Are You Fat-Shaming Your Patients? 

It’s no secret America has a weight problem, and losing weight is key to maintaining a healthy lifestyle. A new study shows that making someone feel bad about their weight isn’t helping – and doctors may be a part of the problem.

Two new studies show the practice known as “fat-shaming” can lead to self-blame and the avoidance of healthcare. Learn how to avoid the blame card so overweight patients don’t feel attacked when they come into the office.

Analyzing the Data on Fat-Shaming

Rebecca Puhl, deputy director at the Rudd Center for Food Policy and Obesity at the University of Connecticut, has been studying obesity for the last two decades.

In one study, nearly 14,000 adult members of WW (formerly known as Weight Watchers) across six countries, including the U.S., Australia, and much of Europe, were surveyed about their experiences with weight stigma between May and July 2020. More than half of participants (55.6 – 61.3%) across the globe said they’ve been shamed about their weight.

Between 76.0% and 87.8% said they’ve experienced weight stigma from family, 72.0%-80.9% said from classmates, 62.6%-73.5% said from doctors, 54.1%-61.7% said from coworkers, and 48.8%-66.2% said they’ve been stigmatized by their friends.

Family members can often be a big part of the problem. “When we asked open-ended questions about people’s experiences of weight stigma from family members, it was often really harsh criticism, teasing, and making fun of them,” Puhl said.

Many participants said they were fat-shamed the most during adolescence, but it doesn’t end with age.

“About 22%-30% of people reported that their first experiences of weight stigma happened by age 10, but weight stigma by family persists over time, well into adulthood,” Puhl added. “That really speaks to the need to address the family environment, which often gets neglected in the context of weight stigma. We need to be helping families engage in more supportive, less stigmatizing communication with their family members.”

Are Doctors to Blame?

Puhl and her colleagues call their other study the first “multinational investigation of associations between weight stigma and healthcare experiences.” They used the same data from the WW survey to see whether healthcare providers are helping or hurting the situation.

Between 63%-74% of those surveyed felt belittled because of their weight when seeing a doctor or healthcare provider.

In every country, this caused the person to blame themselves for their excess weight, leading to the avoidance of healthcare.

“They would get less frequent checkups with the doctor, they were more likely to view that their doctors were negatively judging them about their weight, and that their doctor had less respect for them and didn’t listen to their needs,” Puhl said of the doctor-patient relationship.

The Dangers of Weight Stigma

The research shows that stigma or shame, even just a little, doesn’t work. Some of the participants were barely overweight, but the results indicate that slight teasing can lead to weight gain down the line.

“A common perception is that a little shame or stigma might motivate people to lose weight, but that is not what we see in research,” Puhl said. “In fact, when people experience weight stigma this actually contributes to unhealthy eating behaviors, lower physical activity and weight gain.”

Puhl and her colleagues note a striking relationship found between self-blame and overeating. The more the person blames themselves for their condition, the more weight they’ve gained over the last year.

The authors argue that emphasizing individual responsibility is a mistake as our understanding of obesity evolves. Puhl says the reasons behind weight gain tend to be complex and outside of personal control.

“We certainly have created a society that facilitates obesity, with an emphasis on fast and highly processed foods and a lack of physical activity,” Puhl said. “And we’re ignoring all the other pieces of the puzzle such as genetics, environment, biology, agriculture, prices of food, food deserts and accessibility.”

“Instead, these oversimplified and inaccurate societal beliefs persist that if you just try hard enough, you can have whatever body you want – those are the beliefs that really fuel societal weight stigma,” she added. “Fundamentally, this issue is about respect and dignity and equal treatment of people across different body sizes and weights.”

Change for the Better

When it comes to reducing obesity, Puhl says the change needs to start at home. She encourages loving conversations about healthy behaviors without the stigma that often comes with talking about someone’s physical appearance.

“Our studies show that when parents shift the conversation to healthy behaviors, that tends to be much more effective,” she said. “The focus isn’t on the number on the weight scale, but on the whole family eating fruits and vegetables, replacing soda with water, getting daily physical activity.

Puhl also points to cultural factors that made fat-shaming permissible in the first place. “In the United States, it is legal to discriminate against people because of their weight. Only if you live in the state of Michigan, which passed a law in the 1970s, are you protected from discrimination (based on weight).”

Michigan is the only state to outlaw employment-based discrimination based on weight, leaving many people to fear they will get fired because of how they look.

She argues it’s also about changing the way providers and doctors are trained to think about obesity – and it starts in medical school. “Many schools have diversity curriculum, and we need to make sure that weight is part of that diversity teaching. We need to be educating medical professionals early on in medical school, instead of waiting until they are in clinical practice,” she said.