What other aspects of obese patients’ health care is negatively impacted by a weightism bias? This bias that exists among health care professionals and may significantly affect the health of a large percentage of patients deserves attention and correction to ensure that all patients have access to quality care.

Solutions

To address weightism, physicians need to explore the mindset behind the bias and bring it into consciousness, and address some of the physical barriers inhibiting proper care of the obese.

Studies demonstrating health care provider associations of obesity with negative personality attributes suggest a component of blame may be involved. Obesity is viewed as a character flaw rather than a disease.

Many of the diseases treated by emergency physicians are consequences of a combination of genetics, socioeconomic factors, and patient choices. Blame seems to fall more heavily on the obese, however, than on other diseases with components of patient contribution, such as COPD or even overuse musculoskeletal strain. Separating the blame and the character associations from the disease process is a critical step in addressing weightism.

Identifying and labeling the bias is another essential element of reducing discrimination against the obese. This label helps validate the existence of the discrimination, a concrete step on the path to addressing and counteracting biases. Physicians should become comfortable using the label “weightism” so that this real problem receives due attention.

The significant physical challenges of caring for obese patients also must be addressed in order to prevent propagating the bias. Emergency departments can be equipped with bariatric equipment, such as specialized lifts and CT scanners with higher weight limits. Staff can also be educated regarding specialized techniques to facilitate caring for the obese, such as ultrasound-guided peripheral IV placement and lumbar puncture. Such concrete steps might help improve obese patients’ comfort level in seeking medical care and physicians’ confidence in treating these patients.

Conclusion

The bias against obese patients is real and has the potential to negatively impact a significant proportion of emergency department patients. Perpetuation of the bias against obesity is the result of our willingness to accept it. No longer should we be willing to tolerate such discrimination in our practice. Promoting sensitization and consciousness of weightism starts by acknowledging the problem and talking about it. Eliminating weightism bias in our practice will require a multifacted approach, including education of all members of the health care team and medical equipment modifications to minimize barriers and promote confidence in providing equitable care to all patients.