Bias and Stigma: Weight Discrimination in Today’s Healthcare And What You Can Do About it

What if you had a serious health condition that is common and treatable, but every healthcare provider you saw blamed you for having it?

And what if your condition put you at risk for serious diseases such as cancer, diabetes, and heart disease, but your insurance wouldn’t cover the medical appointments, medications, or surgery needed to get it under control?

That’s what it’s like for millions of Americans with obesity when they visit their healthcare professionals seeking help.

Healthcare professionals don’t blame people for having cancer, or for recurrences, yet those with obesity are often blamed for their diagnosis and failed treatments.

As a medical weight loss specialist, I see how this discrimination hurts people in tragic ways. I want to share the facts about why it happens. And close with a few simple—but powerful—steps you can take to stop the discrimination and improve access to effective obesity treatment.

Is Excess Weight Really a Personal Failing?

There is a false—but pervasive—belief that obesity is the result of overeating and inactivity. It is commonly viewed as a moral failing, rather than a treatable health condition. Those with obesity are frequently seen as lazy, unmotivated, lacking in self-discipline, less competent, non-compliant, and sloppy.

This misunderstanding has fostered a culture of blame that has not solved the problem.

Science tells a different story…

Obesity is a chronic health condition that needs to be treated as seriously as other chronic diseases such as diabetes, cancer, and heart disease. It contributes to the development of over 200 health conditions and 20 types of cancer. There are numerous contributing factors, some of which are not under a person’s control.

It requires skillful evaluation, effective treatments, and ongoing follow-up. Like other chronic conditions, it is progressive and worsens without treatment. Relapses are common.

Despite solid science, those with obesity are often stigmatized and discriminated against in every arena—the workplace, school, personal relationships, social interactions, and healthcare settings.

According to the Obesity Action Coalition, “Obesity stigma is a major issue and is the last socially acceptable form of discrimination in our society.”

The Pervasive Bias & Accepted Discrimination in Healthcare

People with obesity report that they frequently experience negative bias, stigmatization, and discrimination in healthcare settings.

In a study of 2400 adult female respondents, 69% said that physicians were a source of stigma, with 52% reporting that they have been stigmatized on multiple occasions. Nurses also have discriminatory attitudes. In one study, 31% of nurses stated that they prefer not to care for people with obesity.

This translates into discrimination that negatively impacts the health of those affected. Research shows that when seeing people with obesity, healthcare professionals:

  • Spend less time & engage in less discussion
  • Are more reluctant to provide preventive health screenings
  • Perform fewer interventions
  • Attribute unrelated problems to weight

Like many who experience discrimination, people with obesity internalize the stigma and blame themselves for their condition. When they eat healthfully and exercise, but don’t lose weight, they conclude that they aren’t trying hard enough. Out of fear of being blamed, they don’t discuss their struggles or seek guidance from their healthcare professionals.

Research shows that internalized weight bias isn’t just unpleasant, it negatively affects physical and emotional health, increases cardio-metabolic risk, and shortens lifespan.

Are Healthcare Professionals Really to Blame?

Physicians, nurse practitioners, physician’s assistants, and other healthcare professionals don’t set out to treat those with obesity differently than other patients. They are functioning within a system—and a society—that does not provide them with key knowledge and support.

Few receive education about obesity in their foundational and continuing education programs. They are expected to be medical experts, yet have very limited knowledge about obesity and weight loss. Most do not have colleagues to teach, mentor, and support them. They work in systems with high productivity demands that don’t allow for the time needed to address the complexities involved. And when they do take the time, they are rarely reimbursed for their services.

Without evidence-based knowledge, they are not able to view their patients’ excess weight as a medical problem. Out of frustration, many fall into the trap of blaming their patients for their condition…and their failure to improve.

This results in:

  • Reluctance of both clinicians and patients to initiate discussions about weight
  • Patients canceling or delaying medical appointments, including preventive screenings.
  • Health outcomes that are less favorable
  • Lower likelihood of maintaining weight loss

The Ultimate Barrier: Insurance Coverage

Despite the challenges obesity presents, effective treatment is available. Professional guidelines recommend a comprehensive approach that includes nutritional therapy, physical activity prescriptions, stress reduction, and sleep promotion, as well as anti-obesity medications, and for some, surgery.

For those who are fortunate enough to find a healthcare professional that offers effective treatment, the chance of insurance coverage is low. And when services are covered, it is typically limited to a few visits per year. Given the serious nature of weight issues and the complexities involved, this is not adequate.

Despite their effectiveness—and FDA approval—anti -obesity medications are rarely covered by insurance. Without coverage, the majority of approved medications are cost-prohibitive for most people. When they are covered, there is a cumbersome pre-authorization process that requires the participation of both clinician and patient. And after jumping through numerous time-consuming hoops, approval is often denied. It is tragic when we find something that works, but can’t use it because there is no insurance coverage.

If you think this is discriminatory, you are right.

If you think this is unfair, you are right.

If you think this is short-sighted, you are right.

If this were happening for cancer or heart disease or high blood pressure, people would be marching in the streets!

How Do We Solve This Problem?

We need an army of knowledgeable healthcare providers, a bevy of policy makers, and an infantry of informed citizens to reverse course.

The fact that 39.8% of U.S. adults have obesity and another 33% fall into the overweight category makes this important to all of us. With growing prevalence and severity, more Americans are at risk of becoming sicker—and ultimately incapacitated—by the complications of excess weight.

It is imperative that we work towards finding effective solutions for this public health crisis. The health and financial consequences of not doing so are high for those affected, and for society itself.

We need to replace myths with facts, bias with science, and stigma with respect. We need to question our assumptions, expand our thinking, and start a productive dialogue. We need to illuminate and remove barriers. We need to talk about the disease, not the person.

We need everyone—business and community leaders, policymakers, clinicians, and healthcare consumers to understand the ramifications and lobby for access to effective treatment.

We Are Moving Forward

There are a number of organizations and consortiums that are doing just that. By working together, they are bringing about change in legislation, medical education, and public awareness.

During the week of October 30th, over 50 advocates from these organizations were on Capitol Hill. They visited 70 congressional offices lobbying legislators to support the Treat & Reduce Obesity Act (TROA) and recognize National Obesity Care Week.

This advocacy proved fruitful.

The U.S. Senate unanimously passed a bill designating October 29-November 4, 2017 as National Obesity Care Week.

And several legislators offered their support of TROA, bringing the total to 135 House and Senate co-sponsors. More are needed, but this is an increase of 32 since August.

You Can Make a Difference

Five minutes of your time could make a big difference for the over 90 million US adults with obesity. Below I have outlined two simple acts that could change the course of history.

Action Step 1: Contact your legislators about the Treat & Reduce Obesity Act (TROA).

This bill will expand Medicare coverage for obesity treatment, including Part D coverage for anti-obesity medications. When this bill passes, it will be a giant step forward for obesity treatment. Precedent has been that when Medicare opts to cover treatments, other insurers follow suit.

Click here to contact your legislators »

Action Step 2: Join the Obesity Action Coalition (OAC).

This 58,000 member non-profit organization is focused on education, advocacy, and support for those with obesity. Membership is open to everyone at a cost of $10. As a member, you will receive a monthly e-newsletter, updates on advocacy efforts, and a subscription to OAC’s publication, Your Weight Matters.

Click here to join »

Better Days Lie Ahead

Let’s imagine a day in the not too distant future when those with obesity visit their healthcare providers and receive expert care delivered with warmth and respect. Their insurance covers the visits, medications, and other necessary treatments. Period. And their health improves.

If you want to learn more about the barriers and perspectives of people with obesity, healthcare professionals, and employers, click here to read about the recently published ACTION study.

Room for Possibilities

I’m excited to announce that Integrative Medical Weight Management has moved to a larger space, one that creates room for new possibilities!

My new office is located inside the Lake City Professional Center, an historic two story red brick building that was originally an elementary school.

I can easily imagine children running down the halls, squealing with delight, learning and growing with each passing day.  It couldn’t be more perfect!

I believe that healthcare offices should be warm, inviting, comfortable, and inspiring.



Golden angel wings greet all who enter, and serve as a reminder of our power to take flight.

The large paned windows bring the trees and sunlight into the rooms and allow us to glimpse beyond our self-imposed limitations.

The warm, colorful walls hug the rooms, creating a safe space to gestate health.

And did I mention the spacious parking lot and ground floor access? 

If you want to see it for yourself, drop by for a cup of tea or filtered water.  Rest in the firm, comfortable chairs in the waiting room, where you can gaze at the angel wings and expand your vision of you and your health.

 

Current Science vs. The Tainted History of Heart Healthy Nutrition How Common Advice is Wrong and Why You Should Know the Truth

Your first heart cells begin beating four weeks after conception and don’t stop until you take your last breath.

This coordinated effort happens 100,000 times a day, beat after beat, without rest.

Each time I lay my stethoscope over the heart’s pulsating chambers, I marvel at its faithful, steady beat.

As a medical weight loss specialist, my goal is to keep hearts ticking in top form. I share this goal with my patients, who cite heart health as one of their most powerful motivators for weight loss and overall health improvement.

While many factors influence heart health, none are talked about as much as food.

It’s for good reason: food is one of the most powerful substances that we put into our bodies. It can have both positive and negative effects on the heart.

I prescribe low carbohydrate eating because it has been proven to be optimal for heart health.

Low carbohydrate eating reduces or eliminates many of the risk factors for heart disease—type II diabetes, prediabetes, insulin resistance, elevated blood fats, elevated blood pressure, and inflammation. And it induces weight loss, which in itself is good for the heart.

It’s not just medical journals and professional presentations that prove these benefits—I see it every day in my clinical practice.

When patients reduce their intake of refined grains and added sugar and replace them with whole foods, I see reductions in:

  • Blood Sugar
  • Insulin
  • Triglycerides
  • LDL Particles
  • Blood Pressure
  • Inflammation
  • Fatty Liver Disease

When people add meat, eggs, cheese, butter, olives, and nuts to their diets, their waists get smaller and they get healthier.

I know this flies in the face of the low-fat dogma that’s been pushed since the 1970s.

But a growing body of evidence suggests that low-fat, high carbohydrate eating is anything but “heart healthy.”

Two prominent physicians, Robert Lustig and David Ludwig have called it “an experiment that failed.”

Discover More

The Weight Loss Science of Hope Triumphs of Health: The Victories that Thrill and Inspire Me - Part 2

When people lose weight and improve their health, a whole host of wonderful things happen.

Life improves.

Hope grows.

Research shows that losing just 5-10% of initial body weight can greatly improve metabolic, physical, and mental health.  For someone who weighs 200 pounds, a 10-20 pound loss moves them to higher ground.

Better health begins as the first pound is shed and amplifies with each subsequent pound.

Many strive to lose more, thinking it’s only worth it if they lose it all in one big, inspiring push. Then they wind up feeling overwhelmed…and that they’ve failed by not reaching their big goals.

Yet, losing just a few pounds positively improves your current and future health.

The 6 pounds you lose on your way to your big goal of 60 has a greater impact than you imagine.

As a medical weight loss specialist, it is a joy to see how much better people feel—and are—when they lose weight. Whether you have 5-10 pounds to lose or more, health always improves with weight loss. And the risk of developing new conditions declines.

And if the weight loss is maintained, the benefits continue—indefinitely.

FB-weight-loss-science-of-hope-01

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Make Courageous Change One Step at a Time Triumphs of Health: The Victories that Thrill and Inspire Me - Part I

What thrills me most about my work is seeing people transform their lives in remarkable ways.

Not sudden, giant swoops that might land them on the cover of a magazine, but in steady, powerful steps that take them further into health.

They wrestle with discouragement and internal voices urging them to quit…

But they don’t.

No matter how badly things go, they get up the next day and start again, with a desire for health tugging at their souls.

Discover More

Upcoming Engagements:
  • American Association of Nurse Practitioners Leadership & Specialty Conference, Sept 28-Oct 1, 2017 in Reno
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    My Talk: Reducing Barriers to Treatment: Billing, Bias & Advocacy

    Research shows that many with obesity face weight bias and stigmatization from their healthcare providers, resulting in missed screenings and treatment. Learn to deliver care with knowledge and sensitivity and advocate for the health of those with obesity.
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