Written by: 

Kalyn King, RD, CSOWN, LD; Eva Panigrahi, PhD; Colleen Schreyer, PhD; and Mae Zoltowky, BSN, RN, CPHQ; on behalf of the ASMBS Multidisciplinary Care Committee  

Ideally, healthcare settings would be the last place someone with obesity would experience weight bias and stigma, but for many individuals with higher body weights, this is a common experience. Weight stigma has been defined as “negative attitudes, beliefs, stereotypes, and discriminatory behavior” targeted at individuals due to their weight, size, or shape (National Eating Disorders Association Website). These types of biases are prevalent. Weight stigma has been documented in employment, healthcare, and educational settings and is frequently encountered in the media. In healthcare spaces, weight stigma may present as a lack of inclusive seating or equipment, assumptions about an individual’s lifestyle or behaviors, and unsolicited or unrelated comments about weight. Unfortunately, patients seeking obesity treatment, including metabolic and bariatric surgery, may also encounter weight stigma in their healthcare settings. Weight stigma may lead to avoidance of medical care, which in turn may delay assessment and necessary treatment of medical conditions. 

This article reviews strategies designed to help healthcare providers across multiple disciplines address and reduce weight stigma in obesity treatment, with a particular focus on behavioral health, nursing, and nutrition perspectives.

All Providers

Across disciplines, there are three key recommendations to help healthcare providers reduce weight stigma:

• Practitioner education and training:
  • Train clinicians to recognize and mitigate their own implicit biases regarding weight.
  • Promote awareness of the biological, psychosocial, and cultural factors contributing to weight and health.
• Weight-inclusive practices:
  • Focus on health behaviors and well-being rather than weight loss.
  • Use respectful, person-first language that is non-judgmental to reduce stigma and foster a more supportive clinical environment.
• Policy and system-level changes:
  • Advocate for organizational policies that explicitly address weight discrimination and promote inclusive practices in healthcare settings.
  • Encourage adoption of interdisciplinary care approaches. Foster collaboration among behavioral health clinicians, dietitians, nurses, nurse practitioners, exercise specialists, surgeons, and physicians to offer comprehensive care.

Behavioral Health Providers

From a behavioral health perspective, weight stigma contributes to mental health challenges (i.e., depression, anxiety, low self-esteem) and may also reinforce unhealthy behaviors such as disordered eating. Internalization of weight bias can lead individuals to adopt negative self-perceptions, further entrenching these prejudices. Addressing weight bias is a crucial aspect of behavioral health that fosters compassionate and comprehensive care, ultimately enabling patients to overcome obstacles to effective treatment and enhance their overall well-being. Improving weight stigma from a behavioral health perspective involves multi-faceted strategies, including:

• Establishing a collaborative therapeutic environment where patients feel safe discussing experiences with weight bias and stigma.
• Assessing patient’s experiences with weight stigma to enhance understanding and reduce related emotional distress.
• Using evidence-based interventions such as Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) to address internalized weight bias and build self-compassion.
• Offering support groups and psychoeducational programs to empower patients in understanding and coping with the impact of weight stigma.

Nursing Providers

Nurses play a critical role as patient advocates. Whether championing policy change, educating colleagues and communities, or delivering direct patient care, nurses are at the forefront of challenging biases and promoting equitable treatment. As one of the first points of contact for individuals seeking obesity-related care, nurses serve as a “first line of defense” in combating weight bias. Their influence is essential in preventing delayed diagnoses, reducing miscommunication, and fostering trust between patients and healthcare systems.

To effectively reduce weight stigma, nurses can implement the following strategies:

• Evaluating the care environment to ensure it accommodates patients of all body sizes, thereby promoting comfort and enhancing the accuracy of clinical assessments.
• Empowering patients to self-advocate by encouraging them to voice concerns, request supportive staff, or seek alternative providers when experiencing bias.
• Gathering and incorporating patient perspectives to inform more respectful and effective approaches to obesity care.
• Using non-stigmatizing language when discussing lifestyle modifications, and focus on health.

Dietitian

Dietitians generally recognize that most patients have a basic understanding and knowledge of what foods are considered to be “healthy” or unhealthy”. The role of a dietitian goes well beyond this. Dietitians provide patients with additional education on nutrition, supplements, and physical activity, as well as advice on implementing practical and economically sustainable food choices. They can foster increased self-confidence to make optimal dietary choices using approaches such as motivational interviewing to avoid judgment and build rapport. A motivational interviewing approach may also allow dietitians to uncover negative self-perceptions or disordered eating patterns, which may need to be addressed before meaningful changes can occur. Patients may benefit from collaboration between their dietitian and behavioral health providers to address symptoms interfering with optimal food choice. Dietitians can utilize several helpful motivational interviewing strategies:

• Exploring a person’s own motivations for health behavior change, independent of weight.
• Encouraging the client to focus on changes that are most important to the patient and accepting that the valued changes may not always relate to nutrition.
• Asking for permission before giving suggestions to establish a more collaborative approach to care and to avoid providing information “overload”.
• Assessing confidence to make change (e.g., On a scale of 0-10, how confident are you that ____?)
• Avoiding a focus on food choice based solely on using “good” or “bad” categories, calories, or the number on the scale.

 Key Takeaways

All health care providers can help create a more inclusive and collaborative environment that reduces weight stigma and promotes holistic, person-centered care. Meaningful change can be achieved by increasing efforts to educate patients and providers about weight stigma, prioritizing respectful, person-first communication, creating welcoming, inclusive patient care spaces, and, when needed, advocating for change within our own healthcare systems or at the policy level.

Additional Resources

To learn more about weight stigma, including information about research and advocacy, please utilize the following links:  

• Obesity Action Coalition: obesityaction.org
• UConn Rudd Center for Food Policy and Health:https://uconnruddcenter.org/research/weight-bias-stigma/
• No Fat Shame: https://www.nofatshame.com/ (A website for patients and practitioners)
• COPS: https://www.canadaobesitypeersupport.com/ (An experiential learning group for educating healthcare providers in obesity medicine)

TREO Foundation thanks all who contributed to this article.