Overcoming Weight Bias in the Management of Patients With Diabetes and Obesity

Rising obesity rates in the past several decades have been paralleled with increasing evidence of bias, stigma, and discrimination toward individuals with obesity (1). Weight discrimination is commonly reported by Americans (2) at rates comparable to those of racial discrimination (especially in women) (2,3) and has increased in recent decades (4). Individuals with obesity are vulnerable to stigma and unfair treatment from multiple sources, including inequities in employment settings, educational institutions, and health care facilities, as well as in the broader society and the mass media (1), all of which can lead to negative consequences for their psychological and physical health. Several decades of evidence demonstrate consistent weight bias expressed by health care providers (HCPs), which can impair quality of care to patients with obesity and diabetes. In this brief review, we summarize evidence in these areas, discuss the importance of addressing weight bias in clinical care for patients with obesity and diabetes, and highlight the need for increased awareness of this form of bias in diabetes management. Being the target of weight bias and discrimination can lead to numerous adverse health consequences affecting psychological, social, and physical health (Figure 1). Individuals who experience weight stigma have an increased risk for depression, anxiety, low self-esteem, poor body image, substance abuse, and suicidality (5–8). These outcomes remain even after controlling for variables such as BMI, obesity onset, sex, and age, suggesting that psychological consequences are not associated with obesity per se, but rather with experiences of weight stigmatization (9,10). FIGURE 1. Health consequences resulting from experiences of weight stigma. Weight stigma also increases vulnerability to unhealthy behaviors that can contribute to weight gain and obesity (11), including increased likelihood of engaging in binge-eating behaviors, maladaptive weight control, disordered eating patterns, increased calorie intake (11–16 …