Sept. 26, 2003 -- Would you say obese people are lazy, stupid, and worthless? Of course not. Yet this very prejudice infects most people -- including doctors and nurses.
Weight bias is everywhere. That doesn't make it right. But we can't do anything about it if we don't see it. A real eye opener comes from Yale researcher Marlene B. Schwartz, PhD, and colleagues in the September issue of Obesity Research.
The finding: Weight bias is rampant among health professionals who treat obesity. Schwartz says even she is affected -- and she's co-director of Yale's Center for Eating and Weight Disorders.
"I have those biases, too," Schwartz tells WebMD. "None of us are immune. The only way to do something about it is by recognizing it. Insight is the way to behavior change."
The Last People You'd Suspect
Schwartz has been studying bias against obese and overweight people. She finds it everywhere. To prove her point, she gave a test to the health professionals attending the annual meeting of the North American Association for the Study of Obesity.
The test is sneaky. It asks a person to put certain words in certain categories. It's in our nature to do this task faster when we agree with the category the word goes into. Pairing "flower" with "good," for example, takes less time than pairing it with "bad."
The health professionals were much faster at pairing "fat people" with "lazy," "stupid," and "worthless" than with "motivated," "smart," and "valuable."
That's no surprise to Judith Stern, ScD, RD, vice president of the American Obesity Association and distinguished professor of medicine and nutrition at the University of California in Davis.
"Health professionals just reflect the general population. I'm not surprised they reflect this pervasive bias," Stern tells WebMD.
Weight Bias Hurts Health
Health professionals aren't as biased as people in the general population, Schwartz is quick to point out. But their prejudice may be much more dangerous.
"The belief that obese people are lazy, stupid, and worthless has several potential implications for the care of obese individuals," Schwartz notes.
"It can impact the care people get and even their access to care," Stern says. "If you believe obesity is a moral disease and all you have to say to obese people is just eat less and exercise more, and you have too little patience to relate to them as people, it's a problem."
Stern offers the example of Kaiser Permanente of California, which she calls "an excellent HMO." She notes that Kaiser Permanente pays for members' diabetes education classes. It also pays for asthma education classes.
Fighting Weight Bias
"We are optimistic we can think of ways to intervene and help people change these attitudes," Schwartz says. "It's necessary for all of us to become aware of these subtle attitudes we might have. We have to raise awareness so we can monitor ourselves."
One way to start is to take the test yourself. It's available online at the Rudd Institute web site. But if you're already aware of your own weight bias, why waste time? You can get started right away.
"I challenge you to do something nice today -- something that isn't patronizing -- for an obese person," Stern says. "If you're taking public transportation, if you're sitting next to an obese person, instead of moving away, start a nice conversation."
In the longer term, Schwartz says, we need to change our junk-food environment.
"Where we can make changes is to focus less on personal responsibility and look at the environment -- especially when it comes to children," she says. "We are quick to blame them, quick to blame the parents. When they complain about the pervasiveness of junk food, parents are fighting against a terribly powerful force. It is very hard to eat healthy. It takes planning and time and resources that a lot of people don't have. We need to change society to make it easier to eat good foods."