Overcoming weight bias in health care

(Edmonton) Five days after undergoing gastric bypass surgery to reduce the size of her stomach and lose weight, Adrianna O’Regan knew something was wrong. She became violently ill and could not even keep down water.

But when she went to a local hospital, she was refused admission by a triage nurse who said her illness was her body’s way of telling her she needed to lose weight. Undeterred, O’Regan saw her surgeon the next day and learned her bowel had blown up like a balloon—a complication that, if left untreated, would have been fatal.

“I never expected that kind of discrimination from a health professional, especially when I just did something to help me lose weight,” O’Regan remembers of her run-in with the triage nurse and experience with weight bias. It’s a term that refers to negative attitudes and stigmatization of people with obesity.

Mary Forhan, an assistant professor in the Faculty of Rehabilitation Medicine at the University of Alberta, says weight bias isn’t confined to Hollywood or popular culture but happens everywhere—including the health-care sector, where consequences can be life or death.

Feelings of blame and shame

“Patients or people living with obesity feel to some degree disadvantaged by feeling that their health-care providers don’t understand their condition or attribute all of their health problems to their weight, which may not be the case,” says Forhan, an occupational therapist whose research focuses on obesity and rehabilitation. “As a result, many patients living with obesity tend to avoid seeking preventive health care because of this experience of feeling blamed or shamed.”

After hearing numerous such concerns from patients through her research, Forhan, in collaboration with Ximena Ramos-Salas, a PhD student in the School of Public Health, decided to examine the issue in depth and recently published a review of weight bias in health care.

Research shows that although primary-care physicians understand the risks of carrying excess weight, they often lack the training to properly treat obesity. The result is that they oversimplify the disease, fail to send patients for weight-loss counselling and often resort to stereotypes that patients are lazy or unmotivated.

Obesity a complex condition to treat

Forhan said treating obesity is far more complicated than “exercise more and eat less.” A wide range of factors can cause weight gain, including genetic predisposition, injuries preventing mobility, side-effects from treating a mental health condition, a physiological disorder that affects a patient’s metabolism, and social circumstances limiting access to healthy foods or recreation.

When the Canadian Medical Association published guidelines on treating obesity in children and adults in 2007, obesity researchers like Forhan were excited, but that soon faded. Guidelines, she says, are only effective if the information makes it to the front lines, which has been a slow process.

U of A leads way in obesity research

Forhan aims to make progress on the issue at the U of A, training students and clinicians across several health disciplines about safely and respectfully caring for patients with obesity. She also hopes to make gains through research in her role as academic co-lead of the specialized-care bariatric suite in the Health Sciences Education and Research Commons on campus—the only facility of its kind in Canada—working alongside Arya Sharma, chair of obesity research and management in the Faculty of Medicine & Dentistry.

Forhan is also well connected to the Canadian Obesity Network, through which she first built relationships at the Faculty of Rehabilitation Medicine that contributed to her decision to leave her home in Ontario and move to Edmonton this past summer.

“To be able to do the research I wanted to do that I felt was needed, I needed to come to the U of A and an environment that would give me the opportunities to do that,” she says. “There are great senior researchers who have developed some fantastic research, so to have mentors and that support system in place is really invaluable.”

Forhan’s paper was published in the Canadian Journal of Diabetes.