It is widely accepted that people living with obesity are negatively affected by weight stigma, often referred to as weight-blaming; this is a form of discrimination, across all settings, based on stereotypes and prejudices about people who are either obese or overweight.
In healthcare, the negative biases associated with weight stigma are known to limit both access to health services and treatments. This has recently been the focus of a joint international consensus statement, published in Nature*, aiming to end weight stigma in healthcare globally.
Published in Obesity Reviews, researchers at UCL conducted a review to evaluate weight stigma reduction strategies in healthcare practice and healthcare education, with a view to provide recommendations for interventions, learning, and research.
Lead author, Dr Anastasia Kalea (UCL Division of Medicine) said: "Sadly healthcare, including general practice, is one of the most common settings for weight stigmatisation and we know this acts as a barrier to the services and treatments that can help people manage weight.
"A common misconception among medics and others, is that obesity is caused by factors within a person’s control, focusing on diet and exercise without recognition of, for instance, social and environmental determinants.
"In this review, it was clear more needs to be done to educate healthcare professionals and medical students on the complex range of factors regulating body weight, and to address weight stigma, explicitly emphasising its prevalence, origins, and impact."
In the largest study of its kind, researchers undertook a systematic review** of 3,773 international research articles. This included 25 weight stigma interventional initiatives, comprising a total of 3,554 participants.
Through this analysis, researchers identified that weight-inclusive approaches to education in healthcare were effective in challenging stereotypes and improving attitudes. Such methods included ethics seminars discussing patient experiences, embedding virtual story-telling of patient case studies, or empathy evoking activities in the curriculum, such as following a calorie restricted diet or participation in clinical encounters with patients living with overweight and obesity. However, other methods such as video presentations and short lectures were not equally effective in improving attitudes in the long term.
Researchers are now calling on medical schools in both the UK and globally to ensure effective and sustained weight-inclusive teaching is embedded in medical doctor training and is added to the continuing professional development of clinicians.
Dr Kalea said: "Weight stigma needs to be addressed early on and continuously throughout healthcare education and practice, by teaching the genetic and socioenvironmental determinants of weight, by discussing the sources, impact and recognising the implications of stigma on treatment. We need to move away from a solely weight-centric approach to healthcare to a health-focussed weight-inclusive one. And it is equally important to assess the effects of weight stigma in epidemiological research."
Obesity is one of the UK Government’s health priorities. Almost two-thirds (63%) of adults in England are overweight or living with obesity - and one in three children leave primary school overweight or obese, with obesity-related illnesses costing the NHS £6 billion a year***. The urgency of tackling the obesity and overweight has been brought to the fore by evidence of the link to an increased risk from COVID-19.
Dr Kalea added: "Stigma reduction interventions are a current research priority. Improving the ways we educate healthcare professionals early on is a starting point, keeping the focus on our patients; we need to communicate better, listen carefully to our patients needs and let these inform our teaching and research agendas."
Weight stigma is also known to cause ’internalised weight bias’ (IWB), which is when a person applies negative societal or cultural beliefs about body weight to themselves. This can lead to psychological distress, depression, anxiety, low self-esteem and often leads to decreased health motivation and maladaptive coping such as avoidance of timely healthcare, social isolation, reduced physical activity and disordered eating behaviours.
Weight stigma has also been shown to increase risk of developing obesity, and healthcare is one of the most common contexts where weight stigmatisation occurs. Physicians have been reported as the second most common source of weight stigma and discrimination.
Senior author, Professor Rachel Batterham OBE (UCL Division of Medicine), who leads the Centre for Obesity Research at UCL and the UCLH Centre for Weight Management said: "Identifying widely applicable ways to effectively reduce healthcare related weight stigma is urgently needed. In addition to improving healthcare provision, and the health and well-being of patients with obesity, healthcare that not only avoids, but actively addresses and reduces internalised weight bias may help patients better cope with and reduce the effects of stigma until it minimised in society. Not surprisingly, whilst stigmatising does the opposite, empathetic, non-stigmatising weight-related communication can increase patients’ health motivation and intention to comply with health professionals’ advice."
Weight stigma programme launched by UCL
Two years ago the UCL Division of Medicine designed a new MSc Obesity and Clinical Nutrition for healthcare professionals. This applied the evidence in practice to improve obesity management and adopted a weight-inclusive approach.
* Joint international consensus statement, published in Nature , co-authored by Professor Rachel Batterham OBE at UCL.
**A systematic review carefully identifies all the relevant published and unpublished studies, rates them for quality and bias.
*** UK Government: Tackling Obesity
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E: h.killworth [at] ucl.ac.uk
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