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Discriminatory attitudes about patients who are overweight or obese are pervasive in society, even among physicians. Here are five steps to help change that.

Fam Pract Manag. 2022;29(2):21-25

This content conforms to AAFP criteria for CME.

Author disclosures: no relevant financial relationships.

Cardiorespiratory fitness is a strong predictor of morbidity and mortality for individuals of all weights, yet clinicians, researchers, and the public tend to focus more on weight and body mass index (BMI) than the importance of good nutrition and physical activity.14

This reflects a national culture of weight stigmatization and bias expressed through discrimination, stereotypes, and negative attitudes/beliefs about those who are overweight or obese. Those who are overweight or obese report experiencing weight stigma throughout all areas of life, including health care.57 Physicians and other providers sometimes perceive those with obesity as noncompliant, overindulgent, lazy, and unsuccessful. They are less respected than patients who are not overweight, and some doctors report they would rather not care for those who are overweight.6 An inverse relationship has been reported between patient BMI and primary care physicians' patience, job satisfaction, and willingness to assist the patient.8 Doctors choose to spend less time with patients with obesity and order fewer preventive and diagnostic tests for them.6 Furthermore, some physicians report feeling they do not have the comfort, knowledge, time, or skill set to effectively counsel patients on issues related to weight.9

Focusing too much on weight rather than taking a more holistic approach can be detrimental to the care of all patients, whether overweight or not. Prioritizing a number on a scale over patients' individual characteristics and concerns increases the risk of “false negatives” (failing to diagnose a problem, such as type 2 diabetes, because the patient is not overweight) or “false positives” (incorrectly diagnosing a healthy person as unhealthy due to a higher weight). It can also be harder for patients who are overweight to receive proper care for concerns unrelated to weight. For example, if a patient who is overweight or obese seeks an appointment for a sinus infection or seasonal allergies and is given unsolicited advice to lose weight, this can lead to feelings of shame and delay in seeking care in the future.6

Clinicians can lessen weight stigma and improve health outcomes by communicating more productively with patients who are overweight or obese.10 This article offers five recommendations for more compassionate care, reviewed by a panel of patients in the University of South Carolina's Patient Engagement Studio, whose mission is to provide patient perspectives in scientific research and health system innovations.

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