The systematic mistreatment of individuals in larger bodies needs to stop. Here’s where we stand.

Like so many of the bigotries and prejudices in our culture—sexism, ageism, racism, homophobia, the list goes on—weight bias can be so pervasive that people don’t even notice it. They just think it’s the way things are.

For people in larger bodies, that can mean constant disrespect. Sometimes, the mistreatment is subtle. Other times, it can be more direct and disrespectful, like when the gown you’re supposed to put on at the doctor’s office isn’t nearly big enough.

I’m here to say, it doesn’t have to be like that. But to change things, it’s going to take a lot of work. Fortunately, that good work is happening every day.

Weight bias explained

Weight bias means prejudging someone negatively because of their body size. People with weight bias may discriminate against or have negative beliefs about those they perceive to have a larger body.

The effect of those attitudes? The systematic mistreatment of people in larger bodies in all areas of life.

Prevalence of weight bias

Weight bias shows up everywhere—from the doctor’s office and corporate board rooms to the school playground and your Uncle Pete’s house (you know, the relative who constantly comments on your weight and your eating).

Weight bias in healthcare: A classic example is when a patient goes to their doctor about a health condition, and the doctor immediately starts talking about weight loss even though it isn’t related to the reason for the visit.

For too many providers, body weight is the most important predictor of health, so they prescribe weight loss as almost a magic bullet for optimal health.

On the mental health side of things, weight bias shows itself in the way providers too often associate so-called normal weight bodies with good mental health and overall contentment. Or conversely, they assume people with larger bodies are unhappy or in a bad place emotionally.

Weight bias in health care also shows up in operational ways as well. The gowns you’re supposed to change into are often too small, as is the blood pressure cuff. Or the exam-room chair you sit in is too snug. Bottom line: Clothing, objects, and physical spaces are often not designed in a weight-inclusive manner.

Weight bias in the workplace: Bias is common in the workplace—and the wallet often takes a hit because of it.

For example, recent data collected by the U.S. Bureau of Labor Statistics found that:

• Obese men with bachelor’s degrees earn 5% less than non-obese men with bachelor’s degrees.
• Obese women with bachelor’s degrees earn 12% less than non-obese women with bachelor’s degrees.
• Obese women with graduate degrees earn 19% less than non-obese women with graduate degrees.

Past research shows that those with larger bodies also tend to earn fewer promotions, they’re disciplined more harshly at work, and they’re less likely to gain employment in the first place.

The damaging effects of weight bias

In the healthcare setting, when providers think that a person’s body mass index (BMI) is the primary marker of health (and many do), they miss things. They miss symptoms and diagnoses, and they don’t ask important questions about a person’s mental or overall health.

When a patient with a larger body recognizes a provider’s weight bias, they lose trust in them. That leads to postponing or canceling medical appointments because they don’t want to deal with the prejudice of the healthcare system.

Consequently, once minor health concerns become more serious and more difficult to treat. Disease-management visits go by the wayside, because who needs the aggravation of a provider who intentionally or unintentionally demeans you.

Weight bias in the larger culture has a similarly depressive effect on people. When a person doesn’t feel included or valued, the natural response is to draw inward. People lose their desire to engage socially, and become more isolated. At that point mental illness becomes more likely, and eating disorder risk goes up.

Ways to overcome weight bias

More of my fellow providers need to adopt a weight-inclusive approach. We must approach wellness more holistically, rather than zeroing in on a person’s weight as the end all and be all of health. That’s like zeroing in on heart rate, or blood pressure, as the ultimate gauge of a person’s health status.

A person’s weight can be important in some cases, but in general it’s just one aspect of their health. There are many others—both physical and mental—that are equally important and need to be addressed. Patients need to be treated like the whole persons they are.

As patients and as people, we need to advocate for change. If friends, family, or acquaintances show weight bias toward us, it’s important to establish boundaries. We need to let people know, in a kind but firm manner, that certain topics or comments are off-limits.

An example: You have a friend or relative who, when you go out with them, always comments on your weight. A good strategy in these instances is to contact the person before your get-together and calmly ask that they stay away from the offending topic.

In all of your interactions, you have a right to set boundaries, to make your wishes known, and to make people aware of the effect of their words. Many people don’t realize what they’re saying, and will be happy to make changes on your behalf.

Advice for working with medical providers

Advocating for yourself with providers can be difficult to do. Our society tends to look up to providers, and sees them as infallible. So it’s difficult to push back on their attitudes about weight.

But providers aren’t infallible. Sometimes, they need to be educated in these matters, and they usually welcome that.

Example 1: Some patients don’t like to be weighed when they go in for routine doctor appointments, especially if they have sensed weight bias there. If that is the case, let the care team know you prefer not to do get weighed when they take you back to the exam room. If you feel the need to explain it, say that your provider will have plenty of other health data to go on, and doesn’t need your weight. You can also ask the provider to perform a blind weight if needed. With a blind weight, the provider will take a patient’s weight but will not share or discuss it with the patient.

Example 2: If it seems like your provider is weight biased and recommends weight loss for seemingly every condition you see them for, tell them that—as a rule and from now on—you would prefer that they don’t make health recommendations based on your weight.

Example 3: If you’re struggling with your weight or an eating disorder, and you don’t think your provider gets it, ask that they send any weight-related recommendations to another member of your healthcare team, not you. That will give that member a chance to educate the provider about you and your health situation.

Final thoughts on weight bias

From my vantage point as a holistic dietitian working in the eating disorder field, I can say with assurance that weight-bias awareness is increasing. That’s an important first step. It needs to be followed by all of us taking further steps to improve the situation. I see that happening as well.

For example, it’s important to create a vocabulary around this movement, and we’re doing that. Phrases like “weight bias,” “weight-inclusive,” “Health at Every Size,” and “person with obesity” didn’t exist until recently, and they’re giving us a more empathetic and equitable way to communicate than before.

The increased awareness and more robust vocabulary are proof that we’re making progress in a culture that is still rife with prejudice in this area. We still have a lot of work to do.