Weight bias is a real phenomenon, and research demonstrates it can impact employment status, financial status, and even more concerning access to health care. If people with obesity have experienced stigma while receiving health care from an array of providers, they may delay necessary tests to prevent disease, like mammograms, which in turn may lead to delays in diagnosis. Recent efforts by the Obesity Action Coalition (OAC) highlight the importance of advocacy in people with obesity, to enable appropriate behavioral, medical, and surgical treatments can be accessed and received. Data shows that less than two percent of people eligible for bariatric surgery have access to that care. How do we ensure we use respectful language in working with people with obesity? Person-first language is a start; you may have noticed health articles have moved away from calling people diabetics or hypertensives and instead talk about people WITH diabetes and hypertension. It would seem that obesity has a way to go to adopt this approach.
Stephanie Sogg and colleagues from Harvard Medical School published an influential paper in 2018 in Surgery and Obesity Related Diseases addressing the importance of language in the treatment of patients seeking bariatric surgery. Medicine as a science has evolved to have a specialized vocabulary, and obesity as a term has also entered the vernacular in negative loaded ways, perhaps more than words that describe disease states such as diabetes and heart disease. Surveys conducted in the public domain often assign blame and negative attitudes toward obesity. Unfortunately, this also crosses into the medical field with professions such as nursing, psychology, and medicine, all demonstrating high levels of weight bias, which can lead to poorer health outcomes. Obesity treatment can be behaviorally, medically, or surgery based, and even in the surgical realm, people pursuing this form of treatment experience judgment.
It is not uncommon for accusations of taking the “easy way out” to be leveled at people choosing surgery from friends and family. Surgery is only part of a long pathway to optimal health, would we judge someone who had a quadruple bypass? Why is it even acceptable to arbitrate? The bottom line is it isn’t. Still, weight bias is socially pervasive, and given 70% of the US has overweight and obesity, this is problematic for people who want to address their weight by seeking evidence-based treatment.
In the table below, the authors offer alternative language to frame obesity appropriately to reduce the existing bias built into common treatment language when talking to patients about treatment options, and this paper is directed at the medical profession, changing societal norms is harder. Still, in the last decade, there have been significant shifts in people’s understanding that obesity is a more complex construct than the simple equation of calories in and calories out. Obesity is a constellation of diseases. More medical professionals are choosing to become board certified in obesity medicine, which will increase the number of professionals with the most current scientific knowledge of obesity, so, in theory, more people can access evidence-based treatments.
Changing pervasive frames can be challenging, but it is possible and frankly necessary if we are going to make progress in addressing obesity. No one should feel judged for seeking care to optimize their health, whatever those steps may be.
Thanks for reading – Trina
(Opinions are my own)