Daley Sharon F., Ginsburg Brittney M., Sheer Amy J.
Cape Cod Hospital, Hyannis, MA
University of Florida
The World Health Organization (WHO) defines obesity as "abnormal or excessive fat accumulation that may impair health." The prevalence of obesity has risen exponentially over the last 50 years, and the WHO estimates that more than 650 million adults globally were living with obesity in 2016. There is no international consensus on whether obesity should be categorized as a medical condition. In June 2013, the American Medical Association voted to recognize obesity as a disease requiring treatment and prevention, but not all countries agreed. Proponents argue that classifying obesity as a disease leads to more effective management and fewer complications. Labeling obesity as a chronic condition, such as asthma or hypertension, promotes a holistic approach that reduces the stigma and discrimination experienced by affected individuals and improves education for healthcare professionals, policymakers, and the general public. Critics argue that labeling obesity as a medical condition may lead to unnecessary interventions and contribute to further stigmatization by reinforcing negative stereotypes and promoting a narrow focus on individual responsibility rather than addressing the complex underlying socio-economic and environmental factors. Weight bias and stigma are well-documented areas of concern in healthcare settings. Bias refers to attitudes, beliefs, or assumptions—whether conscious or unconscious—that influence how individuals perceive and interact with others. Overt bias is intentional and includes negative attitudes such as blaming patients for their weight. Implicit bias, by contrast, is more subtle and often goes unrecognized; for example, assuming that individuals with obesity are noncompliant with medical recommendations. Weight stigma is the process by which individuals are devalued, marginalized, or discriminated against based on body size; it is often the consequence of bias, reflecting how biased beliefs manifest through behaviors, institutional practices, and social norms. Weight stigma can lead patients to feel judged, avoid seeking care, and experience poorer health outcomes. In clinical settings, bias and stigma can contribute to discrimination, reduced access to care, and compromised patient outcomes. Members of interprofessional healthcare teams may not always recognize the presence or impact of either explicit or implicit bias. As a result, stigma may prompt individuals to delay or avoid necessary medical care due to fear of judgment or discrimination, ultimately delaying diagnosis and treatment. Weight stigma can also erode the clinician–patient relationship, hinder effective communication, and reduce treatment adherence, all of which may lead to suboptimal health outcomes. Obesity is often associated with stigma due to prevailing societal attitudes linking body weight to personal character flaws and a lack of self-discipline. Obesity discrimination rivals that based on race and age, but lacks comparable legal safeguards. In the United States, no federal legislation prohibits discrimination based on weight. Clinicians often view obesity solely as the result of individual choices, such as poor diet and lack of exercise, rather than acknowledging the multifactorial etiology. Similar to stigma, stereotypes, negative assumptions, and bias about individuals with obesity can lead to discriminatory attitudes, creating an environment where patients feel judged or blamed, which can hinder the quality of medical care and affect patient-clinician relationships. Recognizing and challenging these biases is crucial for clinicians to provide compassionate, patient-centered care that addresses the multifaceted nature of obesity and supports individuals in achieving their health goals. People who are overweight or obese report experiencing discrimination from an early age in education, at work, and in healthcare, stemming from the stigma associated with the condition. This stigmatization occurs at younger ages than in the past as the prevalence of childhood obesity increases. Children with obesity are more likely to be bullied than their healthy-weight peers. Commonly held societal beliefs that individuals with obesity are lazy, overindulgent, and lacking in self-control are inaccurate and negatively impact patients. Results from a 2005 study conducted in France showed that most clinicians knew that being overweight and obese pose health risks, and 79% agreed that weight issues fell under their scope of practice; however, 30% of respondents expressed negative attitudes towards obese patients. In another study of patients in weight management programs in 6 Western countries, results revealed that more than two-thirds reported experiencing weight stigma from their doctors. A 2022 Israeli study's results reported that more than half of patients with a body mass index greater than 25 kg/m² noted "insensitive and judgmental comments" from their clinicians. Results from several Australian, British, and Israeli studies have demonstrated similar beliefs. Australian clinicians reported feeling frustrated when treating patients with obesity who they believed lacked self-motivation and compliance. In a British qualitative survey, many primary care clinicians held the view that obesity is caused by unhealthy eating and lack of exercise, solely blaming the patient. In Israel, results from another study showed that 31% of family medicine clinicians judged overweight people as lazier than those of average weight. Surveys have also noted that "difficult" patients, perceived as those with behaviors harming their health, may elicit strong negative emotions. Primary care clinicians may even spend less time with patients with obesity and hold the mistaken belief that labeling them as "obese" will motivate them to lose weight.
世界卫生组织(WHO)将肥胖定义为“可能损害健康的异常或过度脂肪堆积”。在过去50年中,肥胖患病率呈指数级上升,WHO估计2016年全球有超过6.5亿成年人患有肥胖症。肥胖是否应归类为一种疾病,目前尚无国际共识,仍有待讨论。2013年6月,美国医学协会(AMA)投票决定将肥胖认定为一种需要治疗和预防的疾病,但并非所有国家都认同这一观点。支持者认为,将肥胖认定为一种疾病有助于更好地管理并减少并发症。将肥胖标记为一种慢性病,如哮喘或高血压,可促进采取整体治疗方法,减少患者所遭受的耻辱感和歧视,并改善针对医疗保健专业人员、政策制定者和普通公众的教育。批评者则认为,将肥胖标记为一种疾病状态可能导致不必要的干预,并通过强化负面刻板印象和促使人们狭隘地关注个人责任而非解决复杂的潜在社会经济和环境因素,进一步加剧污名化。由于普遍的社会观念将体重与个人性格缺陷和缺乏自律联系在一起,肥胖常常与耻辱感相关联。临床医生可能将肥胖单纯视为个人选择的结果,比如不良饮食和缺乏运动,而不是承认其多因素病因。对肥胖者的刻板印象和负面假设可能导致歧视性态度,营造出一种让患者感到被评判或指责的环境。这会降低医疗质量并阻碍医患关系。认识并挑战这些偏见对于临床医生提供富有同情心、以患者为中心的医疗服务至关重要,这种医疗服务应解决肥胖的多方面性质,并支持个人实现其健康目标。超重或肥胖的人表示,从早年起就在教育、工作和医疗保健中遭受歧视,这种歧视源于与该病症相关的耻辱感。随着儿童肥胖患病率的上升,这种污名化现象比过去出现得更早。社会普遍认为肥胖者懒惰、放纵且缺乏自控力,这种观念是不准确的,会对患者产生负面影响。2005年法国的一项研究表明,大多数临床医生知道超重和肥胖对健康构成威胁,79%的人同意这属于他们的执业范围;然而,30%的受访者对肥胖患者表达了负面态度。澳大利亚、英国和以色列的多项研究也表明了类似的观念。澳大利亚的临床医生报告称,在治疗肥胖患者时感到沮丧,因为他们缺乏自我激励和依从性。在一项英国的定性研究中,初级保健临床医生认为肥胖是由不健康饮食和缺乏运动导致的,完全归咎于患者。在以色列,另一项研究表明,31%的家庭医学临床医生认为超重的人比体重正常的人更懒惰。调查还指出,那些被视为有损害自身健康行为的“难相处”患者,可能会引发强烈的负面情绪。
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