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How To Handle Weight Stigma Issues in Clinical Practice

Learn more about the strategies for addressing weight stigma in clinical practice.
SPEAKER: In the second short talk we’re going to cover some key recommendations in the literature to enhance weight literacy and reduce weight stigma in health professionals.
So first, why do we worry about weight stigma in health care? And what impact does perception of weight stigma have on the individual? The literature shows us quite a lot.
Perception of weight stigma, often called internalisation of weight stigma, is associated with low self-esteem, obesity, physiological stress, depression, and lowered physical activity levels.
And this is because what we think and feel directly impacts our behaviour. And so the perception of stigma within the health care systems will significantly influence patient self beliefs, self-efficacy, and influence how patients engage in the health care system.
Now we may think that we certainly do no harm and would never be stigmatising or discriminating against any of our patients who had overweight. And we may not have any explicit negative attitudes towards people who have overweight. But our subconscious bias, or even the bio-mechanical paradigm with which some health professionals view overweight or obesity, can in itself be pervasively stigmatising. And that is why it is important that we are familiar with the contemporary evidence about the physiology of obesity and evidence based interventions.
The stress of stigma has been widely investigated, particularly in the United States. Perception of weight stigma has been linked to anxiety, depression, self-esteem, body image, and psychological distress. Interestingly this relationship persists even when controlling for body weight or BMI. So it is actually the internalisation or perception of weight discrimination that is most strongly linked to the psychological presentations and weight change.
As you can see in this slide, stress related cortisone reactivity has many documented adverse consequences for the metabolic and endocrine systems.
The flow and effects of perception of weight stigma are outlined here and also in the learning module. The evidence shows us that perception of weight stigma and the stress associated with weight stigma have many flow-on effects for psychological and physiological health, health behaviours, and health care engagement in individuals who are overweight or obese.
But most simply for clinical relevance, perception of weight stigma influences the extent that patients trust and engage with health care professionals. Adopt positive health behaviours and their motivation to act, this has direct relevance for patients’ health care outcomes.
So we know that health care professionals often hold weight stigmatised attitudes and that patients often perceive stigmatised attitudes from their health professionals. There are, however, some simple strategies, which you could consider with the aim of providing a safe, inclusive, environment and experience for patients who have overweight or obesity.
Perceptions of stigma can come directly from the clinician patient relationship. But they can also come from a stigmatising physical environment. And this is something that you should be mindful about in your own clinical practise. Generally, private soundproof consultation rooms are the best to use for a weight management discussion. Patients or clients are much more likely to feel uncomfortable if they know or suspect that someone else is on the other side of a curtain, or if they’re facing mirrors, or even intimidating gym or fitness equipment, all of which could make them feel that there is too much emphasis on their appearance or their weight.
The second thing to consider is the prominence of a patient’s body in your consultation. Now different health care professions have different levels of interaction with the patient’s body. If your profession does involve exposing a patient’s body for physical examination then you should be mindful that it is not uncommon for patients to feel vulnerable or judged. And that they feel like their fat becomes more obvious when the body is touched. You should always wait until the patient is fully clothed and comfortable before you initiate a conversation about weight. Look at this quote from a patient, you’re already in an uncomfortable situation where you’re semi-naked. So maybe it’s not the best time to think about what you look like.
This suggests that talking about body weight is confronting when the patient is undressed in some way for treatment.
Another factor that it’s useful to be aware of is that often health professionals are perceived to be aligned with the health or fitness industries. This can create patient preconceptions about beliefs or approaches that such health professionals may carry with them into their professional roles. Some health professions may also enforce the stereotype of the fit clinician. Look at this quote from a patient, having your weight mentioned by someone who is obviously very fit and healthy made it sort of feel more uncomfortable. Whilst the patient’s judgement of you will generally be out of your control, it is important to be aware of the influence of your own body on others’ ideas or perceptions of themselves.
Something you do have control over is the promotion material, the leaflets, and the images that are displayed in your clinic. If they predominantly feature thin or toned bodies, you may consider replacing them with a more diverse range of bodies to help the environment feel more inclusive for those who are overweight or obese.
Part of understanding the patient experience is understanding how a patient might feel in a clinical scenario when their weight is mentioned or alluded to. Patients interviewed as part of a qualitative research study have spoken of feeling guilt, shame, self-consciousness, and even a sense of failure. Take a look at these quotes, there’s so much talk at the moment about health and obesity that if you’re not really slim and really fit then you feel like there’s something wrong with you. It keeps getting blamed on my weight I think that made me a bit defensive about going. I have a bad back and I’m fat and that might make it worse.
But it certainly isn’t the cause or the root of my back pain.
Patients have also highlighted in qualitative studies that they think a specialised skill set is required for health professionals to deliver weight management. Take a look at these examples, I think it’s all human connection. I mean you can go to a person who’s absolutely awful, who’s got the knowledge, but you don’t feel comfortable talking to them. And so I think their knowledge and your connection is all part of the same thing. I think for me, it’s more about trying to find somebody who can help me live a normal life, the weight loss may come with that, I’d feel comfortable discussing weight with a physical therapist if I thought it was somebody who had some experience.
If that person said, I do have some experience in this field, I’ve studied something. The following quotes are in relation to a physiotherapist delivering weight management to their patients. Of course typically physiotherapists, like many other Allied health workers, are not always associated with having a role in weight management. This research is useful in suggesting that a breadth of health care workers could potentially take on a weight management role if they have, or develop, specialised skills to do so effectively.
So we’ve learned quite a lot from the patient experience. Here’s a quick summary of things to consider to help reduce stigma and enable your patients to feel more at ease. Firstly you could consider using a range of body sizes when creating visual material. Also have a think about where you place mirrors and whether or not you actually need those mirrors in the clinic environment. You should also have a think about the suitability of equipment or furniture. And ensure that any furniture you do have accommodates a range of body sizes.
Also consider the layout of the clinic, both in terms of your treatment rooms, but also your waiting rooms, and any other areas that the patient might go to for testing or analysis. Finally, consider the patient sensitivity when exposing or disrobing their body and the potential that they may have associated negative self judgement. There are a number of resources mentioned in this talk that are flagged throughout this module, which you can find in the coming reference pages.

Watch this video to discover how to manage issues related to weight stigma in your clinical practice.

Based on your experiences and clinical current setup, what do you think you may do differently or change in your clinical setting now to help reduce the negative experiences people have had in the past based on the articles discussed in the video?


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