiatives related to healthy weights, body image and eating disorders. Kimberley is co-leading the creation of BalancedView

  1. Puhl, R. (2011). Weight stigmatization toward youth: A significant problem in need of societal solutions. Childhood Obesity, 7(5), 359-363.
  2. Ciao, A.C. & Latner, J.D. (2011). Reducing obesity stigma: The effectiveness of cognitive dissonance and social consensus interventions. Obesity (Silver.Spring), 19(9), 1768-1774
  3. Puhl, R. & Heuer, C. (2009). The stigma of obesity: A review and update. Obesity, 17(5):941-964.
  4. Rukavina, P.B. & Li, W. (2008). School physical activity interventions: Do not forget about obesity bias. Obesity Reviews, 9(1), 67-75.
  5. Puhl, R.M. & Brownell, K.D. (2003). Psychosocial origins of obesity stigma: Toward changing a powerful and pervasive bias. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity, 4(4), 213-227.
  6. Goffman, I. (1964). Stigma: Notes on the management of spoiled identity. New York: Prentice-Hall.
  7. MacKean, G. & Germann, K. (2013). Reducing weight bias and stigma in British Columbia’s health care system: Findings from a critical review of the literature and environmental

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