Weight Based Discrimination in Medicine
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Discrimination in the Doctor's Office
Weight discrimination is bias against a person due to their weight. It can be subtle or it can be blatantly obvious. The number one place where patients face weight-based discrimination is the doctor’s office. Sometimes physicians not trained to properly understand obesity medicine make the mistake of attributing symptoms of more serious diseases simply to excess weight. A recent instance was when one lady went to the physician for a shortness of breath problem and her physician attributed that symptom to her excess weight. However, it ended up being that she had lung cancer. She was not properly treated due to the stigmatization and generalization against overweight patients. It is also important to mention that this sort of bias, directly or indirectly, is worst when it comes from people of influence, such as parents, politicians, celebrities, doctors, etc.
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Psychological Effects of Weight Bias
Those who experience weight-based discrimination are emotionally affected which can lead to challenges such as increased body dissatisfaction, eating disorders, or other self-destructive behaviors. Additionally, research has shown that weight-based discrimination can also manifest into physical problems as well.
Patients may change their priorities in order to protect themselves from experiencing bias. It has been shown that those who experience bias are less likely to get routine medical check-ups or care. The false notion that those with excess weight are lazy or not disciplined is very harmful. Individuals are more likely to continue to further do the habits that are conducive to obesity such as eating more or avoiding exercise in a sense of almost hopelessness and acceptance of such things being told to them.
These sort of stereotypes increase the occurrence of binge-eating and it becomes a constant downward feedback loop. Overeating is a common emotion-regulation strategy. When people face discrimination, they have negative emotions which lead to them overeating. They then face further bias and fall into a spiral of repeated self-sabotaging behaviors. Public health measures that are taken with a good intent at their cores but proceed in the method of shaming and blaming individuals have been shown not to help people. Such methods lead people to have a negative perception of their body weight, which increases their negative emotions and thus leads to decreased cognitive control.
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Physical Impacts of Weight Based Discrimination
Physical effects of weight based discrimination are higher C-reactive protein (CRP) levels. C-reactive protein is an agent that is indicative of the level of inflammation in the body. Those with not too high BMIs who face weight discrimination will have higher inflammatory levels that their non-discriminated counterparts with the same BMI. Their CRP levels would be as high as someone who is heavier than them and faces serious health complications. Therefore, even if someones BMI is not as dangerous, weight discrimination can lead them to experience the same physical manifestations, ailments and inflammatory levels. Increased CRP levels also increase the risk of depression. Due the the physical and behavioral complications, those who experience weight bias and/or discrimination tend to keep that weight on for four years longer than those with the same weight who do not experience bias.
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Sources:
Amy, N. K., Aalborg, A. K., Lyons, P. K., & Keranen, L. K. (2005). Barriers to routine gynecological cancer screening for White and African-American obese women. Original Article Published: 04 October 2005 Barriers to Routine Gynecological Cancer Screening for White and African-American Obese Women N K Amy, A Aalborg, P Lyons & L Keranen International Journal of Obesity , 30, 147–155. Retrieved from https://www.nature.com/articles/0803105
Obesity, Cluelessness, and Shamefulness. (2019, September 13). Retrieved from https://conscienhealth.org/2019/09/obesity-cluelessness-and-shamefulness/.
Sutin, A. R., Stephan, Y., Luchetti, M., & Terracciano, A. (2014). Perceived weight discrimination and C-reactive protein. Obesity, 22(9), 1959–1961. doi: 10.1002/oby.20789
Sutin, A. R., & Terracciano, A. (2013). Perceived weight discrimination and obesity. PloS one, 8(7), e70048. doi:10.1371/journal.pone.0070048
Tomiyama, A. J., Carr, D., Granberg, E. M., Major, B., Robinson, E., Sutin, A. R., & Brewis, A. (2018). How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Medicine, 16(1). doi: 10.1186/s12916-018-1116-5
Wium-Andersen MK, Ørsted DD, Nielsen SF, Nordestgaard BG. Elevated C-Reactive Protein Levels, Psychological Distress, and Depression in 73 131 Individuals. JAMA Psychiatry. 2013;70(2):176–184. doi:10.1001/2013.jamapsychiatry.102