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Weight stigma...one of my experiences...



Weight Stigma is defined as bias of discrimination towards individuals who are perceived by others to be overweight or obese.  Having Polycystic Ovary Syndrome (PCOS) I’ve been on the receiving end of weight stigma myself.  Here’s just one of many examples.  Many years ago, I attended a Gynaecologist appointment on the 9th floor of the hospital block.  I was feeling very ill and extremely low at the time with pain, heavy menstrual bleeding and anaemia for several months and had waited a long time for this appointment.  I was worried I might have cancer given that we are warned to get abnormal bleeding checked and so was looking forward to finally getting some answers and most importantly some help. Little did I know I would get neither.


On my arrival, the gynaecologist opened my medical file and he proceeded to circle my weight with his pen. Circling round and round.  “How did you get here?” he asked.  I replied that I got the bus.  “No”, he said, “How did you get to the 9th floor?”.  I replied that “I got the lift”.  He questioned “why not the stairs?” and began to say things like I shouldn't be that weight for a woman that young. That I should exercise more. That I shouldn't be that weight.....and so it continued. The whole conversation revolved around weight. That experience led me to disengage with healthcare for a long time. This was a serious issue as PCOS has long-term consequences as I would later find out.


THE CONSEQUENCES OF WEIGHT STIGMA


There is a constant negative discourse associated with living in a larger body.  We are constantly reminded of it through the media and healthcare but it has real life consequences.   Women with PCOS are more likely to be obese than non-PCOS females [1].  Yet a recent study on PCOS found that participants felt they were stigmatised in relation to weight and a failure to respond to treatments [2].  It has been reported that doctors often associate overweight and obesity with non-compliance, hostility and dishonesty.  For example, 87% believe obese people are indulgent and 32% lack willpower.  Many prefer not to treat overweight patients [7].  While 50% of people were not offered any suggestions on how to lose weight it has also been found that often doctors underestimate people’s desire to lose weight [8].


Weight stigma can compound the consequences of overweight and obesity, and may lead to disordered eating and increased calorie consumption [3].  It can contribute to bias by healthcare providers that may affect clinical judgements and can result in women delaying seeking help due to embarrassment [4].  Weight stigma also hinders diagnosis and negative comments can lead to disengagement which has the potential for serious conditions to go undetected [5]  Despite the fact that higher-weight patients are at elevated risk for endometrial and ovarian cancer, some physicians report a reluctance to perform pelvic exams [6]


TIME FOR CHANGE


It has been suggested that increasing awareness through sensitivity training in medical staff and ensuring inclusive medical facilities will have a huge impact on women’s health care [9].  Training should include education about non-behavioural contributors to BMI such as genes and diseases that create obesity as a symptom such as PCOS [5].  Other suggested changes include creating more accessible environments by providing for example larger examination gowns. Most importantly, there is a need to treat people with respect and remove prejudice and blame [10]. 


References:

[1]    U. Durmus, C. Duran, S. Ecirli, Visceral adiposity index levels in overweight and/or obese, and non-obese patients with polycystic ovary syndrome and its relationship with metabolic and inflammatory parameters, J. Endocrinol. Invest. 40 (2017) 487–497. doi:10.1007/s40618-016-0582-x.

[2]    M. Busby, L. Simpson, Perceptions of coping with the long-term consequences of Polycystic Ovary Syndrome at different stages of the menopausal transition ., (2019).

[3]    T. Lancet Public Health, Addressing weight stigma, 2019. doi:10.1016/S2468-2667(19)30045-3.

[4]    M. Burke, Stop the Stigma!  Eliminating Implicit and Explicit Bias Toward Adult Obese Women Receiving Gynecological Care:  A Quality Improvement Project to Cultivate Empathy and Increase Knowledge of Best Practices, Dr. Nurs. Pract. Proj. (2018). https://scholarworks.umass.edu/nursing_dnp_capstone/152 (accessed August 8, 2019).

[5]    A.J. Tomiyama, D. Carr, E.M. Granberg, B. Major, E. Robinson, A.R. Sutin, A. Brewis, How and why weight stigma drives the obesity ‘epidemic’ and harms health, BMC Med. 2018 161. 16 (2018) 123. doi:10.1186/s12916-018-1116-5.

[6]    C.H. Adams, N.J. Smith, D.C. Wilbur, K.E. Grady, The Relationship of Obesity to the Frequency of Pelvic examinations, Women Health. 20 (1993) 45–57. doi:10.1300/J013v20n02_04.

[7]    R. Puhl, K.D. Brownell, Bias, Discrimination, and Obesity, Obes. Res. 9 (2001) 788–805. doi:10.1038/oby.2001.108.

[8]    I.D. Caterson, A.A. Alfadda, P. Auerbach, W. Coutinho, A. Cuevas, D. Dicker, C. Hughes, M. Iwabu, J. Kang, R. Nawar, R. Reynoso, N. Rhee, G. Rigas, J. Salvador, P. Sbraccia, V. Vázquez‐Velázquez, J.C.G. Halford, Gaps to bridge: Misalignment between perception, reality and actions in obesity, Diabetes, Obes. Metab. 21 (2019) dom.13752. doi:10.1111/dom.13752.

[9]    S.R. Lindheim, T.L. Glenn, L.D. Whigham, Recognizing and eliminating bias in those with elevated body mass index in women’s health care., Fertil. Steril. 109 (2018) 775–776. doi:10.1016/j.fertnstert.2018.03.002.

[10]  R.M. Puhl, C.A. Heuer, The Stigma of Obesity: A Review and Update, Obesity. 17 (2009) 941–964. doi:10.1038/oby.2008.636.

(c) M Busby, 2019


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