Is weight bias making us sicker?
Inside the move toward more inclusive healthcare for every body
Imagine visiting a healthcare professional with shortness of breath, only to find the conversation quickly turns to your weight. You leave with advice to lose weight, but uncertain whether your symptoms have been fully explored. While this does not reflect every patient’s experience, research drawing together 32 studies shows that weight stigma can shape clinical interactions, affect the care patients receive and create barriers to accessing health services. Northern NSW Local Health District clinician and Bond University PhD candidate Casey James has spent more than a decade exploring a different way to care for people: one that focuses on improving health rather than changing the number on the scales.
Weight bias in healthcare
Weight bias can influence the way people in larger bodies are assessed, treated and spoken to in healthcare settings. Research suggests it can be driven by conscious and unconscious assumptions about a person’s health, behaviours and personal responsibility based on their body size.
“We all have unconscious internalised bias from the world that we live in. We grew up in a society that has a thin ideal and we make assumptions about people based on their appearance,” Casey says.
She stresses that most healthcare professionals genuinely want the best for their patients. However, studies of patients’ experiences in healthcare show that weight stigma can affect the care they receive, including an undue focus on weight when it is unrelated to the reason they sought treatment.
“It could be presenting to the doctor for a broken toe or the flu and being told to lose weight. Even if that’s done in a compassionate way, it may leave something undiagnosed,” Casey explains.
“It may leave a patient feeling unheard or uncomfortable seeking care in the future. Building trust is important so people feel able to return when they need support and can benefit from timely assessment and treatment.”
The dietitian who discovered a different approach
Early in her career as a dietitian, Casey followed the weight-centric model she had been taught. When patients lost weight and then regained it, she felt frustrated that she was not helping them achieve what they had sought support for and pursued further training in health coaching and motivational interviewing.
“Through that, I came across the non-diet approach, which is a nutrition approach that is weight-inclusive and looks at putting weight to the side and focusing on people’s relationship with food and their nutritional balance. That expanded my understanding of weight bias and weight stigma,” she says.
“It was a bit of a light bulb. It made me go, ‘Oh, there’s a different way to look after people.’ I started practising that way over 10 years ago and found it a lot more rewarding and a lot more valuable.”
Weight and health
Growing evidence is challenging the use of body weight as a standalone measure of an individual’s health. Traditional training has generally treated weight as a major, modifiable risk factor. In some healthcare settings, weight loss can become the primary treatment goal, taking precedence over other interventions or being made a condition of accessing them.
“Weight is impacted by genetics, health conditions, education, socioeconomic status and access to food, and family commitments, as well as many more factors beyond food and exercise,” Casey says.
“We also have quite strong evidence that intentional weight loss is not sustainable for most people. When we go through weight loss, it impacts our metabolism. Then, in time, for the majority of humans, we have weight regain.
“We can improve many aspects of people’s health without making weight loss the primary outcome.”
Putting weight to the side
Weight-inclusive care, sometimes described as a health-centric approach, shifts the focus from body size to the health concerns and outcomes that matter to the individual patient.
Depending on their needs, this could involve improving nutrition, accessing mental health support, reducing stress, sleeping better, managing medication, strengthening social support or finding enjoyable ways to move.
“There are cases where weight does need to be considered, but there are many conditions and situations where we can improve people’s health and quality of life irrespective of what their weight is,” Casey says.
“If weight reduces during those health interventions, then it reduces, but it’s just not the outcome that we’re looking to measure.”
Weight-focused harms
Research indicates patient behaviours can influence health and mortality across the weight spectrum, supporting a greater focus on these behaviours and direct health measures rather than weight alone.
“Some chronic health conditions are more related to what we do as opposed to what we weigh, and most of them can be improved with better lifestyle behaviours,” Casey says.
“Nutritional deficiencies, osteoporosis, gastrointestinal disorders and the risk of eating disorders are all things that can come from intentional weight-loss interventions. It’s not a harmless thing to advise someone to lose weight.
“My research aims to increase awareness and understanding of the impact of weight bias in healthcare services to support clinicians to provide more inclusive care without focusing on changing body weight.”
Training healthcare professionals to think differently
Supported by the New South Wales Health Education and Training Institute’s Rural Research Capacity Building Program (RRCBP), Casey is working with Bond University and Northern NSW Local Health District to develop weight-inclusive training for healthcare professionals.
Casey’s PhD project, Co-Design of a Weight Inclusive Health Care Professional Development Program, will bring together clinicians, researchers and people with lived experience to co-design an evidence-based professional development program. The training will equip healthcare professionals with the knowledge, skills and confidence to provide more inclusive, respectful and equitable care.
“Education is only one part of looking at weight bias in healthcare systems. There are things like policies, equipment and facility access that also need to be looked at,” Casey says.
“We also want people to be reflective about where their beliefs come from around what health looks like. My hope is that a cross-discipline training package will start that process.
“Hopefully, it will build some scaffolding within health districts where we can look at policies, audit spaces and take a more holistic look to see if we can make health services more inclusive and welcoming for all bodies.”
Casey’s research is supervised by an interdisciplinary team including Associate Dean Dr Jessica Stokes-Parish, Assistant Professor Dr Louise Van Herwerden, Senior Lecturer Dr Lisa Vincze, Associate Professor Conjoint Dr Kate Mueller, and Assistant Professor Christina Turner.
By bringing industry experience and university research together, the project demonstrates how partnerships can respond to real-world health challenges and translate emerging evidence into practice.
Advocating for weight-inclusive care
People experiencing weight bias can set boundaries and ask their healthcare provider to explain the evidence behind their recommendations.
Casey suggests using questions such as:
Can we focus on the health concern I came in to discuss rather than my weight?
What evidence shows that weight loss would improve this specific condition?
Does that evidence demonstrate long-term health benefits?
What are the risks and potential side effects of the weight-loss intervention you are recommending?
What is likely to happen to my weight after the intervention ends?
Is there evidence that this treatment would be unsafe for me specifically?
What options are available to improve my health without making weight loss the primary goal?
Dr Jessica Stokes-Parish
Ms Louise Van Herwerden
Christina Turner
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