“Not at my clinic”​ – Why fat shaming should have no place in obesity treatment

Image of a vintage scale

Fresh from my time at Obesity Week 2019, I came across a compelling op-ed in the Globe and Mail by Sasha High, medical director of the High Metabolic Clinic in Mississauga. Commenting on a recent fat-shaming Golden Globes segment by talk show host James Corden, Sasha passionately argues for a shift in our perception of people suffering from obesity in order to change how we approach its treatment and management. Despite the advances in obesity management and treatment, and its recognition as a disease, she claims its patients continue to suffer discrimation. This stigmatization redirects ‘blame’ onto patients, and creates a culture of discrimination that permeates every aspect of their lives, impacting not only their physical, but also mental health. 

In addition to the personal impact, these negative perceptions of obesity, known as weight or obesity bias, also have important ramifications for the diagnosis and management of obesity and its comorbidities. A recent study from Fruh et al. (2017) in the UK reported a significant prevalence of obesity bias amongst primary care physicians. More than 50% of physicians surveyed reported perceiving obese patients as “awkward, unattractive, ugly, and non-compliant” and having spent less time with these patients than thinner patients. 

Why are these figures important? As Sasha bluntly points out in her op-ed, fat-shaming should have no place in obesity treatment. Enacted stigma on the part of primary care physicians has critical ramifications for patients, and can reduce the quality and availability of patient-centred care. As physicians, it would be taboo to treat a patient with cancer or coronary disease with contempt; yet patients suffering from obesity often fail to receive the same consideration. The perpetuation of these negative stereotypes creates a hostile environment that can hamper diagnosis and treatment. Patients can recognize this negative bias against them, and the deterioration of the bond between patient and provider not only makes the patients less likely to seek out treatment, but also can decrease adherence to management recommendations, making treatment less effective and exacerbating the development of more severe comorbid diseases. 

Our society as a whole requires a profound change in the way we approach and inherently stigmatize weight. While this paradigm shift will require more collaborative action across multiple sectors of society, as physicians we can do our part by working to create a more supportive and understanding environment for our patients. Easy steps to combating obesity bias in our own practice and offices include: 

  • Use language and terminology that patients are comfortable with when discussing weight
  • Employ sensitive weighing procedures
  • Practice bias-free treatment approaches
  • Provide medical equipment (i.e. gowns, office chairs, etc) that can accomodate for larger sized persons

And the last, but perhaps the most important step we can implement in our practice? Recognize our own implicit bias. Self-awareness is the first step in change, and it is critical that we are conscious of our own attitudes and values in order to avoid alienating our patients and ensuring that we are providing the highest quality of care.