What Can Women's Healthcare Providers Do to Reduce Weight Bias?
Healthcare for obese patients need not be compromised by these barriers. Providers can implement several strategies to increase access of gynecologic services by obese patients and improve their quality of care. Following are some strategies to consider.
Weigh With Care
Given that being weighed at the healthcare provider's office can induce sufficient anxiety and embarrassment to lead some obese women to avoid or delay preventive health screenings, it is critical for providers to be aware of this issue and ensure that the dreaded routine of "getting on the scale" is conducted appropriately and sensitively. A key first step is to ensure that weighing procedures take place in a private location, out of view of other staff and patients. Ensure that the scale can accommodate large patients accurately and comfortably. Asking a patient for her permission to be weighed and using sensitive language can help neutralize this often negative experience for obese patients. In addition, offering patients the option of facing backwards on the scale can help reduce anxiety for those who would prefer not to see the results. Finally, recording the patient's weight silently without comments can help avoid communication that may be interpreted by patients as judgmental or critical.
Use Sensitive Language
Discussing weight with patients is a sensitive topic, one that can be frustrating for both healthcare providers and patients. Many obese patients feel embarrassed, ashamed, and anxious about their weight, and it is important for providers to be mindful of their communication and tone and to use language about weight that patients feel comfortable with. Certain words to describe weight may be interpreted as pejorative or offensive to patients. For example, some research has found that obese patients prefer such words as "BMI" and "excess weight" rather than "fat," "obesity," or "weight problem." Patient preferences for language to describe body weight may vary considerably; before initiating conversations about body weight, it can be helpful to ask patients which terms they would prefer. Encouraging patients to actively participate in this conversation can help them feel more engaged and empowered about their health and can promote positive and productive discussions about health.
Create a Weight-Friendly Women's Healthcare Setting
The anxiety and shame that many obese women experience about their weight can be particularly salient when medical equipment and supplies are too small to be functional. Ensuring a positive healthcare experience for obese patients requires that basic equipment is appropriate for use with large body sizes, especially in gynecologic settings. Asking patients to disrobe but providing them with gowns that are too small; conducting routine procedures on examination tables that aren't sturdy; or performing cervical screenings without adequate supplies, such as long vaginal specula, are examples of how routine appointments can lead to loss of dignity and feelings of embarrassment and shame for obese patients. Guidelines for appropriate medical equipment for use with obese patients, published by the American Medical Association, can help you determine whether your office setting is appropriately equipped for obese patients and where improvements are needed.
Assume That Obese Patients Have Experienced Weight Bias
Given the prevalence of weight stigmatization in multiple domains of living (such as the workplace, healthcare settings, educational institutions, and familial and social relationships), it's likely that obese patients already have been mistreated because of their weight in the past. This can have long-term consequences for emotional and physical health. Being aware that obese patients may have had previous stigmatizing experiences can help healthcare providers better understand patient reluctance or anxiety about discussing their weight and the importance of listening to patients and providing support and empathy.
Focus on Health Behavior Rather Than the Scale
Healthcare providers often communicate with their patients that they need to lose weight without offering tangible, realistic strategies to help them engage in healthier eating and physical activity behaviors. Instead of focusing only on weight loss goals, it is important to shift the emphasis to behavior change goals that patients can easily monitor and maintain over time (eg, reducing intake of sugar-sweetened beverages, increasing consumption of fruits and vegetables, and engaging in daily physical activity).
In addition, many overweight and obese women experience poor body image and body dissatisfaction, but it may do more harm than good to use this as a motivator for lifestyle changes, because it can reinforce negative affect and maladaptive eating behaviors. Instead, providers can help patients focus less on changing their physical appearance and more on ways to develop a healthy, nurturing relationship with their bodies through improved eating and physical activity.
Seek Out Additional Resources
If obese patients in your practice are avoiding preventive services, such as mammograms or pelvic examinations, it may be helpful to consider additional strategies, such as:
Request a contact within a diagnostic department to help with obese patients who may have additional needs. These needs could be related to maternal obesity in pregnancy; specific education for providing clinical examinations for very obese patients; or technical expertise, such as sonography technicians who are experienced with obese patients.
Contact your professional association to obtain support for obese patients, or to request education and training on performing specific procedures (eg, pelvic examinations) with obese patients to improve care of these patients.
Consider requesting double appointment slots for obese patients who require preventive care services to ensure that sufficient time is allotted to perform procedures effectively and accurately.
For more information and resources on weight bias in healthcare, please visit the Yale University Rudd Center for Food Policy and Obesity website.