Weight Bias in Healthcare

5 min readAug 29, 2022

By Yasmina Zaarour

Societal stigmatization of obesity manifests from internalized weight bias, including negative connotations and labels surrounding people who weigh more than the societal ideal . Weight stigma presents itself in the way people labeled “obese” are bullied as children, paid less as adults, and portrayed negatively in television shows and movies [1]. On an individual level, beliefs about how people should look or how much they should weigh are acquired at a young age. When impressionable young children hear their parents make negative comments about their own bodies, they internalize them [2]. However, while those who make such comments may have good intentions, they tend to have the opposite effect [2]. One study in the American Journal of Public Health found that 79% of overweight people coped with psychologically damaging comments by increasing food intake [2]. Another study found that this effect of weight stigma on increased food intake was independent of an individual’s BMI [3]. Physicians can play key roles in either managing or worsening patients’ experiences with weight stigma [3].

Unlike race-, gender-, and sexuality-based bias, weight-based bias is still legal in every state [2]. This means that healthcare providers can legally treat patients differently based on their own internal prejudices. This usually results in physicians overgeneralizing, by pin-pointing obesity as the cause of every illness [4]. One woman in Jacksonville, for example, reported seeing her family doctor for heavy periods, exhaustion, and stomach cramps, and without any testing (which would have otherwise been done on a thinner person), he blamed her issues on “being fat” [5]. After switching physicians, she got a proper diagnosis of an enlarged uterus. This case demonstrates the physical danger of misdiagnoses. Another woman experienced something similar, where her physician mistakenly diagnosed her with Type II diabetes without any clinical evidence [4]. Experiences such as these cause distrust in the medical field, which leads to hesitancy to see doctors when ill, and eventually higher risk of developing critical conditions [4].

A quantitative measure of obesity, BMI, is calculated at nearly every doctor’s visit. But despite its widespread use, it can be inaccurate as it only takes into account total weight and height [6]. There are other aspects that determine if someone’s body weight is right for them, including body fat percentage, gender, and age. Additionally, obesity’s negative effects are not black and white, with high BMI being protective against death after surgery. Another issue with the BMI is that its creator, Lambert Adolphe Jacques Quetelet, was not a healthcare provider of any kind; he was a mathematician and astronomer in the 1830s. Instead of using BMI as a blanket marker of health, experts today call for further research to be done regarding the metabolic pathway between obesity and chronic disease.

The COVID-19 pandemic only made negative body image talk and weight stigma even more prevalent, especially when 42% of Americans report undesired weight gain [7]. Because obesity is one of the highest risk factors for developing a more serious form of COVID-19, fear surrounding the pandemic could have worsened the negative connotations around the word “obesity.” However, the endless bombardment of media coverage regarding the “COVID 15” neglects the psychological and structural determinants of body weight. Increased food intake became a normal coping mechanism when the pandemic took away many people’s healthy ones. People particularly vulnerable to using food to cope with stress are those who have experienced weight discrimination pre-pandemic, according to a study by clinical psychologist Rebecca Puhl, furthering the point that stigmatizing comments can cause long-lasting damage to our psychological and physical health.

On a structural level, the COVID-19 pandemic reduced people’s access to healthy, fresh food, especially those living in low-income areas or food deserts [7]. With lockdown orders and social distancing measures in place, people were encouraged to stockpile food to minimize leaving the house. This means that most people, particularly those living paycheck to paycheck, resorted to buying mostly non-perishable foods and less fresh, whole produce, leading to unhealthy eating patterns. Additionally, many low-income areas are not as walkable and have a lack of safe, outdoor green space, so inability to exercise and get fresh air can reduce one’s ability to cope with quarantine orders. Lastly, many people in marginalized communities did not have the luxury of working from home, which added to the stress of potential exposure to COVID, finding childcare, and paying for food. These various structural factors affecting marginalized communities were only amplified during the pandemic, adding to psychological distress. Therefore, the narrative surrounding weight gain during such a stressful period in time should be changed to be more compassionate and considerate of why people gain weight.

Changing the narrative requires those in positions of authority to start reflecting on their own internalized beliefs. As primary sources of health information, physicians have a responsibility to have positive and empathetic conversations with patients, and this includes treating them as whole beings and not just a body [3,4,5]. By taking into account social determinants of health, such as the ones described previously, physicians can come up with individualized plans to manage patients’ health conditions instead of attributing every illness to obesity [4]. The American Medical Association attempted to normalize this in healthcare settings by passing official recommendations in 2017 to use more neutral language when referring to weight [3]. Another welcomed change would be to offer a wider range of blood pressure cuffs, hospital gowns, and waiting room chairs in clinics to improve patients’ comfort at already nerve wracking visits [1].

Many individuals’ internalized weight stigma stems from comments made by those they trust, including their doctors. And as doctors vow to “do no harm,” they should reflect on ways that their weight-filled conversations harm patients both psychologically and physically. Reducing obesity rates in America, and associated chronic diseases, begins with reducing guilt, fear, and discrimination.

Yasmina Zaarour is a third year Neuroscience major at UCLA and is a THINQ 2022 intern.

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Weight Bias in Healthcare

Written by THINQ at UCLA