Most Patients With Obesity Face Stigma From Doctors Too

More than half of individuals who were overweight or obese in six Western countries reported teasing or discrimination from family, friends, or co-workers, and two-thirds reported this treatment from their doctors, according to a large cross-sectional study.

A survey of approximately 14,000 adult participants in the Weight Watchers International program found the proportion who had experienced weight stigma from any source ranged from 61.3% in Canada to 55.6% in France and Germany, reported Rebecca Puhl, PhD, of the University of Connecticut in Hartford, and colleagues.

A high percentage of participants in each country experienced weight stigma from family members (range: 76.0%-87.8%), classmates (72.0%-80.9%), co-workers (54.1%-61.7%), and friends (48.8%-66.2%). Teasing was the most common treatment experienced, reported by more than half of participants in each country, Puhl’s group stated in the International Journal of Obesity.

And 66.6% of participants reported experiencing weight stigma from their doctor. The prevalence ranged from 62.6% in Australia to 73.5% in Germany. In the U.S., 62.6% of respondents said their doctor had stigmatized them about their weight at one time or another.

“Healthcare professionals are not immune to societal negative weight-based stereotypes that have become so ingrained in our culture,” Puhl explained in an email to MedPage Today. “They’re not immune to broader societal messages about body weight which so often emphasize personal willpower or discipline rather than the many complex environmental, genetic, and societal factors that contribute to weight regulation.”

“Moreover, the topic of weight stigma is rarely included in medical school curriculum or medical training,” Puhl noted. “Our findings reiterate that weight stigma needs to be addressed, early on in medical training, to help health care professionals become aware of these biases and learn strategies to minimize weight stigma in their clinical care.”

Study participants who experienced weight stigma from doctors and others reported going for medical check-ups less frequently, feeling uncomfortable having their body examined, having lower quality healthcare experiences overall, and feeling that their doctors listened to them less carefully and did not respect what they had to say, Puhl and colleagues noted.

The study included 13,966 adult members of Weight Watchers in France, Germany, Australia, Canada, the U.K., and the U.S. The mean age was 52, and >90% of participants from each country were white females. The mean BMI was 30.5.

Each participant completed an identical, online, anonymous survey in the dominant language of their country. The survey included three yes/no questions asking if participants had ever been teased, treated unfairly, or discriminated against because of their weight. The survey also assessed when in participants’ lives stigma occurred (e.g., childhood, young adulthood) and from what sources (e.g., doctors, family members, friends). The surveys were completed during May-June 2020.

Previous research has shown that self-blame, or internalized weight bias, is also common among patients who are overweight or obese, the researchers noted.

“We need to help people cope with the weight stigma they are experiencing (and internalizing) so that it does not interfere with their health or healthcare in such harmful ways,” Puhl told MedPage Today. “So our findings provide a compelling reason for us to be targeting not only weight stigma from doctors or healthcare professionals directed towards patients, but also finding ways to help reduce the internalization of bias that people have and supporting them in their healthcare experiences.”

Families were another important and potentially harmful source of weight stigma, Puhl said. “Our study findings show that family members were the most common source of stigma reported by participants in the six countries we studied. These findings suggest that cross-country efforts to address weight stigma need to prioritize the home environment — too often family-focused interventions or education have received less attention than weight stigma in settings like employment, but we can’t ignore the finding that family members are such a common source of weight stigma.”

Doctors and other healthcare professionals can play an important role in these efforts by using clinical visits as an opportunity to educate parents about the harms of weight stigma, modeling respectful language and communication about weight, and helping parents identify strategies to provide a more supportive family environment, Puhl said.

Study limitations included the primarily middle-age white women participants, and the fact that all were from Western countries, so the study results might not be generalizable to more diverse populations, the authors noted.