Dispelling nutrition myths, ranting, and occasionally, raving

A smile doesn’t hide your weight bias

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I completed an online course on weight bias and stigma for healthcare professionals last week. There was quite a bit that was good but there were a couple of things that rubbed me the wrong way.

If you’re not already aware Obesity Canada states that, “weight bias refers to negative attitudes and views about obesity and about people with obesity. Weight stigma refers to social stereotypes and misconceptions about obesity. These social stereotypes and misconceptions include beliefs that  people with obesity are lazy, awkward, sloppy, non-compliant, unintelligent, unsuccessful and lacking self-discipline or self-control.” 

Weight bias and stigma can cause significant harm to fat people. In fact, they likely cause more damage to people than carrying extra weight itself does.

The course I took was very good about making this clear and provided the facts as well as showing how harmful weight bias can be to patients. However, there was a video with some experts that I felt undermined the message. Here are the quotes that bothered me:

“If weight loss was easy we wouldn’t have the current obesity epidemic that we have.” – Director of Research and Anti-Stigma Initiatives at the Yale Rudd Center

“People think that for someone who’s overweight all they need to lose weight is some self-control and trying harder to eat less and exercise more. If that only worked we wouldn’t have the problem that we have today. The causes of obesity are very complex…” – Director of Research and School Programs at the Yale Rudd Center

The Yale Rudd Center is well-regarded for their work in reducing weight stigma and both of these individuals quoted above are prominent in the field. At first glance what they’ve said seems innocuous. However, the fact that this was a course intended to combat weight stigma, the experts are saying that obesity is an “epidemic” and a “problem” runs counter to the message they’re trying to convey. It just goes to show how deeply ingrained weight bias is when the very experts trying to counter it are inadvertently perpetuating it. When you say that obesity is a problem then you are saying that fat people are a problem. And I don’t see how that’s not stigmatizing.

The other problem I had with the course were the case scenario videos they shared. There would be one video where staff and medical professionals were rude and unprofessional to patients regarding their weight. Then they would show a video that was intended to show a positive interaction. Really the only differences in the “good” videos were that the healthcare professional was all smiles and asked the patient if they could talk about their weight before advising behaviour change under the guise of promoting healthy behaviours rather than telling them directly to lose weight. To me, the message was the same, it was “you need to lose weight” delivered with a smile rather than scorn. There was still no looking at overall health to determine if weight loss was actually warranted, there was still no consideration of other causes of the presenting ailments, and there was still no recognition that simply telling people to eat healthier and move more (especially without first determining what their current lifestyle is like) is not an effective way to get people to lose weight.

Overall, I felt that the message of the importance of not perpetuating weight bias was lost when all the healthcare professionals were still delivering the message to their patients that they should lose weight. And yes, some people can benefit from losing some weight, but this should be determined with appropriate assessment and then weight management options need to be appropriately discussed with the patient. Simply telling someone, on the basis of their BMI, to eat less and move more with a smile is not helpful.

If you do happen to know of a good online weight bias course please let me know as I’m still looking!

Author: Diana

I'm a registered dietitian from Nova Scotia, living and working in Ontario, Canada. My goal is to help people relearn how to have a healthy relationship with food.

5 thoughts on “A smile doesn’t hide your weight bias

  1. Thank you Diana!!!! I really appreciate your point of view on this topic!!!

    So many people think weight is simply that you need to eat less but in all honesty it’s about so much more!!! I have PCOS and am a clean eater. I am overweight and the comments I get on a regular basis can be incredibly cruel.

    Everything from having people call us fat in public, telling me I am as fat as a whale and on and on. I have even gone to job interviews and had a potential employer tell me I couldn’t do a job because I couldn’t walk up steps… at the time I lived on the 3rd floor of a building with no elevator and I was running 4 to 5 days a week and was up to about an hour each time!

    I have experienced great health care professionals who look at my blood work results and others and say, what can I say? things look so great! You are healthy BUT your body carries extra weight… I can’t say anything to you because of your blood work and lifestyle. I have had others be incredibly cruel and without even looking at anything assume I eat 3 buckets of deep fried chicken a day…with I don’t know how much other stuff and without knowing my history or where I am health wise advising me that I should get gastric sleeve and they would send me right now.

    So again Thank you!

    It’s good to know some people are finally starting to get it!

    At least some people are really starting to get it. This means more that you know.

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    • Thank you for sharing your experience Kim. I can only imagine how frustrating and insulting these experiences are for you.

      I’m noticing a definite change in attitude and perspective among dietitians over the past few years and I’m hopeful that this will continue among all healthcare professionals and the general population. It’s hard when it’s so embedded in our society but it benefits no one to judge people and make assumptions based on their size.

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  2. Great points made, as I agree, a blanket weight loss recommendation for all is senseless and harmful. I would keep the definition of obesity (as per the WHO, CMA, etc) in mind though. In that, it is a a chronic disease when excess weight impairs one’s health, and for many people, it is a problem. I fully understand that many people live in larger body sizes without any health issues, and for them, we would never recommend “treating” their size. I don’t believe that the UConn Rudd Center is implying that everyone with excess weight would benefit from weight loss – only for those wherein their excess weight impairs their health. Obesity is not defined solely based on one’s BMI (think about the Edmonton Obesity Staging System). Just some food for thought. 🙂

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    • Yes, tools like the EOSS are helpful. I would also hope that the Rudd Centre wouldn’t push a weight loss agenda but their messaging did show that implicit bias that they’re supposedly trying to fight and I wanted to bring attention to that. It is definitely a complex topic and there are so many considerations when it comes to an individual’s health.

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  3. My gosh I love reading your posts! So intelligent and realistic. This is exactly why I’ve enjoyed being a counselor for the past 25 years, specializing in nutrition. I’ve been conducting several seminars at our town’s senior center on the mental, physical and spiritual connection to food. I love seeing the lightbulb come on when they realize how the hypothalamus triggers nutrient cravings regardless of how much “willpower” they try. Keep on inspiring others my new friend, :)

    Liked by 1 person

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