7 steps physicians can take to combat bias against patients who are obese

Colony S. Fugate, DO, asked all the physicians attending her Saturday OMED session on reducing weight bias to pull out a sheet of paper and a pen. She instructed them to write down one negative word that described themselves, and then to surround it with five positive descriptive words they identified with.

“Then write across the top of the paper—I am more than just one word,” Dr. Fugate said. “And just like us, we have to remember that our patients are more than just one word. They are more than addicts, more than asthmatics, more than obese.”

Dr. Fugate, the director of the family health and nutrition clinic at the Oklahoma State University Center for Health Sciences in Tulsa, elaborated that subconscious bias against patients who are obese and overweight can be even more prominent than it is for patients with other health conditions, because physicians are able to see right away whether a patient is overweight or obese.

That observation can affect the care a physician provides. For instance, a physician may assume that a patient lacks willpower or won’t be compliant. Often, physicians aren’t even aware that this is happening—they may have implicit bias, which occurs when people internalize stereotypes and aren’t consciously aware of their biased attitude.

However, physicians can take steps to mitigate their implicit biases, Dr. Fugate noted. Here are several she outlined, drawing on her own experience as well as advice from the University of Connecticut Rudd Center for Food Policy and Obesity:

1. Take an online implicit association test to better understand your own implicit biases.
2. Make sure you consider all of a patient’s health issues rather than using weight as a scapegoat.
3. Understand that obesity is a complex disease with complex causes, and that it requires a complex holistic solution.
4. Practice empathy, using preferential language such as weight, excess weight and BMI rather than obesity, fatness and unhealthy body weight. Use “people-first” language such as “patient with excess weight” rather than “overweight patient.” “It is a challenge to change the way you talk when you are used to talking a certain way, but with practice it does come fairly easily,” Dr. Fugate said.
5. Acknowledge the fact that losing a lot of weight and keeping it off are highly difficult, if not impossible, tasks for most people to achieve.
6. Understand, and share with your patients, that small amounts of weight loss can translate to major improvements in health outcomes.
7. Consider evidence-based models of health behavior change such as cognitive behavioral therapy and motivational interviewing.