Getting 'over' being overweight: improving service for all patients

What is obesity?

Obesity is an extremely complex condition resulting from many factors. Genetics, epigenetics, adverse childhood experiences, and cultural, environmental, emotional, and physiological determinants all contribute to weight (Hale, 2019). Obesity is increasingly common in Western society and its effects are negatively impacting patient outcomes.

Why is considering care of overweight and obese patients important?

Statistics Canada (2018) reports approximately 61% of Canadian adults are overweight or obese. With the majority of Canadian adults falling into these categories it’s absolutely time to consider how this population can be better served in their health care journeys.

Stigma as a barrier to healthcare

The term ‘stigma’ describes physical characteristics or character traits that mark the bearer as having lower social value. There is substantial empirical evidence that people with obesity elicit negative feelings such as disgust, anger, blame and dislike in others (Phelan, et al, 2015). These negative feelings have no place in therapeutic relationships and must be recognized and actively challenged.

What is the result of stigma toward overweight patients?

Primary care providers have reported less respect for patients with obesity compared with those without, and low respect has been shown to predict less positive affective communication and information giving (Phelan, et al, 2015). If primary care providers are less likely to provide information and positive communication to their patients it is not out of the realm of possibility that these patients will be less likely to seek out care from these providers. This negative communication style may also decrease trust in the primary health care system.

How might mistrust impact COVID-19 vaccinations?

Attitudes among those living with obesity are particularly important to understand, because obesity is a significant risk factor for poorer COVID-19 outcomes and is associated with conditions that themselves are independent risk factors for severe COVID-19. Valis and Glazer (2021) report those living with obesity in Canada are highly ambivalent about COVID-19 vaccination. Despite their being at high risk, their confidence in vaccines is very low.

Respondents participating in clinical obesity management programs were less confident in vaccinations than the general survey respondents. This may reflect greater skepticism or disillusionment related to the weight bias experienced from the medical system by most individuals with obesity (Valis, & Glazer, 2021).

How can patients with obesity be better served?

Promising strategies to reduce stigma in the primary care setting include improving provider attitudes about patients with obesity and/or reducing the likelihood that negative attitudes influence provider behaviour; altering the clinic environment or procedures to create a setting where patients with obesity feel accepted and less threatened; and empowering patients to cope with stigmatizing situations and attain high-quality health care (Hale, 2019).

One change to reduce perceived stigma in health care settings

The feelings of perceived stigma by patients with obesity are multifactorial and there is no quick fix. One small change primary health care providers can easily implement is to refrain from routinely weighing patients especially for routine visits. This small change takes the focus away from the patients weight and may reduce anxiety experienced by the patient.

The problem of stigma related to those who are overweight or obese is a complex issue which involves personal perceptions, values and beliefs. Canadian health care providers must face this issue head on to ensure better care is available to all Canadians.

References

Hale, I. (2019). Improving care for patients with obesity by recognizing weight bias. BCMJ, 61(5), 216-218. Retrieved from https://bcmj.org/cohp/improving-care-patients-obesity-recognizing- weight-bias

Phelan, S.M., et al. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16, 319–326. Retrieved from https://onlinelibrary.wiley.com/doi/pdf/10.1111/obr.12266

Statistics Canada. (2018). Obesity in Canadian adults, 2016 and 2017. Retrieved from https://www150.statcan.gc.ca/n1/pub/11-627-m/11-627-m2018033-eng.htm

Valis, M., & Glazer, S. (2021). Protecting individuals living with overweight and obesity: Attitudes and concerns towards COVID-19 vaccination in Canada. Obesity, 29(10). Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1002/oby.23182