February 02, 2023
Read 6 minutes
Rosen is the Director of Nutrition and Dietetic Services for GI OnDEMAND and co-founder of EDGI Training.
Stigma of obese patients can affect access to quality health care as well as their comfort and trust in physicians, while leading to misdiagnosis and “negligent medicine,” researchers and nutritionists report.
“Weight stigma is our negative beliefs and stereotypes based on a person’s weight, size or shape that affect the type of care they receive.” Beth Rosen, MS, RD, CDN, Beth Rosen, owner of Nutrition and director of nutrition and dietary services for GI OnDEMAND, told Helio. “It affects a broad spectrum of people with gastrointestinal disease because it’s not a stigmatizing disease condition as much as the patient’s body size.
“It’s important to know that there is not one GI disorder, or any chronic disease, that only affects people with larger bodies.”
Empirical evidence has shown that the drivers of weight gain are complex, yet misconceptions lead many to believe that it is within a person’s power to control their body weight through lifestyle modifications.
“This belief reinforces negative stereotypes of people living with obesity, including laziness and lack of willpower.” Adrian Brown, PhD, RD, Written by senior research fellows and colleagues at the University College London Center for Obesity Research eClinical Medicine. “The assumption that weight is under voluntary control misleads public health policies, confuses messages in the popular media, undermines access to evidence-based treatments, and undermines advances in research.”
In a 2016 meta-analysis, Spahlholz and colleagues reported a prevalence of perceived weight discrimination of 19.2% among patients with class I obesity and 41.8% among patients with class II obesity. Furthermore, a 2018 UK survey by the All-Party Parliamentary Group on Obesity found that 88% of patients with obesity reported stigma, 42% felt uncomfortable talking about weight with their provider and were treated respectfully by providers when seeking advice.
“People with obesity who report weight bias in the health care setting have less trust in their providers, are less likely to access health care screenings and services, have poorer outcomes, and are more likely to avoid future health care,” Brown and colleagues wrote. . “In fact, research has reported that because of weight stigma experiences, overweight or obese women delay routine cancer screening, with 83% of physicians reluctant to screen obese women.”
Helio spoke with Rosen about the harmful effects of weight stigma on patients with GI disorders, how to better care for stigmatized patients and advice for speaking weight-neutral language.
Helio: How weight stigma can be detrimental to patient dietary intervention for the Their GI condition?
Rosen: A major issue with weight stigma when it comes to GI health is that it can lead to misdiagnosis and inadequate care. If a patient with a large body walks in and the physician suggests weight loss to treat their medical condition, that is negligence medicine.
Weight loss is not a health behavior, and the recommendation can further stigmatize an already stigmatized individual, as well as prevent them from receiving the care they need. In a weight-inclusive or weight-neutral model, patients are given treatment options for their disease regardless of their body size.
There is considerable evidence that weight bias influences clinicians’ attitudes, including how patients are diagnosed, treatment options and whether they are told that the client will follow, or “comply” with, recommendations. I have seen cases where patients are prescribed a fad diet for weight loss, instead being referred to a registered dietitian to implement a dietary intervention for that specific disease state.
Healio: How often does disordered eating occur? in This patient population?
Rosen: If you are working with people with GI disorders, you are working with people with eating disorders, disordered eating or disordered eating. About 98% of patients with eating disorders have functional GI disorders. In most cases, the eating disorder comes first, but for some illnesses where people either fear eating or restrict their food intake because they blame food for their symptoms, disordered eating can be the trigger.
It is important for GI physicians to know that anyone who walks in the door may have an eating disorder and should be screened for an eating disorder, because it is so prevalent. Refer those patients to disorder professionals to treat them before they develop GI problems. In some cases, GI issues can be resolved with treatment of the eating disorder.
Healio: How can providers and other medical professionals fight weight stigma?
Rosen: Implicit bias fuels weight stigma. The first step is to admit that we all have it, and the second step is to get training to minimize it. Many resources exist online for assessing and combating implicit bias; Harvard University has a project called Project Implicit and the NIH has a program where they offer tools to correct your implicit bias and remove some of the stigma from body shape.
It is also important that physicians begin to practice weight-inclusive care by focusing on behaviors to improve health rather than “weight loss,” which could be more movement, better sleep hygiene, stress management, or changes in diet. You can do all of those things without losing weight and still find improved health results.
Another big one is to move away from BMI as a measure of health, because it’s so flawed. People exist in all shapes and sizes. We are all born different, so it only makes sense that we grow up differently.
Healio: What is the best way to care for a patient who experiences this type of stigma?
Rosen: Look at the patient-centered care model, which includes three tenants: one of communication, two of partnership and three of health promotion. None of them have weight to speak of.
Listen to the customer’s experience and acknowledge that their experience was detrimental to them. Sometimes just saying “I trust you” is enough to make a client feel comfortable with you. It is also important to note that part of the communication is consensual, such as asking the patient, “Can I touch you?” or “Is it okay if I take your blood pressure?” or “Would you like to weigh in today?” And if the answer is no, we respect that.
An example of partnership is giving them options to improve their health, asking their opinion and discussing it before implementing care. And finally, health promotion through health behaviors. Again, weight loss is not a health behavior, but what we can do to promote health based on what may be controllable factors.
Healio: What advice would you give to medical professionals? maintaining Neutral language when discussing weight?
Rosen: If they have to talk about body size, avoid using terms like “fat” and “overweight.” As I mentioned, “fat” is pathological language that means you’re sick if you’re big, and you don’t have to be; Every body size gets every kind of disease. And then also avoiding the word “overweight,” because that implies that there’s a specific weight you should be, and if you’re not, your current weight is wrong.
Bodies vary – there is no “correct” weight based on height. Your ideal weight is your natural weight; This is where you land when you’re not restricting and when you’re not mindlessly overeating because of the restriction. Not messing around with yo-yo dieting or weight cycling stabilizes your body. Unfortunately, many people don’t know where that is, because they haven’t had the opportunity to live in their bodies without being affected by the stigma of making it smaller.
The language I suggest using with a large patient, if you have to discuss anything about their weight (again, if it doesn’t speak to their health, there’s no reason to talk about it), is, “Let’s talk about what. Your fruit and vegetable consumption,” or “Have you heard of the Mediterranean diet?” or “We know from research that a plant-forward diet helps reduce the risk of liver disease – is this something that interests you?”
We also need to consider other determinants of health because while diet and exercise influence us, so do genetics, access to care, socioeconomic status, and weight stigma.
Healio: What else is important for our readers to know about this topic?
Rosen: First and foremost, using obesity as a measure of health perpetuates weight stigma. Size variations exist and we know from research that diets are neither sustainable nor safe. We should stop recommending them.
There will always be fat people, but if we reduce prejudice, we might have fat people who seek care when they don’t feel well, we might have fewer eating disorders, and hopefully, less harm.