Reducing Weight Stigma in Clinical Settings for ED Treatment

Weight stigma is a negative belief or judgment about another person or self, based on weight, shape, and size. In studies looking at weight stigma in the general population from preschool through adulthood, children as young as three had negative stigmas around weight.

Many elementary school children and college students, when asked, felt that peers who were overweight were lazy, less happy, and less popular [1]. These beliefs typically continue to strengthen as we age and enter the workforce.

Many medical and clinical based professionals are weight-biased against overweight patients. Many will prescribe medicine or weight loss regimens rather than adequately address a person’s overall health.

This approach can lead patients to feel guilt and shame, avoiding medically necessary appointments. Stigma in the office may prevent individuals from seeking treatment.

Research has shown that overweight individuals are more likely to avoid routine preventative care and when they do seek health services, they may receive compromised care [1].

“Obese individuals turn to for trust, hope, affirmation, and optimism; these weight biases are extremely concerning. Stigma in the health care office may make it more difficult to seek treatment, broadening health disparities among people who are overweight or obese. Research shows that overweight clients are more likely to avoid routine preventative care and when they do seek health services they may receive compromised care.” [1]

Eating Disorders and Weight Stigma

When a person is struggling with an eating disorder, weight gain or obesity can drive symptoms of the disease. In another study, those who were overweight and read a weight-stigmatizing news article consumed more high-calorie snack foods compared to their peers who read a weight-neutral article [1].

Binge eating episodes can be a way of coping, increased weight gain and further feelings of weight stigma. In another study 67% of women with bulimia reported others making negative comments about their weight or body shape and that experiencing weight stigma may contribute to the development and/or maintenance of an eating disorder [1].

Weight Bias in Healthcare Settings

There have been some studies on the beliefs of healthcare professionals where clinical practitioners report those who are obese as lazy, lacking in self-control, are noncompliant with treatment, are unsuccessful, unintelligent, and dishonest [2].

Weight bias also seems to be the most common among medical doctors, and research shows that if a person’s body mass index (BMI) is in the ‘overweight’ or higher category, that the clinician has less respect for patients, less desire to help them, and report that heavier patients are less likely to adhere to medications than peers who are thinner [2].

Increased Training

As many clinical providers are weight biased, it seems to show that there is a lack of knowledge and education among various professional on eating disorders.

Often in many medical training schools and facilities, there is very little if any education and training on eating disorders, giving way for lack of identification or treatment options.

If a client who is overweight comes to their primary doctor for treatment as the first line of therapy, and the doctor has very little training, may recommend weight loss treatments first rather than assessing for an eating disorder.  Eating disorders come with various underlying issues such as trauma, depression, and anxiety which fuel the coping mechanism of the eating disorder itself.

A study showed that weight bias is typically more varied by demographic characteristics, such as gender, race, and BMI [2]. Personal and psychological issues can also play a role in weight stigma too.

One way to reduce the stigma of weight in the medical profession it to classify obesity as a disease to help students and clinical staff to understand that eating disorders are a complex chronic condition with various psychological, mental health issues.

Addressing professionals attitudes, beliefs, and perceptions around obesity and eating disorders can help reduce weight stigma as well.

Providing education and training around eating disorders can assist those who work with individuals understand the various issues that are a part of this disease.

According to the Institute of Medical and National Institutes of Health guidelines, it is suggested that health providers set realistic goals for patients to lose and maintain weight. They go on to advise that modest weight loss of 10% body weight is accepted [2].

Bias Among Eating Disorder Professionals

A study that looked at the attitudes and treatment and perceived patient outcomes looked at professionals who specialize in treating eating disorders and surveyed 329 professionals.

Results showed that negative weight perceptions were present in some of the professionals.

88% of participants felt confident and prepared to treat BED, but a majority of those surveyed felt that they had observed other professionals in their field make negative comments about patients who were obese [3].

Reducing weight stigma in the clinical setting is extremely important, in particular among those professionals who treat eating disorders. Being able to provide adequate care to those who are struggling with an eating disorder helps increase motivation and commitment to treatment.

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About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.

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References:

[1] M. (n.d.). Weight Stigma and Eating Disorders. Retrieved August 06, 2017, from http://www.mirror-mirror.org/weight-stigma-and-eating-disorders.htm
[2] Puhl, R. M., Luedicke, J., & Grilo, C. M. (2013, December 04). Obesity bias in training: Attitudes, beliefs, and observations among advanced trainees in professional health disciplines. Retrieved August 06, 2017, from http://onlinelibrary.wiley.com/doi/10.1002/oby.20637/pdf
[3] Puhl, R., Latner, J., King, K., & Luedicke, J. (2013). Weight Bias among Professionals Treating Eating Disorders: Attitudes about Treatment and Perceived Patient Outcomes. Retrieved August 06, 2017, from http://www.uconnruddcenter.org/
Published in the International Journal of Eating Disorders

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on October 11, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on October 11, 2017.
Published on EatingDisorderHope.com