How to help patients who are overweight or obese feel welcome in your practice

Weight bias is pervasive in the U.S., including in health care, where its consequences can be particularly damaging. Multiple studies have documented that patients who are overweight or obese (women in particular) tend to delay seeking health care to avoid being shamed due to their weight or because they fear their physician will attribute all health concerns solely to their weight.^1,2

The following tips can help practices avoid weight bias in patient care:

• Examine potential biases by asking yourself, “When I see patients who are overweight, do I automatically assume they are inactive, have a poor diet, or are uneducated or lazy?”

• Before addressing weight-related issues, ask the patient’s permission to discuss the topic (e.g., “Would it be OK to talk about your weight today?”).

• Once you have the patient’s permission, transition to questions about the patient’s goals, values, motivations, lifestyle, and challenges or barriers to change.

• Be mindful of the words you use to discuss weight with patients. Terms like “fat,” “large size,” “heaviness,” “ideal weight,” “morbidly obese,” and “weight problem” are generally off-putting. It may be helpful to ask patients how they prefer you to refer to weight.

• Focus on the patient's holistic well-being rather than just weight, and help patients develop sustainable lifestyle habits rather than just pursuing weight loss.

• Make sure the furniture in your waiting and exam rooms is comfortable for patients of higher weight, and use appropriately sized equipment, including scales, blood pressure cuffs, specula for female exams, and gowns.

These resources can help you reduce weight bias in your clinic:

• Weight Bias CME training session, American Academy of Family Physicians,
• Preventing weight bias toolkit, University of Connecticut Rudd Center for Food Policy & Obesity,
• Weight bias program, Obesity Action Coalition,
• Overcoming weight bias in the management of patients with diabetes, Clinical Diabetes,
• Adult obesity provider toolkit, California Medical Association Foundation and California Association of Health Plans.

1. Lee JA, Pausé CJ. Stigma in practice: barriers to health for fat women. Front Psychol. 2016;7:2063.

2. Mensinger JL, Tylka TL, Calamari ME. Mechanisms underlying weight status and healthcare avoidance in women: a study of weight stigma, body-related shame and guilt, and healthcare stress. Body Image. 2018;25:139–147.

Read the full FPM article: “Ending the Stigma: Improving Care for Patients Who Are Overweight or Obese."

Posted on April 11, 2022 by FPM Editors