Obese patients ‘being weight-shamed by doctors and nurses’

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Doctors and nurses often “weight-shame” people who are overweight or obese, leaving them feeling anxious, depressed and wrongly blaming themselves for their condition, research has found.

Such behaviour, although usually the result of “unconscious weight bias”, leads to people not attending medical appointments, feeling humiliated and being more likely to put on weight.

The problem is so widespread around the world that health professionals need to be taught as students that excess weight is almost guaranteed in modern society and not the fault of individuals, so they treat people more sensitively, according to the authors of the study, who have shared their findings with the Guardian.

Dr Anastasia Kalea and colleagues at University College London analysed 25 previous studies about “weight stigma”, undertaken in different countries, involving 3,554 health professionals. They found “extensive evidence [of] strong weight bias” among a wide range of health staff, including doctors, nurses, dieticians, psychologists and even obesity specialists.

Their analysis found that a number of health professionals “believe their patients are lazy, lack self-control, overindulge, are hostile, dishonest, have poor hygiene and do not follow guidance”, said Kalea, an associate professor in UCL’s division of medicine.

She added: “Sadly, healthcare, including general practice, is one of the most common settings for weight stigmatisation and we know this acts as a barrier to the services and treatments that can help people manage weight.

“An example is a GP that will unconsciously show that they do not believe that the patient complies with their eat less/exercise more regime they were asked to follow as they are not losing weight.

“Or [it could be] a dietitian, as specialist in weight management, judging the patient for not being able to follow a very low-calorie diet for a long period of time but not providing other support. Or a nurse that will be bothered by the patient needing a different set of scales to take down their weight.

“The result is that patients are not coming back or they delay their follow-up appointments, they avoid healthcare prevention services or cancel appointments due to concerns of being stigmatised due to their weight.”

She was “shocked” to find that during the Covid pandemic, when many NHS services were suspended, “many patients mentioned that they were happier with the online sessions for their treatments and they were not missing any appointments. They felt that they were not judged from the moment they leave their house to go and see their doctor.”

Kalea and her team’s findings have been published in the journal Obesity Reviews. They aimed to identify which strategies help to train health professionals to be less judgmental in how they talk to patients who are worryingly overweight. In the UK, two-thirds of adults are either overweight or obese, which has sparked warnings of even more cases of diseases such as cancer and diabetes in years to come.

The language health professionals use with such patients is vital to building a rapport, getting them to engage in attempts to reduce their weight and avoiding them feeling blamed for it. “Using patient-first language when they refer to someone living with being overweight or obesity is the beginning. It is ‘a patient with obesity’, not ‘an obese patient’. It is ‘someone who is managing their weight’, not ‘struggling with their weight’. It is more than semantics.”

Medical students, nurses and other health specialists need to be trained in “non-stigmatising weight-related communication”, the authors say in the paper.

Tam Fry, the chairman of the National Obesity Forum, said weight-shaming by health staff was a “shameful” problem which had very negative consequences for patients.

“In the 30 years since the UK decided to pursue a public health policy, educating health professionals in how to deal with obesity has never been a priority either in medical schools or postgraduate settings,” he said. “It is shameful that the condition continues to be regarded by health professionals as being solely a personal problem, little to do with them and it’s disgraceful that they stigmatise patients for being overweight.

“This is the last thing a patient wants to hear from professionals who they trust will help them.”

He backed the researchers’ conclusion that too many health staff give overweight patients the impression that they believe that their excess pounds are the result of a failure of personal responsibility.

“Obesity has never been a ‘personal problem’,” said Fry. “Healthcare professionals need to get wise to the fact that many individuals affected are powerless to overcome the obesogenic environment in which they live, notably the ultra-processed food which slick advertising and relentless encourages them to eat.

“They are invariably cash-poor and depend on this cheap but less than healthy food to live – an environment from which they have no escape.”

NHS England has been approached for comment.