Everyone Secretly Hates Fat People?

This blog was inspired by my paper discussing the content and accuracy/quality of that content on weight loss and weight acceptance blogs, so I figured I should look at one of the issues commonly addressed (indirectly, usually, but sometimes directly) in the fatosphere.

The fatosphere, first off, is like a pocket of the blogosphere dedicated to fat acceptance. It's pretty fun and I learned a lot about perspectives and experiences very different from mind. From an anthropological view, I had a great time writing that paper.

This week's post is dedicated to thin privilege, and I will be looking at it through the lens of physician bias. 

Now, I'm not here to degrade the work of any doctor. I applaud anyone who works in the healthcare system to improve the lives of other human beings and, in many cases, to save some of those lives. So far, this blog has been just me but I have dreams of a grander future and I do not want to give the impression that doctors of any kind are bigots by nature. 

But...

Several studies^{(1, 2, 3, 4)} have found a significant weight bias among physicians, even those who research or work with obese patients. Some results have suggested this negative bias extends to other institutionalized forms of discrimination, including adoption proceedings⁽⁴⁾. There is compelling research to show we can use social pressure to change such biases among physicians⁽⁵⁾, but the unsettling truth is that it is there in the first place. 

Similarly, while there is evidence to suggest that moderate weight loss can alleviate chronic illnesses like hypertension (a precursor to heart disease) and hyperlipidemia⁽⁶⁾ and diabetes^{(7, 8)}, one study showed some doctors will treat the chronic illness instead of the obesity⁽²⁾.

Schwartz and colleagues used the Implicit-Associations Test to examine the subconscious biases of clinicians and researchers attending an international obesity conference and found a statistically significant amount (p<.0001) maintained an anti-fat bias⁽⁹⁾. These are people who understand obesity better than any other doctor, they know it has multiple causes, and a significant number still have an anti-fat bias. 

Is it clear why I put the disclaimer about doctors at the top? It's important to remember that the IAT is an *implicit* associations test. No one started it thinking fat people were lazy and worthless, at least not consciously. The point of this is that this stigma extends so deeply in many Western societies that even the obesity experts may still have a bias. This may interact with the fact that their job is often figuring out how to reduce obesity, but it does not justify or explain any bias.

Where does biology or biomedicine come in to this? Well, it doesn't. By itself. But in the healthcare system where such strong bias exists, where health professionals (doctors, nurses, researchers, etc.) who are entrusted with the care of the sick may implicitly avoid the necessary treatment out of a subconscious bias, these problems will be nearly unsolvable. When less than 50% of physicians feel confident in their ability to prescribe weight loss programs and only 14% believe they are successful in treating obesity(2), how can we expect to fight the "obesity epidemic" and help those who are unhealthy and obese? 

We can't. And this is why healthcare needs more anthropology. 

More on that next week.

Cheers,

J.G.

1) Schwartz, M. B., Chambliss, H. O. N., Brownell, K. D., Blair, S. N., & Billington, C. (2003). Weight bias among health professionals specializing in obesity. Obesity research, 11(9), 1033-1039.

2) Foster, G. D., Wadden, T. A., Makris, A. P., Davidson, D., Sanderson, R. S., Allison, D. B., & Kessler, A. (2003). Primary care physicians’ attitudes about obesity and its treatment. Obesity Research, 11(10), 1168-1177.

3) Jay, M., Kalet, A., Ark, T., McMacken, M., Messito, M. J., Richter, R., & Gillespie, C. (2009). Physicians' attitudes about obesity and their associations with competency and specialty: A cross-sectional study. BMC Health Services Research, 9(1), 106.

4) Puhl, R., & Brownell, K. D. (2001). Bias, discrimination, and obesity. Obesity research, 9(12), 788-805.

5) Puhl, R. M., Schwartz, M. B., & Brownell, K. D. (2005). Impact of perceived consensus on stereotypes about obese people: a new approach for reducing bias. Health Psychology, 24(5), 517.

6) Goldstein, D. J. (1992). Beneficial health effects of modest weight loss.International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity, 16(6), 397-415.

7) Lifshitz, F., & Hall, J. G. (2002). Reduction in the incidence of type II diabetes with lifestyle intervention or metformin. J Med, 346, 393-403.

8) Knowler, W. C., Fowler, S. E., Hamman, R. F., Christophi, C. A., Hoffman, H. J., Brenneman, A. T., ... & Steinke, S. C. (2009). 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet, 374(9702), 1677-1686.

9) Schwartz, M. B., Chambliss, H. O. N., Brownell, K. D., Blair, S. N., & Billington, C. (2003). Weight bias among health professionals specializing in obesity. Obesity research, 11(9), 1033-1039.