More than 30% of the American population is obese.¹ Studies have repeatedly demonstrated a bias against obese patients, present even in health care professionals.^2-4 As emergency providers, we risk providing suboptimal care to a large percentage of our patients unless we proactively address this bias. Such prejudice or discrimination against individuals who are overweight is commonly referred to as weightism.⁵ This article outlines some of the literature demonstrating a bias against the obese and suggests concrete measures emergency physicians can take to safeguard against it.

Obesity Bias

Studies in psychology, psychiatry, sociology, and medical literature consistently demonstrate bias against obese persons by other individuals in a variety of contexts. Preschoolers deem overweight peers to be less desirable playmates.6 Obese students may face lower college acceptance rates, and higher rates of wrongful dismissal from college. Once they join the workforce, obese individuals are less likely to be hired for a variety of jobs,^2,7 and they may earn wages that are substantially less, on average, than other workers.⁸

While we may believe we treat all of our patients equally, physicians, too, are guilty of this bias. In a controlled survey of physicians, Klein et al. observed a tendency for physicians to associate obese patients with poor hygiene, hostility, noncompliance, and dishonesty.⁹ Even health care professionals who specialize in obesity have been found to harbor a bias against the very patients they treat.⁴

The practice of medicine may in fact exacerbate weightism. In a study of nursing students and registered nurses, Poon and Tarrant found that although both groups demonstrated bias against obese patients, RNs demonstrated more negative attitudes against obese patients than the students did.³ This study raises the question of how the bias against obese patients propagates.

Medical professionals can face real physical challenges when examining and caring for obese patients, including difficulty with venous access and limb manipulation. Do these challenges further worsen an already negative association with obesity?

The bias against obese patients likely affects their care. A study by Adams et al. revealed a majority of obese patients were reluctant to undergo a pelvic exam and that 87% of physicians were reluctant to perform a pelvic exam on an obese patient.¹⁰ Amy et al. showed a discrepancy in rates of pap smears when examining different BMI groups among a study population consisting entirely of obese patients; the rate of pap smear among those with BMI between 25 and 55 kg/m2 was 86%, compared with only 68% in those patients with BMI greater than 55.¹¹