Weight Bias in Healthcare: How to Improve Patient Outcomes

For clinicians committed to upholding the ethical imperative of nonmaleficence, remaining aware of personal biases that may affect patient care is essential. However, research increasingly shows that weight bias among health care providers is widespread and deeply harmful to patients. Such findings highlight the need for comprehensive efforts to increase awareness of weight bias and reduce its impact on patient health.

How Weight Bias Shows Up in Health Care Settings

“One common manifestation of weight bias occurs during patient-provider interactions in which providers display their negative attitudes towards higher-weight patients,” according to Samantha Philip, a doctoral student in the Department of Psychological and Brain Sciences at Texas A&M University in College Station.

For instance, some physicians make “judgmental or insulting comments about patients’ weight, offer blunt and unsolicited weight-loss recommendations, and use scare tactics,” as Dr Philip and colleagues found in a 2023 study.¹ 

Weight bias may drive the assumption that a higher-weight patient’s health challenges are caused by their weight, and providers may believe the myth that weight is a matter of personal control and willpower, she continued. On the contrary, studies have demonstrated that weight is significantly influenced by genetic and environmental factors and that the “most common outcome of weight loss is weight gain,” with an earlier study showing that up to two-thirds of people eventually gaining back more weight than they lost.^2,3

“Another myth is that high body weight is inherently unhealthy,” Dr Philip said. Although higher BMI has been linked to higher mortality risk, for example, physical activity has been found to fully account for this relationship.^4,5 “In other words, health outcomes are much better predicted by behaviors than by weight itself.”

Dr Philip also pointed to structural forms of weight bias embedded in the broader health care system. Health care settings may lack size-inclusive seating in waiting rooms and size-inclusive medical equipment in examination rooms, thus signaling to higher-weight patients that they are unwelcome. 

“Additionally, patients are categorized using a BMI chart and labeled as ‘obese’ or ‘overweight’ and are routinely provided weight management counseling if their BMI is within a certain range,” she noted.⁶ “Studies show that these labels are frequently stigmatizing to patients and that unsolicited weight management counseling—even when delivered with a neutral tone—can be stigmatizing.”^7,8

Weight Bias in Pediatric Settings

Such bias and stigma regarding higher-weight patients is not limited to adult health care settings, noted Kathryn E Kyler, MD, MSc, FAAP, a pediatric hospitalist in the Division of Hospital Medicine at Children’s Mercy Kansas City and assistant professor of pediatrics at the University of Missouri-Kansas City. “Weight bias in pediatric health care is more common than one might think,” she said.^9,10

In a study published in 2024 in the Journal of Eating Disorders, Dr Kyler and colleagues surveyed providers at a large pediatric hospital and found that 1 in 5 survey respondents incorrectly believed that higher-weight patients are more likely to be non-compliant with recommended treatments.⁹ 

Their findings further revealed that more than one-third of providers surveyed reported that other professionals in their field hold negative stereotypes against higher-weight patients, and nearly one-half of respondents indicated that they had overheard a colleague making disparaging comments about such patients.⁹

Effects of Weight Bias on Patient Care and Health

“These inherent biases or beliefs in stereotypes can negatively affect both the provision of care and the health of patients,” Dr Kyler said. “Weight-based discrimination has been linked to psychological and medical effects such as depression, negative self-esteem, disordered eating, lower likelihood of exercise, decreased glycemic control, and increased cortisol levels.”^9,11

Dr Philip described multiple ways in which weight bias can undermine the quality of patient care, including effects on clinical judgment and decision-making. Along with the view that higher-weight patients are less treatment-adherent and more responsible for their health challenges, studies have demonstrated that providers may view these patients as less healthy than lower-weight patients.¹¹

Due to weight bias, clinicians may conduct an inadequate clinical examination, fail to order necessary testing, and provide limited treatment options. Providers with unchecked weight bias may also spend less time with higher-weight patients.¹¹

“This bias can lead to providers overlooking underlying medical conditions and denying patients access to essential and accurate treatment,” Dr Philip said. In a provisionally accepted scoping review, she and her colleagues found that “weight bias manifests in similar ways, even in mental health treatment settings,” she shared.¹²

Various studies have shown that weight bias can damage the relationship between patients and providers and create barriers to health care access for higher-weight patients. “Because of weight bias, these patients report poorer expectations of treatment, lower trust, and poorer communication with their clinicians compared to their lower-weight counterparts,” Dr Philip explained.¹³“In turn, patients seek out new doctors and delay or avoid medical appointments altogether.”^11,14

Clinician Recommendations for Addressing Weight Bias

To improve care and outcomes for higher-weight patients and reduce the harms associated with the weight-centric health care model, provider awareness and changes in treatment practices are crucial.

“The first step clinicians can take is to grow their own knowledge about existing biases they may have toward patients based on their weight,” Dr Kyler advised. The Weight Implicit Association Test, developed by Project Implicit, can “inform you about your own biases, allowing you to check those biases more consciously at the door when you care for individuals of all weights.”

She recommends that providers maintain a sense of curiosity, withhold judgement, and keep an open mind regarding their patients. “Everyone has a different background and life experience, so approaching each patient interaction with fresh eyes is key.”

Dr Philip suggests that clinicians approach their own weight bias with curiosity rather than shame and focus on actions they can take to reduce the impact of weight bias on patients. “Weight bias is deeply embedded in our culture, and beliefs about weight are socialized. What providers do with the knowledge of their bias is most important.” 

She recommends that clinicians reflect on messages they have learned from the media, their education, and close others regarding weight and size, and consider the following questions:

• What assumptions do you make about larger peoples’ characteristics, intelligence, or health?
• What automatic emotional reactions do you have toward higher-weight patients?
• How might these assumptions and reactions affect the care you provide to higher-weight patients? 

“Reducing weight bias takes work, and it is recommended that you seek training from a new perspective to unlearn some of the myths that are commonly taught in health care programs but reinforce weight stigma,” she said.