Weight stigma is when one is treated differently than others because of their weight. It can be overt or subtle, ranging from job discrimination to derogatory remarks from family, friends, coworkers, or even healthcare providers. Often, people with a higher BMI are passed over for jobs because of their weight or are paid less than their lower-weight counterparts. Examples include an airline firing their flight attendants if their BMI is too high, not based on work performance, or an obstetrician refusing to treat patients with a high BMI. Often, an undesirable person is portrayed as heavy on TV and in movies. For example, the evil witch is often portrayed as obese in animated films, or the bumbling idiot on sitcoms is often a heavy person.

People with obesity are constantly reminded about their weight, usually in a derogatory manner. They are told that obesity is their fault, and if they could simply eat less, they would not have this problem. That is like telling people with COPD to breathe more or telling somebody with depression to “think happy thoughts.” These sorts of comments reinforce weight bias and add to the already heavy burden people with obesity face. Many people with obesity grow to believe that obesity is their own fault, brought on by laziness or lack of willpower, in spite of the fact that science has shown this is simply not true.

We are slowly educating the public that obesity is a chronic disease like high blood pressure or diabetes. While behavior does play a role in the development of obesity, it is not the sole cause. Further, just because there is a behavioral component to the disease, it is no less a disease than lung cancer caused by nicotine, a pelvic fracture caused by a car accident, or cervical cancer caused by a sexually transmitted infection. People with obesity deserve the same level of compassionate care and respect from their healthcare providers. They also deserve access to evidence-based treatment options like anti-obesity pharmacotherapy and bariatric surgery.

Addressing Weight Stigma in the Exam Room

To help address weight stigma in a clinical setting, here are three steps physicians can take in their practice.

1. Use person-first language. Do not label patients with a disease. We would never call a patient “cancerous.” Similarly, don’t call your patients “obese.” A patient has cancer; similarly, a patient has
2. Avoid stigmatizing terms. We all try to use preferred language with patients. Unfortunately, however, obesity itself is often perceived in a negative way. Instead, perhaps use terms like “unhealthy weight” or “unhealthy BMI.”
3. Ask permission. People do not always want to talk about their weight, especially at an unrelated visit. Always ask permission first. Here’s an example. “Jane, I’ve determined that your BMI may be contributing to the knee pain you are experiencing. Is it okay if we talk about your BMI?”

Obesity is a disease worth treating. By recognizing that people affected by obesity have likely been experiencing weight bias in multiple areas of their life, you have an opportunity to connect with them by treating people of all shapes and sizes equally. Equip your office to accommodate all patients. Have wide chairs and a scale that can weigh patients up to 600 pounds in a private area. Train your staff that body weight is a sensitive measurement and to avoid making derogatory comments. Always use person-first language, and either offer or refer patients to evidence-based obesity treatments.

Join the Obesity Medicine Association today to stay in the know about preventing, treating, and reversing the disease of obesity and find resources for obesity and mental health: https://obesitymedicine.org/