Reducing Weight Stigma in Healthcare and Health & Fitness Settings [Podcast Series]
[:55] Dr. Bantham introduces her guest, Dr. Rebecca Puhl
Dr. Rebecca Puhl is Distinguished Professor in the Department of Human Development and Family Sciences at the University of Connecticut.
She is also Deputy Director of the Rudd Center for Food Policy and Health.
[1:13] Progress in addressing weight stigma
“[S]ince I started in this field, which was 25 years ago, we have seen significant progress with awareness and education and strategies to reduce weight stigma. But, you know, progress is slow, and what we are ultimately trying to do here is to shift societal attitudes that are strongly ingrained in our culture about body weight, and to eliminate a form of social stigma.”
[3:14] Weight stigma in healthcare settings
“[S]ome evidence suggests that when we compare to how providers care for patients with a lower weight, that when it comes to treating patients with higher weight, some healthcare providers are spending less time in their appointments or demonstrating less rapport with patients or less patient-centered communication. Some feel like they just don't engage in as much discussion or intervention, and they tend to have lower respect for patients as BMI increases. And so those kinds of stigmatizing experiences can both reduce the quality of care for patients, but can also contribute to patients avoiding healthcare.”
[7:11] Weight stigma in health & fitness settings
“The first is that we do know that people who have higher body weight experience stigma and anticipate stigma in physical activity settings, you know whether that's judgment or staring or negative comments or teasing because of their body size. And sometimes that can occur from other people who are exercising in the same physical activity setting, but sometimes it can also come from instructors or trainers who unintentionally are contributing to stigma, either by making assumptions about a person's fitness level or body size, and that certainly can lead to embarrassment and anxiety about being physically active in front of other people.”
[11:22] Visual images of people with diverse body sizes
“And so, you know, it is something that I really encourage health professionals to carefully consider in their work, in their presentations, and their educational kinds of outreach activities to ensure that the visual images that they have are appropriate and respectful.”
[14:40] Reducing weight stigma
“You know, certainly one of the first priorities in trying to reduce weight stigma is to recognize and address our own personal biases, and we just know that healthcare professionals are not immune to weight bias. We are all exposed to the same messages that we see in society, and so it's important to really examine our own attitudes and our implicit assumptions about body weight and obesity, and to really try to avoid stereotypes that people with higher weight are lazy or unmotivated, etc.”
[17:50] Factors that reinforce weight stigma
“You know, the prevailing idea is that if you want to lose weight, you just have to work hard, and if you don't lose weight, you didn't work hard enough, right? So those are heavily ingrained values in our culture that also perpetuate this.”
[21:47] Constructive responsibility framework
“Yeah, so this is an approach where we acknowledge that individuals have responsibilities for their health behaviors, while also holding industries, policies, institutions, and environments responsible for the conditions that shape those behaviors. So it shifts some of that responsibility upstream. So food companies, policymakers, healthcare systems, the built environment, these become responsible actors too.”
[24:14] Motivation for studying weight stigma
“I quickly saw that weight stigma was a problem, but that there were a lot of questions that hadn't been studied to understand it. So, trying to understand, you know, how pervasive it is? How are people coping with it? How does it impact their health? And you know, how do we get rid of it?”
[27:58] Call to action
“Fundamentally, it's recognizing that people of all body sizes deserve to be treated with respect and dignity. I think a lot of times, health professionals and practitioners underestimate their power and influence to effect policy change, and yet they can be so impactful.”
