Canadian researchers are finding that obese people often encounter bias, discrimination and stigmatization when dealing with health professionals, many of whom seem to believe that excessive weight is the obese person’s own fault.
“This bias often means delays in treatment or lack of care, which can be life-threatening,” said Mary Forhan, an assistant professor in the faculty of rehabilitation medicine at the University of Alberta who recently co-authored a research review of weight bias in health care. “It’s getting better but it’s almost as if there’s a resistance [by care givers] to see beyond the weight, which means obese people often don’t seek preventative care because they’ve been blamed for overeating or not exercising.”
Research shows that health-care providers understand the implications of too much weight, said Dr. Forhan, but they often lack the time, resources or knowledge of specialized treatment, and so develop an oversimplified, stereotypical attitude that such patients are lazy, unmotivated or simply overeat.
Dr. Forhan and her team are working to change attitudes among health-care students at the university, as well as among allied health professionals such as first responders. One of the tools at their disposal is a specialized bariatric care suite on campus that’s used to train health professionals. She believes occupational therapists like her can play a role in obesity treatment. “There’s a resistance to suggesting equipment like long-handled shoehorns or hand-held reachers or other specialized equipment that could make everyday life easier. We wouldn’t withhold assistive devices from a spinal cord patient but we seem to from the obese patient.”
Obesity on stage
Atlantic Canada has one of the highest rates of obesity in the country. Researchers from Dalhousie University decided to turn their recent Nova Scotia research into a live drama as part of a “Balancing the Scales” workshop for health-care students at selected universities in the region. Their paper looked at the multi-faceted problems involved in weight management within a health system that, it says, has built-in biases and barriers.
“Obesity is such a complex issue,” said Sheri Price, one of the authors and an assistant professor of nursing at Dalhousie. “Research papers often sit on a shelf, so we wanted to take our findings to students in a way that disseminated how patients and professionals feel.”
All the spoken words are taken from transcripts of obese people, policy makers and health professionals who were interviewed by the Dal researchers. On stage, the setting is a clinic where an overweight patient spends time in the waiting room and then sees the doctor. Although the actors talk and interact with each other, they also turn to face the audience with their thoughts, frustrations and emotional feelings about caring for and living with obesity.
The play opens with an overweight actress entering the waiting room, wondering if she will be humiliated again by being weighed in view of others. Eventually she struggles to sit in the only empty seat – a narrow chair with arms.
“Everyone just watched me stuff myself into this chair like a sausage.” The actress shifts uncomfortably. “I hate when people look at me like that,” she continues. “I know what they’re thinking: ‘Look at how fat and lazy she is.’”
The workshops include a mix of students from various disciplines like nursing, nutrition, diagnostic imaging, and respiratory and radiation therapy. “The ideal workshop number is around 30 but the response has been so great that we have been forced to limit it to a hundred and then we break into three groups after the play to discuss and to rewrite it,” said Dr. Price.
She said the feedback has been overwhelmingly positive, with students affirming that they’ll apply the information in their careers. Among the student comments were: “Made me think of patients as people with real struggles, not just statistics” and “There are situations in X-ray when we have no equipment that can image a very obese patient. We need to find solutions to this – communicate restrictions with doctors so they are referred in a way that they are not set-up for failure.”
A small dissemination grant from the Canadian Institutes of Health Research has allowed them to take the actors to UPEI, UNB, Memorial and Dalhousie for the workshops. Currently, the Dalhousie researchers are discussing whether to go national with their workshop but say funding is the main hurdle.