Weight Bias and Stigma in Healthcare Settings. Has Obsession with BMI (Body Mass Index) Caused Medical Practitioners to Forget the Tenet of the Prayer of Maimonides: “In the Sufferer Let Me See Only the Human Being”?
Anne Emmerich, MD, Psychiatrist, Massachusetts General Hospital
While the Hippocratic oath, thought to date to the 5th century BCE, is the traditional ethical text recited by medical students when they graduate to the rank of physician, some institutions use the Oath or Prayer of Maimonides, the former of which is thought to have been written in the 12th century by Maimonides, a Jewish physician in Cairo, Egypt, and the latter of which is thought to have been written by a German Jewish doctor named Markus Herz, in the 18th century. A paraphrase of the Prayer of Maimonides reads – “Inspire me with love for my art and for thy creatures… In the sufferer let me see only the human being”.
Our society is obsessed with thinness and this extends to healthcare settings where the focus on weight can make large patients feel that clinicians do not value or even recognize them as unique individuals. A “one size fits all” approach has become the reflexive response of many health providers who often do not recognize that body shaming comments can create negative emotional impacts that have long term consequences for health management such as disruption of the clinician-patient relationship and patients dropping out of healthcare treatment altogether. Large patients are routinely told that their weight is the reason for whatever physical complaint brings them to the doctor’s office. Numerous reports exist of serious health issues being missed because weight was thought to be the “problem”. Alternatively, practitioners confuse weight with health and refuse to believe that a large patient might have normal blood pressure or cholesterol or might not have diabetes and that the patient might have other concerns they wish to discuss with their clinicians. Patients are ordered to lose weight via diet, medications, surgery – without these recommendations resulting in meaningful weight loss for the majority of patients. Studies show that most people who participate in crash diets wind up gaining more weight than if they had not dieted at all. And most clinicians are unaware of, and do not talk to their patients about, the risks that follow weight loss surgery including elevated levels of alcohol dependence and suicide. Furthermore, weight stigma itself has been shown to increase allostatic load which is associated with increased levels of inflammation.
This paper will introduce the audience to the concept of, and potential consequences of, weight bias and stigma in healthcare settings. The author will explore models that attempt to explain how weight bias impacts patients such as the stereotype threat model and trauma theory. The author will describe efforts being made at a large teaching hospital to introduce a new approach for clinicians to use when working with large bodied patients, one that supports the Maimonides tenet of recognizing the human being in every patient we work with.The Health at Every Size and Body Trust models will be discussed. Case examples will be offered.
Our society is obsessed with thinness and this extends to healthcare settings where the focus on weight can make large patients feel that clinicians do not value or even recognize them as unique individuals. A “one size fits all” approach has become the reflexive response of many health providers who often do not recognize that body shaming comments can create negative emotional impacts that have long term consequences for health management such as disruption of the clinician-patient relationship and patients dropping out of healthcare treatment altogether. Large patients are routinely told that their weight is the reason for whatever physical complaint brings them to the doctor’s office. Numerous reports exist of serious health issues being missed because weight was thought to be the “problem”. Alternatively, practitioners confuse weight with health and refuse to believe that a large patient might have normal blood pressure or cholesterol or might not have diabetes and that the patient might have other concerns they wish to discuss with their clinicians. Patients are ordered to lose weight via diet, medications, surgery – without these recommendations resulting in meaningful weight loss for the majority of patients. Studies show that most people who participate in crash diets wind up gaining more weight than if they had not dieted at all. And most clinicians are unaware of, and do not talk to their patients about, the risks that follow weight loss surgery including elevated levels of alcohol dependence and suicide. Furthermore, weight stigma itself has been shown to increase allostatic load which is associated with increased levels of inflammation.
This paper will introduce the audience to the concept of, and potential consequences of, weight bias and stigma in healthcare settings. The author will explore models that attempt to explain how weight bias impacts patients such as the stereotype threat model and trauma theory. The author will describe efforts being made at a large teaching hospital to introduce a new approach for clinicians to use when working with large bodied patients, one that supports the Maimonides tenet of recognizing the human being in every patient we work with.The Health at Every Size and Body Trust models will be discussed. Case examples will be offered.