In order to understand what is meant by prejudice and discrimination in health care due to obesity, one must understand the basic concepts of the statement. First let us start with the what is meant by obesity. According to the Centers for Disease Control and Prevention (2018) Obesity is measured by an individual’s body mass index (BMI) of being 30.0 or higher. Obesity can be a result of behavioral, educational, environmental and genetic factors. According to Hales, Carroll, Fryar, & Ogden (2017) the trends in obesity rates for adults and children have risen steadily from 1999 to 2016. The obesity rate for adults, ages 20 years old and over, in 1999-2000 was at 30.5 percent, increasing by 9.1 percent to have a percentage of 39.6 in 2015-2016. The obesity rate for children, ages 2 to 19 years old, in 1999-2000 was at 13.9 percent, increasing by 4.6 percent to have a percentage of 18.5 in 2015-2016. Obesity has steadily been rising throughout the years becoming more relevant within society but still being placed under negative connotation.
Secondly, to understand the statement prejudice and discrimination in health care due to obesity one must understand the concept of prejudice. “Prejudice is the tendency of an individual to think about other groups in negative ways, to attach negative emotions to those groups, and to prejudge individuals on the basis of their group membership” (Healey & Stepnick, 2017, p. 28). Prejudice can be looked at in two various aspects one cognitive prejudice, which is how an individual would think in a stereotypical manner, and affective prejudice, which is how an individual would feel about a person or topic. A form of cognitive prejudice would be a physician or nurse thinking that a person who comes into their health care facility is lazy because they are obese; whereas, affective prejudice would be a feeling of disgust or hatred about having to look, touch or treat an obese patient.
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Thirdly, to understand the statement prejudice and discrimination in health care due to obesity one must understand the concept of discrimination. “Discrimination is the unequal treatment of a person or persons based on group membership” (Healey & Stepnick, 2017, p. 37). Discrimination within the health care arena may occur by a physician or nurse if they are not listening to the medical concerns of an obese patient that comes into the health care facility, and instead focusing on the patient’s weight and dismissing all other information the patient is relaying. However, a normal or slightly overweight patient came in with the same health concerns the physician or nurse would take note and provide treatment accordingly. This scenario is an example of health care discrimination.
It should be noted that prejudice and discrimination in health care can come from a variety of sources besides physicians and nurses. For example, therapists, dieticians, cardiologists, other specialist, and receptionists. As well as health care facilities encompassing private practices, hospitals, nursing homes, and outpatient facilities, where prejudice and discrimination can occur. Also, medical providers may demonstrate internally cognitive and affective prejudice, but never act on those negative feelings.
Health Care Providers
There have been several studies conducted that have provided evidence that prejudice and discrimination occur within the health care field in accordance with the perception and treatment of obese patients being different from those of average weight (Phelan, Burgess, Yeazel, Hellerstedt, Griffin, & Ryn 2015; Puhl & Brownell, 2012; DiGiacinto, Gildon, Stamile, & Aubrey, 2014) and thinking that it is the patients sole responsibility for identifying their own problem and doing something about it (DiGiacinto et al., 2014). This type of thinking could be partial due to some health care providers not possessing adequate resources, education, and patient counseling skills to address weight management with patients. According to DiGiacinto et al. (2014), approximately half of physicians claimed they were not professionally ready to treat obese patients. The lack of readiness and education could lead a patient towards further weight gain and other medical complications associated with obesity as the health care provider is not adequately sufficient in addressing this issue.
According to Phelan et al. (2015), primary care providers reported less patient-centered communication with obese patients because they do not believe they will stay with the treatment course. Thus, having less effective communication and information being provided between the health care provider and patient. Also, the provider spends 28% less time with an overweight or obese patient compared to an average weight person and order less diagnostic testing, or considering other treatment plans beyond advising the patient to just lose weight, as the provider feels it is a waste of time.
Obese Patients
Obese individuals are frequently the targets of prejudice, derogatory comments, and discrimination, even within the health care system, despite approximately one-third of the U.S. adult population being obese (Phelan et al., 2015). The attitudes health care providers display impact the care of the obese patient, which then in turn can influence the patient’s experience. For instance, if the experience with the health care provider was negative, it can cause additional stress, future avoidance to seek out care, mistrust in the treating provider, and poor follow through of treatment ideas. According to Phelan et al. (2015), negative obesity attitudes may increase poor patient-centered communication, “which is associated with a 19% higher risk of patient non-adherence, as well as mistrust, and worse patient weight loss, recovery and mental health outcomes” (para 8).
Unfortunately, due to the stress our society puts on obese individuals to conform or assimilate to the dominant groups’ standards, coping skills become critical to use. When coping responses of obese participants were looked at, the results showed that 79% used eating as a coping mechanism, 74% cried and isolated themselves from others, 73% resorted to negative self-talk, 75% refused to diet, and 25% of participants pursued therapy to increase their coping behaviors (DiGiacinto et al., 2014).
Social Status
Assimilation
Our society’s idea of being beautiful, healthy, and fit is to be thin. If one is not thin, they are looked down upon and pressure is put on them to diet. In the western culture, obese people have become the source of derogatory humor that can be seen on TV or heard on the radio and in everyday conversations. Obese individuals are “portrayed as lazy, gluttonous and undisciplined” (Phelan et al. 2015, para. 7) through this derogatory humor. According to Puhl & Brownell (2012), “physicians’ responses may reflect protestant ethic values, which emphasize self-discipline, persistence in the face of adversity, and achievement – characteristics that physicians believed were low or absent in patients with conditions like obesity” (para. 26). These outlooks are what fuels assimilation. Assimilation is the process in which different groups come to share a common culture and merge together socially, and differences decrease, but not always by equal and fair means to both groups (Healey & Stepnick, 2017). As society continues to put social identity and stereotypes on obesity and praises thinness, it fuels the drive for some obese individuals to make multiple attempts to diet not to become healthier, but to culturally assimilate to look and fit in with the dominant group “thin individuals” that are looked at to be superior. This shows that thin or average weight groups continues to dominate through ethnocentrism, competition, and power, as prevalent through the thought processes established within the studies of how health care providers deem obese patients, and throughout what marketing and social media says is the appropriate way to look and live.
Lastly, our society tends to try to dominate through a closed system, which is the “interaction between members of the dominant and minority groups in a paternalistic system is governed by a rigid, strictly enforced code of etiquette” (Healey & Stepnick, 2017, p. 114). This is noted by how social media continuously advertises diet pills or weight loss surgery, and shows thin models as the result. Even sex appeal for movies, shows, and clothes constantly are only portraying thin women or muscular men as being those that belong. Therefore, social media is making a statement to the minority group that we except you to look like this, so if you take these pills or have this surgery you can blend in.
Pluralism
Event though there is constant pressure to culturally assimilate to what society deems as beautiful, healthy and driven, there are obese individuals that do not become driven to want to assimilate, but rather exist through pluralism. Pluralism is where they can maintain their own individual identity even if that encompasses their weight (Healey & Stepnick, 2017). This minority group “obese individuals” may even become group oriented where they begin to bond with other obese individuals, and develop relationships with them because they understand them and don’t judge or try to change them.
How to Stop Prejudice and Discrimination of Obesity
In order to remove prejudice and discrimination, individuals have to transform society’s attitudes on obesity, and begin to endorse laws that would prohibit discrimination based on weight (Puhl, 2018). This would mean breaking down the institutional discrimination among people in the general community, health care providers/specialists, medical students, law makers, and social media personalities. When referring to institutional discrimination, it is the “societal equivalent of individual discrimination and refers to a pattern of unequal treatment based on group membership that is built into the daily operations of society, whether or not it is consciously intended” (Healey & Stepnick, 2017, p. 38). Thus, meaning taking the labels that obese individuals are lazy, unmotivated, ugly, and worthless given to the minority group “obese individuals” by the dominant group “thin or average weight individuals”, and working to educate and change their perceptions. This is important because no one knows what someone else’s situation is and outward appearances have nothing to do with what a person is truly like.
Some ways to break this vicious cycle that has developed as “prejudice and racism reinforce the pattern of inequality between groups, which was the cause of prejudice and racism in the first place” (Healey & Stepnick, 2017, p. 117) is by implementing the following ideas. According to Puhl (2018), one is for patients or individuals with obesity to be self-advocates. When the individual recognizes they are in a situation of where they are being discriminate, they need to find the courage and address the issue to help prevent further stereotypical ideas and behaviors from occurring while in the moment. Health care providers can help and encourage obese patients to share their stories, and participate in activities to decrease isolation and identify coping strategies in dealing with discrimination and prejudice, as well as finding support groups. However, before health care providers/specialists can address the needs of the patient, they must first address any prejudice and discrimination within themselves or other staff members within their organization. This will require one to examine their own thoughts, attitudes, and behaviors regarding obesity. Also, educating other providers on the “genetic, environmental, biological, psychological and social contributors to weight gain and loss” (Phelan et al., 2015, para. 17) could increase awareness about one’s own thoughts and the issues surrounding obesity, in order for others working within the organization to become an accurate and empathic understanding of obesity in patients (Puhl, 2018). Not only can health care providers educate themselves and other staff members, they can go into the community and begin to educate the general public on having an understanding that the stigma placed on obese individuals are false, and that society needs to show increased multiculturalism and “stress mutual respect for all groups” (Healey & Stepnick, 2017, p.55).
Lastly, health care providers should encourage patients not to focus on weight loss, but the benefits of physical activity and healthy eating. This could help to change the patient’s mind set, and have greater success in weight loss due to wanting it for themselves, and not trying to assimilate to what they feel society’s standards are for them to be. When physiological factors are impeded by the encouragement of others, such as the health care providers then the obese or overweight person is more able to accept when they have a bad day and get back on track verses when feeling a sense of prejudice a person is more likely to continuously fail and eventually just give up.
Solutions
To add to strategizes under stopping prejudice and discrimination of obesity, it would be beneficial to start education and understanding of weight during health education classes in elementary school where society can begin to understand what weight management is and why physical activity is overall important. While there are sporting programs available to children outside of the school system not every family can afford such programs, nor do all schools offer recess or gym every day. Therefore, it would be beneficial to offer gym on a regular basis and provide free after school sports to start the encouragement process at a young age for physical activity. While this would start the awareness, those in the medical field should continue to be given thorough training and given educational courses on weight problems to decrease discrimination and prejudice. A small study was done with medical students who had improved attitudes about obese patients after they were given educational courses on weight issues compared to those in the control groups that maintained negative stereotypes about weight (Puhl & Brownell, 2012). Thus, showing this technique of educating medical students could halt students coming out into the health care field with negative perceptions on overweight and obese individuals. This would make communication more open and effective and less bias on prescribing appropriate treatment.
Another solution to open up communication that was beneficial personally to me was to speak to the patient about their daily routines. We are all busy in life with work, children, school, and etc. I know for myself when I get home and everything is done at 9 o’clock at night I don’t want to exercise or get up at 4:30 am to exercise. Therefore, if health care providers are asking questions about the patient’s day, they may be able to find little strategies to help the patient incorporate some form of physical activity within there day that is at a pace appropriate for them.
Lastly, prejudice and discrimination can be an unconscious factor to health care providers, but a conscious issue for the obese person as noted by the health care environment. For instance, waiting room chairs may be too small due to the armrests or blood pressure cuffs, scales, instruments, and gowns maybe too small for the patient, and either the provider has to track one down because it is not easily accessible, or not available. All of this can signal to the patient that they do not fit in to the standards society has placed on individuals. Therefore, facilities need to have large width chairs or chairs that don’t have armrests to be more spacious to heavier individuals, which some facilities have begun to install. When it comes to medical equipment the facility should have a larger set of cuffs, scales gowns, and etc. beside the equipment for smaller individuals to make everyone feel accommodated and not insecure about themselves.
Conclusion
Our society needs to begin changing our thought patterns on the superficial aspects of human beings and begin embracing multiculturalism, which means not judging someone based upon looks alone, including obesity. Ethnocentrism continues to plague even the most educated individuals, as noted from the studies conducted looking at prejudice and discrimination of health care providers/specialists. It is time for the minority group “obese individuals” to challenge the institution and their position. Obese individuals can begin challenging the institution on discrimination by resisting the stigma they place on obesity, and show the dominant group that they are not powerless and will not assimilate to their type of thinking. Health care providers need to continue to educate themselves, understand their own prejudice and discrimination mannerism, begin to treat the patient and as they would any other patient and provide accurate treatment. Ultimately, the goal of the health care provider “is to improve the patients’ health, longevity and quality of life through the provision of patient-centered care. Health care providers must identify modifiable behaviours that increase disease risk, and help patients change them” (Phelan et al., 2015, para. 2).
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