Lori Smith, MD, is dedicated to ensuring her primary care office in Charlotte, North Carolina, is comfortable and welcoming to patients with obesity. Throughout her nearly 30 years as an internal medicine doctor, she has heard many patients express discomfort with the treatment they have received due to weight bias among physicians or their staff.
What is Weight Bias?
Weight bias refers to negative attitudes towards individuals who are overweight or obese. Even though 42 percent of U.S. adults 20 and older are obese*, weight bias remains prevalent in society.
When weight bias manifests in healthcare, it can result in individuals being subjected to insensitive comments, and patients feeling blamed for their health conditions. Feeling stigmatized because of weight can cause people to avoid or delay seeing a doctor, and when they do seek treatment, they may receive lower quality care.**
“People have had doctors say things to them like, ‘You just need to push away from the table.’ Or, ‘You’re in pain. Well, you’re going to be in pain unless you lose weight,’” Smith says. “Obesity is a complex disease. We don’t blame people for other diseases. We give them tools and support to manage it.”
As a board-certified internal medicine physician and obesity medicine specialist, Smith wants her patients to know they are in a safe and welcoming environment from the moment they arrive. To help achieve this, her staff receives training on weight bias in healthcare. She has also created a size-inclusive environment that includes:
- Armless, spacious waiting room chairs, ensuring individuals of any size can sit comfortably in any chair in the waiting room.
- A private weighing area with scales that accommodate larger individuals and handrails for stepping onto the scale.
- Bariatric exam tables with automatic power lift, enabling patients to sit down without needing to step up onto the exam table and lie down comfortably.
- Larger blood pressure cuffs, longer syringes, and other equipment to provide care to people of all sizes.
Dr. Smith shares more on weight discrimination, how she counters it, and her approach to weight management with her patients who are concerned about obesity and want to address it.
What is weight bias in healthcare?
Weight bias refers to the notion that people may blame individuals who are overweight or hold negative preconceptions about individuals due to their weight.
Do some medical professionals have weight bias?
Yes. Sometimes it can be unintentional, or unrecognized. Often, people are not aware of it unless it is brought to their attention.
What might someone experience as a result of weight bias in healthcare?
Studies have shown patients feel unheard or receive less time and attention.
Obesity is at epidemic levels, but it took a while for it to be recognized as a chronic disease. Therefore, we don’t treat it as a chronic disease at the societal level, and even in healthcare. People are stigmatized because it’s thought to be their fault. The attitude is, “All they need to do is eat better and exercise,” when we know it’s not that simple.
If people come in with diabetes, we don’t say, “Well, we’re not going to give you these tools or these medications. All you need to do is eat better and lose weight.” But that is sometimes what people with obesity hear.
We know that behaviors can play a part in many different diseases such as diabetes, heart disease, high blood pressure, high cholesterol, heart disease, COPD, and more. We provide tools for other chronic diseases, so we need to offer support and resources to people with obesity as well.
Do people sometimes avoid doctors after they’ve experienced weight bias?
Yes. Research has shown that weight bias can act as a barrier to people seeking care. Over the years, I have heard it so many times. Often, people choose not to visit the doctor’s office because they feel uncomfortable or have been treated or looked at in an undesirable manner.
One of the things we know is scolding someone like they are child does not work. “You should be doing this” or “You should be doing that.” Often, people have already been traumatized through the years. They may have body image issues or have tried to lose weight without success. Once again, the attitude of “It’s all your fault” is something we know to be untrue.
How does weight bias impact healthcare costs, and what is your message to other healthcare providers?
When patients feel isolated or believe they cannot access preventive services or experience preventable delays in diagnosis, it leads to increased cost. People need a safe place where they feel like they can get the help they need. It benefits both them and all of us. We have to try to put ourselves in their shoes and ask, “Am I being sensitive to this group of patients?” Ask yourself, “Is this a friendly, open, welcoming place for patients with obesity?” It can be as simple as ensuring you have enough chairs to accommodate them, so their first impression is not “I don’t even have a place to sit.” Do you offer any sensitivity training to the staff?
What message do you have for people with obesity who may be avoiding the doctor?
If we are sick, we want to be heard and evaluated. We don’t want a cursory exam. If we have concerns, we don’t want to be dismissed with someone saying, “Oh, if you would just lose weight, then that would go away.” Sometimes, conditions are not diagnosed or are dismissed because they are related to weight. People want support and tools available to help them manage their disease.
What are some things that people can do if they want to lose weight and how do you approach weight management?
Patients have various treatment options ranging from diet and lifestyle changes to medication to surgery.
At Avance Care Mallard Creek, you can count on the support of our team of dietitians and therapists, led by Dr. Lori Smith, a board-certified obesity specialist. Our dedicated professionals can conduct screenings for eating disorders or mood disorders. Given that many individuals grapple with issues such as depression, anxiety, trauma, or concerns related to body image, it is imperative to explore and address any underlying factors. We strive to comprehensively evaluate your well-being and provide the necessary assistance.
There are numerous factors that can affect our weight. While most people are familiar with the impact of diet and exercise, our sleep, environment, learned behaviors, hormones, gut health, metabolism, and medications also play a role. It is not simply about a matter of calories in and calories out.
We approach weight management step by step, recognizing we will not have all the answers right away. It is long-term with ups and downs. We can try different strategies, and if something doesn’t work, we move on to the next. It requires commitment and patience.
Having support is critical. We’re also introducing support groups for weight management. When you have support or when someone helps you, it is beneficial for that support to come from someone who is also walking in those same shoes, or who has been there.
Weight management support groups are coming to Avance Care Mallard Creek soon. In the meantime, get to know Dr. Smith, or schedule an appointment with her or her team.
*Source: CDC, https://www.cdc.gov/obesity/data/adult.html
**Source: Obesity Reviews, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381543
