Thursday, February 8, 2018

Weight bias, stigma, and discrimination - barriers to access to care?

The #obsm obesity chat has been going strong for just over a year now, adding new participants with each chat! In honor of that success, we’ve decided to revisit a popular topic this month -- weight bias, stigma, and discrimination -- but with a new twist: how does weight bias impact access to science-based care for obesity?


Bias, stigma and discrimination based on body size are a reality for many people with obesity. One manifestation of obesity bias is fat shaming, which some believe encourages weight loss. The reality is, however, that it can have severe detrimental consequences for patients’ emotional and physical wellbeing. As Rebecca Puhl, PhD writes, “If fat shaming were an effective approach to provide incentive or motivation to lose weight, the majority of Americans wouldn't be struggling with overweight and obesity.”

Data has shown that another common belief, that obesity is a result of poor individual choices, is false. Rather, obesity develops from a combination of genetic, biological, and environmental factors in addition to behavioral factors. Research shows that obesity bias can affect nearly every aspect of patients’ lives--including educational and work environments, hiring practices, and health care.


In medical settings, patients with obesity report being treated disrespectfully and receiving inappropriate comments about their weight. Unfortunately, some physicians view patients with obesity as being lazy or non-compliant. Indeed, about half of physicians admit to weight bias.


Unfortunately, government policymakers and individuals who make coverage decisions for health-insurance companies are not immune to these biases. Unlike other chronic diseases, basic health-insurance policies rarely include coverage for obesity treatments. Instead, this coverage is usually a “rider” that must be added at an additional cost. Even when policies cover some obesity treatments, patients face unusual restrictions. For instance, bariatric surgery patients are often forced to participate in lengthy managed weight-loss programs before getting access to this potentially life-saving surgery.

While government-funded programs cover some obesity treatments -- Medicare now covers bariatric surgery for some patients and a small amount of behavioral counseling -- these benefits are limited and do not include coverage for any weight-management medications.
How can we change policymakers’ and health insurers’ biases against offering a full range of science-based care for people with obesity? This is a conversation enriched by having all stakeholders at the table.


With our next #obsm #obesity tweetchat, we hope to raise awareness of obesity bias and discuss strategies for gaining greater access to care. Specifically, we plan to pose the following questions:


How do weight bias, stigma, and discrimination affect obesity treatment/coverage decisions?

How can we educate policymakers and insurers that obesity is not a matter of personal choice but a chronic disease that should be treated like any other disease?

Have you, as either a patient or provider, successfully appealed a denial of coverage for an obesity treatment? If so, what worked?


What can societies such as The Obesity Society, the American Society for Metabolic and Bariatric Surgery and the Obesity Action Coalition do to improve access to care? What are they already doing?

What actions can individuals take to advocate for increased access to care for obesity?


Resources:

http://www.obesity.org/obesity/resources/facts-about-obesity/bias-stigmatization

http://www.medscape.com/features/slideshow/lifestyle/2016/public/overview#page=7

Sabin J, Marini M, Nosek BA. Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLoS ONE. 2012;7(11): e48448.

Puhl RM, Luedicke J, Grilo CM. Obesity bias in training: attitudes, beliefs, and observations among advanced trainees in professional health disciplines. Obesity. 2014;22:1008-1015.

Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Rev. 2015;16:319-326.

Puhl R, Brownell KD. Bias, discrimination, and obesity. Obesity Res. 2001;9(12):788-805.

http://www.aafp.org/news/practice-professional-issues/20170209obesityhospice.html
those with obesity receive less hospice care, less likely to die at home

http://www.obesityaction.org/weight-bias-and-stigma