Stigma in obesity: The HCP perspective


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I’m Dominique Durer, I’m a physician, general internist, specializing in obesity management and eating disorders. And I have a private practice in Vevey, and also Eurovisita Center, which is a camps, where we can follow children, adolescents, and obese adults. I also work with Professor Alain Gaulet in the University Hospital of Geneva.

Weight stigma and weight bias generally refers to negative attitudes to a person just because he’s overweight or obese. In a study in 1994, Crandall already reports that some reason why obesity is associated to such negative stigma, are due to two factors. First, obesity volume is visible.

And second, obesity is perceived to be under personal control. In the case of obesity, individuals themselves are considered responsible for their condition. And it’s generally attributed to lack of willpower and laziness.

So the more the people think that body weight status refers to willpower, diet, and physical activity, the more negative attitude will be expressed. So what are the consequences of this stigma? First, an increase of risk of depression, a low self-esteem, a poor body image, but what is more important, an increase of eating disorders and binge eating, an exercise avoidance, and as a result, a further weight gain. So there is an occupation where really we don’t expect to find stigmatization, namely the GPs, the obesity specialists, and other doctors.

We expect them to be with full empathy to understand their patients. And yet doctors make really negative stigma, negative bias to their obese patients. In 2013, SWIFT reported that in general, doctors think that obesity is controllable.

And this is linked to stigmatization. In 2001, Tachman reported that doctors have negative bias to both obesity, but also to the person who is obese. And they think that this person are dishonest, non-compliant, they are poorly controlled, unintelligent, so all these negative ideas.

A Chrysler report is also that as BMI increases, the doctors are likely to have less patients and less desire to treat them. They think it’s a waste of time and they have less respect for them. We have a pediatrician in our region who has decided to follow obese adolescent and obese children, and he has really traumatized them.

Afterwards, I could follow seven of them in my practice, and they reported to me their traumatic experience. At each consultation, they have been teased and insulted, telling them that they were like big cow, elephant tracks, that they were really responsible of their state, and that they should feel guilty because it’s so easy to lose weight. Just eat less and move more, a piece of cake, easy.

So these adolescents have been really deeply shocked, and after years, they still really hate this pediatrician, and of course, they didn’t lose any weight. They even put weight during this period. There was a very interesting article published by Flint in the British Journal of Obesity in 2015, reported how deleterious is negative attitudes by doctors towards the obese patients, and they explained the patients in this paper that they felt really disrespect, criticism, of being dismissed by their doctors.

And this is very important because it can lead to avoiding and canceling their appointment with their doctor, so they won’t be treated. There is also another study by the Yale University that describe that 70% of the doctors, GPs or obesity specialists in US, are making negative stigma to their obese patients. So why GP mainly are making that? First, we can say maybe they don’t have, they are not really trained in a specific area like obesity.

Second, they are isolated mainly. They are not part of a multidisciplinary and a team with specialists, dieticians, psychologists, to be efficient. Third, they anticipate the patient will fail, and they will, in general, blame him because he was not compliant enough to the treatment without putting himself or themself into question.

And last, there is very few or not anymore your obesity drugs to help the GPs to treat the patients. And Pucci in 2013 made a very interesting study with medical doctors and doctors. He exposed them to a 17-minute video created by the Yale University.

It’s called Weight Bias in Healthcare Setting, and you can have it in YouTube, just putting the title and Yale University. It’s very interesting. Half of the video, you see a patient, how he’s stigmatized in a healthcare setting, and the other half, you can see the same team, but really very empathic and respectful.

Afterwards, they discuss together about obesity and their experience, and this has really reduced, really very drastically, stigmatization. I think that we have to educate the GPs and even the obesity specialists about stigmatization because of these dramatic consequences of stigmatization and because the obese patient already suffer of stigmatization also from medias at school, even in family and from friends. So we have something to do.

So I think that we have to educate the GPs