Weight bias—the last accepted form of discrimination

We British Columbians pride ourselves on being the most inclusive and accepting province in a country that is known as being pretty nice overall. But the fact is that we are inclusive and tolerant until we aren’t. While we won’t tolerate bigotry and discrimination on the basis of race, religion, sex, or sexual orientation, we’re still accepting of discrimination against people who suffer from obesity.  

If we’re honest with ourselves, most of us can remember a time when we saw someone who suffered from obesity and we thought that it was definitely their fault. Why couldn’t that person have a bit more self-control? Why couldn’t they eat a little less and walk a little more? Some of us may even have thought that obesity results from laziness, gluttony, or weakness.

We can make jokes about fat people and rarely get called on it. We talk about how so-and-so has really gained a few and our friends agree. I’ve even had fellow health care professionals ask me about my “fat surgery.”

These are all examples of what we call weight bias. The negative attitudes and judgments (conscious or subconscious) toward individuals who are overweight or obese. These beliefs all too often lead to discriminatory practices. Talk about an excellent way to undermine the struggles that these people are going through. The truth is, obesity is a medical disease (not a your-fault problem) and is recognized as such by the Canadian Medical Association.

I’ve been doing bariatric surgery for several years now and I can tell you there’s nothing lazy or weak about my patients. Most of my patients have tried every diet under the sun. They’ve lost and regained the same 50 kg more times than they can count. Always fighting against a complex interplay between gut-hormones acting on centres in the brain with social stressors such as abuse, poverty, and discrimination piling on. All these forces pull us back to our metabolic set-point, which in patients who are obese is a dangerous weight that leads to a host of other diseases—diabetes, hypertension, heart disease, osteoarthritis, and cancer to name a few.

Our society’s acceptance of weight bias explains, in part, why the wait list to enter a bariatric surgery program now stands at 28 months, with another 6 to 9 months before patients are ready for surgery! No other wait list in the province (surgical or medical) is that long, nor would this kind of a wait list be tolerated for joint replacements, hernia surgery, cataract replacement, or any other condition for that matter. 

So why is it okay for a patient suffering from obesity? Partly because of the misconception that obesity is a your-fault problem that can be corrected with simple changes in diet and exercise and partly because it’s not a headline-catching topic.

Even if we don’t make discriminatory comments, some feel it is okay to think them. And it certainly seems okay to ignore patients who become more sick (and cost our health care system millions) while waiting a remarkably long time to access care.

We are British Columbians—kind, accepting, and compassionate. Let’s extend that behavior to people who struggle with this disease. We’ve been taught not to judge a person until we’ve walked a mile in their shoes. The next time you find yourself judging someone who is obese, I urge you to think about things from their perspective. Imagine living a life of constant judgment from those around you while fighting a disease that’s doing its best to debilitate you before ending your life prematurely. Their struggles are significant and the cost to society is massive. We can certainly do better as a province—and certainly as a profession—to understand and lend a helping hand.
—Sharadh Sampath, MD, FRCSC, General and Bariatric Surgery
Director, Richmond Hospital Metabolic and Bariatric Surgery Program
Head, Division of General Surgery
President, BC Obesity Society
Clinical Assistant Professor, UBC Department of Surgery

This post has not been peer reviewed by the BCMJ Editorial Board.

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