Research shows that many people living with obesity experience weight-related shame in clinical practice. Unsolicited weight-loss advice from GPs, medical equipment that fails to accommodate larger body sizes and concerns about being judged for their weight by healthcare providers are just some of the reasons why people with obesity may experience shame because of their weight. Broadly speaking, experiences of weight-related shame arise because of the common belief that obesity is caused by greed, laziness and a lack of self-control. Because obesity is largely viewed as a condition that individuals can control they are often blamed for it, and subsequently blamed for the costs that obesity poses to the UK’s National Health Service (NHS) and the wider economy. In this way, obesity is seen as not only a private concern but also a public one, with people who live with it viewed as irresponsible and reckless in terms of the effects that their lifestyle behaviours have on others.
In some cases, experiences of weight-related shame in clinical practice can lead to GP avoidance. This, in turn, can have negative implications for preventative healthcare more broadly, as people who do not visit their GP are less likely to undergo preventative screening that detect early signs of life-threatening conditions such as cancer (e.g., cervical screening). A recent study conducted by the UK’s All-Party Parliamentary Group for Obesity found that 42% of people did not feel comfortable discussing their weight with their GP, with many citing feelings of weight-related shame as the primary reason. In another study, Olson and colleagues found that participants reported delaying or cancelling appointments with their physicians because of embarrassment about their weight (72%), anticipating being weighed (13%), and wanting to lose weight before they saw their physician (63.9%).
Another study conducted in 2006 found that women with higher weights were more likely to delay or avoid visiting their healthcare providers because of experiences of being shamed in healthcare settings. In relaying their experiences participants reported disrespectful treatment from clinicians, embarrassment about being weighed, negative attitudes of providers, unsolicited advice to lose weight, and physicians using medical equipment that fails to accommodate their body size.
Because obesity is widely understood to develop due to the individual choices that people make, negatively commenting on a person’s weight is often perceived as criticising the way that person chooses to live their life. In this way, GPs who comment on a patient’s weight risk offending them by linking their size to their lifestyle habits. Additionally, they risk de-medicalising obesity by placing it outside of the realm of medical intervention. GPs are not social workers, and many would argue that they have no business involving themselves in the personal lives of their patients. However, many GPs continue to recognise the importance of having weight-related discussions with patients who are overweight, with some demonstrating weight-related biases towards patients who they view as lazy and irresponsible because of their lifestyle “choices” (Foster et al., 2003). For some patients, recognising these biases can induce feelings of weight-related shame that lead to self-blame and self-criticism. Conservative commentators often frame these effects of weight-related shame positively, viewing them as a necessary and effective step towards substantial weight-loss (Boucher, 2019). But research shows that weight-related shaming does not work. As noted by Susan Greenhalgh in her book Fat-Talk Nation: The Human Costs of America’s War on Fat, negatively commenting on a person’s excess weight in order to motivate them to lose weight is largely counter-productive as the feelings of shame that come from those comments can lead to an increase in behaviours that promote further weight gain (e.g., comfort eating).
For people who adopt a “facts over feelings” approach to obesity, concerns about offending people by negatively commenting on their weight are deemed unimportant if those comments lead to substantial weight loss that could improve that person’s health. Whilst most of the GPs that I interviewed in a study that explored weight-related discourse in primary care consultations recognised the importance of engaging in weight-related discussions in ways that do not cause offence, some adopted the “facts over feelings” approach by showing open disdain for patients who continued to demonstrate poor health behaviours despite being advised to make positive lifestyle changes.
By solely focusing on the physical health benefits of losing weight for people who are living with obesity, GPs who adopt this approach risk overlooking the negative implications that weight-related discussions can have on their patient’s mental health. Mental health and physical health are interrelated, therefore GPs need to be mindful of the physical and psychological effects that judgmental conversations about weight can have.
It is important for GPs to provide weight-loss support in a non-judgmental way for patients who seek it, and to advise them about practical ways to lose weight that suit their financial budgets, time constraints and physical abilities.
Tanisha Jemma Rose Spratt
Boucher, G. (2019) Bill Maher Weighs in On U.S. Obesity: Fat Shaming “Needs to Make a Comeback”. Available: https://deadline.com/2019/09/bill-maher-weighs-in-on-u-s-obesity-fat-shaming-needs-to-make-a-comeback-1202728488/. Accessed 27/07/2021.
Foster, G D et al. (2003) Primary Care Physicians’ Attitudes about Obesity and Its Treatment. Obesity Research, 11(10), 1168-1177.
Greenhalgh, S. (2015) Fat-Talk Nation: The Human Costs of America’s War on Fat. Ithaca: Cornell University Press.