Weight bias compounds health problems, and surgeons need to recognize and stop it
It was 6:30 A.M., and I was getting ready to head down to the operating room for the first case of the day: an abdominal wall hernia repair. In preparation for the case, I logged on to the electronic health record portal and read through the patient’s medical history and the preoperative notes written by the surgical team. In many of the physician notes, the first line noted the patient’s body mass index of 41.
Antifatness is socially ingrained and virtually inescapable. Pop culture idolizes thinness. The Centers for Disease Control and Prevention created an alarmist “obesity epidemic” based on exaggerated data that haven’t held up. Like everyone else in society who is socially conditioned to this bias, clinicians are not exempt from harboring antifatness.
Weight bias is heightened and reinforced in the surgical setting, where surgeries on higher BMI individuals take more time, cost more money and have an increased risk of complications. Antifatness attitudes and behaviors may be higher among surgeons partly as a result of the lack of filter people may have when the patient is sedated. The increased time and care required in these cases can be difficult for surgeons, whose time and care are already strained given staff shortages.
A culture of antifatness among surgeons leads to compounding negative impacts on individual patients and the health system. Studies show weight bias from providers is palpable for patients. Patients can sense the lack of dignity and respect in providers’ attitudes and, in turn, may choose not to interact with the system that degrades them.
Ultimately, the biases and behaviors that maintain antifatness need to change. Potential avenues for change include creating systemwide education, amending medical documentation, reframing patient conversations and advocating for upstream policies that increase access. A health provider’s goal should be health—vital statistics, lab results, symptom reduction, time spent exercising, mental health—not thinness.
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