Effective strategies in ending weight stigma in healthcare

Abstract

Weight stigma impacts negatively healthcare quality and hinders public health goals.The aim of this review was to identify strategies for minimizing weight bias among healthcare professionals and explore future research directions. An electronic search was performed in PubMed, PsycINFO and Scopus (until June 2020). Studies on weight stigma reduction in healthcare students, trainees and professionals were assessed based on specific inclusion and exclusion criteria. A narrative synthesis was undertaken to analyze emerging themes. We identified five stigma reduction strategies in healthcare: (i) increased education, (ii) causal information and controllability, (iii) empathy evoking, (iv) weight-inclusive approach, and (v) mixed methodology. Weight stigma needs to be addressed early on and continuously throughout healthcare education and practice, by teaching the genetic and socioenvironmental determinants of weight, and explicitly discussing the sources, impact and implications of stigma. There is a need to move away from a solely weight-centric approach to healthcare to a health-focused weight-inclusive one. Assessing the effects of weight stigma in epidemiological research is equally important. The ethical argument and evidence base for the need to reduce weight stigma in healthcare and beyond is strong. Although evidence on longterm stigma reduction is emerging, precautionary action is needed.

“Is it time to throw out the weighing scales?” Implicit weight bias among healthcare professionals working in bariatric surgery services and their attitude towards non-weight focused approaches

“…Likewise, in a review of strategies to address weight stigma in healthcare, it is recommended that HCPs should move away from a weight-centric approach, towards an approach focused on health and weight-inclusivity. 13 Positive treatment outcomes beyond weight, referred to as “non-scale victories” , were proposed by HCPs in our study. The most frequently suggested measures were severity of co-morbidities, quality of life, and mental health, which suggests HCPs value outcome measures of health improvements.…”

“…Identifying widely applicable ways to effectively reduce healthcare related weight stigma is urgently needed. 13 One of many approaches could be to adopt non-weight focused approaches within obesity services. However, given the barriers cited by HCPs in our study, alternative outcome measures need to be validated and the acceptability of these within clinical practice and with clinical commissioners will need to be examined.…”

“…Clinical encounters contribute to the formation of HCPs’ beliefs and attitudes 13 and there is a growing concern that the repetitive and narrow focus on weight as both an access point to services and the primary measure of change might be contributing to, and proliferating, stigmatisation of PLwO within the healthcare setting. 14 Mandating weight loss as a pre-cursor to access to bariatric surgery is a contrived issue.…”

“… 17 The dominant weight-centric paradigm in healthcare services may have unintentional negative consequences, including stigmatisation, and therefore there are calls to move away from a weight-centric to health-focused approach to patient care. 13 …”

Weight stigma speaks Italian, too

“…Some strategies have been demonstrated to help reducing the weight stigma between the health professionals, such as developing dedicated educational programs and giving information about obesity determinants, which often are not dependent on the patient's will [32]. In addition, it has to be considered that not always the weight loss is achievable and safe for all the subjects with an increased weight [32].…”