Addressing Stigma and Bias in Patients with Obesity & Adiposity-Based Chronic Disease

Publication Date: May 4, 2023
Last Updated: May 4, 2023

Overview

Key Definitions

  • Weight bias = negative ideologies associated with excess body weight
  • Weight stigma = thoughts and acts of discrimination toward individuals due to their weight and size and a result of weight bias
  • Internalized weight bias = when a person applies negative weight stereotypes (bias) to themselves and engage in self-devaluation
  • Implicit weight bias = unconscious bias toward a person who has obesity, beliefs or attitudes outside of an individual’s awareness and control
  • Explicit weight bias = awareness of bias and intentionally behaving negatively toward a person who has obesity

Summary of Recommendations

Weight stigma and IWB impair quality of life for patients with ABCD and constitute complications of this disease. At the same time, stigma and IWB exacerbate the severity of ABCD as a disease and compromise the efficacy of ABCD treatment. To address the impact of weight stigma and IWB, AACE puts forth the following consensus recommendations:
  • Patients with ABCD should be screened for the presence and degree of stigmatization and IWB; the Weight Self-Stigma Questionnaire and the Weight Bias Internalization Scale are validated tools that can be used to assess stigmatization and IWB.21,30,31
  • As complications of ABCD, the presence and degree of weight stigma and IWB should be incorporated into the staging of ABCD severity.
  • IWB and stigmatization can lead to or exacerbate psychological disorders such as depression, anxiety, stress, and disordered eating; patients with ABCD should be screened and treated for these psychological issues. Mental health conditions and social determinants of health should also be incorporated into the staging of ABCD severity.
  • Health care professionals and organizations should implement policies and actions to reduce the impact of weight bias in patient care including, but not limited to, implicit bias training for staff, obesity education of health care professionals to reduce explicit bias, use of person-first policies and language in treatment plans and health records, and adoption of the new proposed ABCD nomenclature for classification and staging of obesity along with clinical goals of therapy.
  • Health care professionals and organizations should advocate for improved access to evidence-based treatment modalities and increased research into practice-based solutions to limit the impact of IWB on management of ABCD.

Overview

Title

Addressing Stigma and Bias in the Diagnosis and Management of Patients with Obesity/Adiposity-Based Chronic Disease and Assessing Bias and Stigmatization as Determinants of Disease Severity

Authoring Organization