Review| Volume 37, ISSUE 3, P205-209, June 2013

Inequities in Healthcare: A Review of Bias and Discrimination in Obesity Treatment

  • Mary Forhan
    Address for correspondence: Mary Forhan, PhD, University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario T6G 2G4, Canada.
    University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada

    Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall, Edmonton, Alberta, Canada
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  • Ximena Ramos Salas
    Centre for Health Promotion Studies, University of Alberta, School of Public Health, Edmonton, Alberta, Canada
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      A b s t r a c t

      This review is based on an exploration of the published literature over the past 20 years in the area of weight bias, stigma and discrimination and its association with obesity treatment. National and international obesity organizations have identified obesity stigma as a key barrier to effectively addressing the obesity epidemic and have called for theory driven interventions to reduce it. Both the Canadian Obesity Network ( and the Obesity Society ( have strategic directions, mission statements and collaborations that strongly oppose weight bias and recognize the potential of such bias to negatively impact obesity treatment. Comprehensive reviews of the literature in the area of weight bias have been published and have subsequently raised awareness of the potential impact of weight bias and discrimination on the health and well-being of individuals living with obesity. The purpose of this review is to highlight drivers of weight bias and to discuss its impact on obesity treatment.

      R é s u m é

      Cette revue s'appuie sur une exploration de la littérature publiée au cours des 20 dernières années en matière de préjugés, de honte et de discrimination liés au poids, et leur lien avec le traitement de l'obésité. Les organisations nationales et internationales sur l'obésité ont considéré la honte de l'obésité comme l'obstacle majeur à une lutte efficace contre l'épidémie d'obésité et ont fait appel aux interventions fondées sur la théorie pour la réduire. Le Réseau canadien en obésité ( et l'Obesity Society ( ont des orientations stratégiques, des énoncés de mission et des collaborations qui s'opposent fortement aux préjugés liés au poids et reconnaissent les répercussions négatives qu'a le potentiel de ces préjugés sur le traitement de l'obésité. Des revues exhaustives de la littérature en ce qui concerne les préjugés liés au poids ont été publiées et ont subséquemment fait prendre conscience des répercussions potentielles de la discrimination et des préjugés liés au poids sur la santé et le bien-être des individus atteints d'obésité. Le but de cette revue est de mettre l'accent sur les déterminants des préjugés liés au poids et de discuter de leurs répercussions sur le traitement de l'obésité.


      Mots clés

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      1. Canadian Obesity Network. Canadian Obesity Network—First Canadian Summit on Weight Bias and Discrimination. 2011.

      2. The Obesity Society. The Obesity Society: position statement on weight bias and discrimination. 2010.

      3. Canadian Institutes of Health Research-Canadian Obesity Network. INMD-CON Bariatric Care—Workshop Report. December 2010.

      4. Canadian Obesity Network. Toronto Charter on Obesity and Mental Health. 2012.

      5. Action Coalition. Action Coalition's policy agenda. 2012.

        • Puhl R.M.
        • Heuer C.A.
        The stigma of obesity: a review and update.
        Obesity. 2009; 17: 941-964
        • Puhl R.M.
        • Brownell K.D.
        Bias, discrimination, and obesity.
        Obes Res. 2001; 9: 788-905
        • Teixeira M.E.
        • Budd F.M.
        Obesity stigma: a newly recognized barrier to comprehensive effective type 2 diabetes management.
        J Am Acad Nurse Pract. 2010; 22: 527-533
        • Brown I.
        • Thompson J.
        • Tod A.
        • et al.
        Primary care support for talking obesity: a qualitative study of the perceptions of obese patients.
        Br J Gen Pract. 2006; 56: 666-672
        • Kaposy C.
        The influence of the stigma of obesity on H1N1 influenza vaccine sequencing in Canada in 2009.
        Vaccine. 2011; 29: 9607-9610
      6. Mold F, Forbes A. Patient's and professional's experiences and perspectives of obesity in health-care settings: a synthesis of current research. Health Expectations.

        • Sharma A.M.
        Does the focus on obesity prevention promote bias and discrimination?.
        Conduit. 2009; 3: 6
        • Terre L.
        • Hunter C.
        • Poston W.S.
        • et al.
        A treatment of obesity in the primary care setting: are we there yet?.
        Eat Disord. 2007; 15: 135-143
        • Hebi M.
        • Xu J.
        Weighing the care: physician's reactions to the size of the patient.
        Int J Obes Relat Metab Disord. 2002; 25: 1246-1252
        • Bertakis K.D.
        • Azari R.
        The impact of obesity on primary care visits.
        Obes Res. 2005; 13: 1615-1623
        • Drury C.A.
        • Louis M.
        Exploring the association between body weight, stigma of obesity and health care avoidance.
        J Am Acad Nurse Pract. 2002; 14: 554-561
        • Adams C.H.
        • Smith N.J.
        • Wilbur D.C.
        • Grady K.E.
        The relationship of obesity to the frequency of pelvic examinations: do physician and patient attitudes make a difference?.
        Women Health. 1993; 20: 45-57
        • Olson C.L.
        • Schumaker H.D.
        • Yawn B.P.
        Overweight women delay medical care.
        Arch Fam Med. 1994; 3: 888-892
        • Turner K.M.
        • Salisbury C.
        • Shield J.P.
        Parent's views and experiences of childhood obesity management in primary care: a qualitative study.
        Fam Pract. 2011; 29: 476-481
        • Walls H.L.
        • Peters A.
        • Proietto J.
        • McNeil J.J.
        Public health campaigns and obesity: a critique.
        BMC Public Health. 2011; 11: 136-153
        • Puhl R.
        • Peterson J.L.
        • Luedicke J.
        Fighting obesity or persons with obesity? Public perceptions of obesity-related health messages.
        Int J Obes. 2012; : 1-9
        • Puhl R.M.
        • Peterson J.L.
        • Luedicke J.
        Motivating or stigmatizing? Public perceptions of weight-related language used by health providers.
        Int J Obes. 2012; : 1-8
        • Guttman N.
        • Salmon C.T.
        Guilt, fear, stigma, and knowledge gaps: ethical issues in public health communication intervention.
        Bioethics. 2004; 18: 531-552
        • Wadden T.A.
        • Anderson D.A.
        • Foster G.D.
        • et al.
        Obese womens' perceptions of their physicians' weight management attitudes and practices.
        Arch Fam Med. 2000; 9: 854-860
        • Forhan M.
        • Risdon C.
        • Solomon P.
        Contributors to patient engagement in primary health care: perceptions of patients with obesity.
        Prim Health Care Res Dev. 2012; 14: 1-6
        • Kristeller J.L.
        • Hoerr R.A.
        Physician attitudes toward managing obesity: differences among six specialty groups.
        Prev Med. 1997; 26: 542-549
        • Price J.H.
        • Desmond S.M.
        • Krol R.A.
        • et al.
        Family practice physicians' beliefs, attitudes and practices regarding obesity.
        Am J Prev Med. 1987; 3: 339-345
        • Lau D.
        • Douketis J.
        • Morrison K.
        • et al.
        2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children.
        Can Med Assoc J. 2007; 176: 1-118
        • Kirk S.F.
        • Tytus R.
        • Tsuyuki R.T.
        • et al.
        Weight management experiences of overweight and obese Canadian adults from a national survey.
        Chronic Dis Inj Can. 2012; 32: 1-8
        • Artac M.
        • Dalton A.R.H.
        • Majeed A.
        • et al.
        Uptake of the NHS Healthy Check Programme in an urban setting.
        Fam Pract. 2013; ([Epub ahead of print])
        • Schwartz M.B.
        • Chambliss H.O.
        • Brownell K.D.
        • et al.
        Weight bias among health professionals specializing in obesity.
        Obes Res. 2003; 11: 1033-1039
        • Sharma S.
        • Wharton S.
        • Forhan M.
        • et al.
        Influence of weight discrimination on weight loss goals and self-selected weight loss interventions.
        Clin Obes. 2011; 1: 153-160
        • Wee C.C.
        • Davis R.B.
        • Huskey K.W.
        • et al.
        Quality of life among obese patients seeking weight loss surgery: the importance of obesity-related social stigma and functional status.
        J Gen Intern Med. 2013; 28: 231-238
        • Fardouly J.
        • Vartanian L.R.
        Changes in weight bias following weight loss: the impact of weight-loss method.
        Int J Obes. 2012; 36: 314-319
        • Lund T.B.
        • Sandoe P.
        • Lassen J.
        Attitudes to publicly funded obesity treatment and prevention.
        Obesity. 2011; 19: 1580-1585
        • Padwal R.S.
        • Chang H.J.
        • Klarenbach S.
        • et al.
        Characteristics of the population eligible and receiving publicly funded bariatric surgery in Canada.
        Int J Equity Health. 2012; 11: 54
        • Downey M.
        • Still C.
        • Sharma A.M.
        Is there a path for approval of an antiobesity drug: what did the Sibutramine Cardiovascular outcomes trial find?.
        Curr Opin Endocrinol Diabetes Obes. 2011; 18: 321-327
        • Padwal R.S.
        • Wang X.
        • Sharma A.M.
        The impact of severe obesity on post-acute rehabilitation efficiency, length of stay and hospital costs.
        J Obes. 2012; 2012: 972365
        • MacLean L.
        • Edwards N.
        • Garrard M.
        • et al.
        Obesity stigma and public health planning.
        Health Promot Int. 2009; 224: 88-93
        • Gibbs W.W.
        Treatment that tightens the belt: is insurance part of America's obesity problem?.
        Sci Am. 1995; 272: 34-35
        • Martin L.F.
        • White S.
        • Lindstrom W.
        Cost-benefit analysis for the treatment of severe obesity.
        World J Obes. 1998; 22: 1008-1017
        • O'Brien K.S.
        • Puhl R.M.
        • Latner J.D.
        • et al.
        Reducing anti-fat prejudice in preservice health students: a randomized trial.
        Obesity. 2010; 18: 2138-2144
        • Diedrichs P.C.
        • Barlow F.K.
        How to lose weight bias fast! Evaluating a brief anti-weight bias intervention.
        Br J Health Psychol. 2011; 16: 846-861
        • Freedhoff Y.
        • Sharma A.M.
        Best weight: a practical guide to office-based obesity management.
        Canadian Obesity Network, Edmonton, AB2010
        • Canadian Obesity Network
        5As of obesity management.
        Canadian Obesity Network, Edmonton, AB2012
        • Sharma A.M.
        • Kushner R.F.
        A proposed clinical staging system for obesity.
        Int J Obes. 2009; 33: 289-295