The Canadian Medical Association categorizes obesity as a medical condition, one caused by many factors, but it’s important to recognize that not all higher-body weight people have obesity.
Contrary to many harmful stereotypes, higher-body weight people can be perfectly healthy and some higher-body weight people may have fewer health issues than some lower-body weight people. While weight can contribute to developing health conditions (e.g., type 2 diabetes), that does not mean that every higher-weight person is unhealthy or will develop these conditions.
And yet stigma around weight continues to exist in all areas of society…including health care.
Terminology: weight bias, weight stigma, and weight discrimination
Before we dive further into this topic, it’s important to understand some key terms.
- Weight bias refers to negative attitudes toward obesity and higher-weight people.
- Weight stigma refers to incorrect assumptions about obesity and higher-weight people (e.g., higher-weight people are lazy, unmotivated, and lack self-control).
- Weight discrimination occurs when those biases and stigma affect decisions that directly impact a person’s life, usually negatively. In health care, these decisions can lead to medical negligence, delay in diagnosis, and denial of specific health services, as assumptions are often made that every physical complaint is related to weight.
Weight discrimination in health care
According to Obesity Canada, 64% of adults with obesity (or 3 out of every 5 higher-weight adults) report experiencing some form of weight bias from a health care professional. This may look like any or all of the following :
- Having symptoms automatically attributed to weight (even when they are not related)
- Lectures on weight management or weight loss, when that information was not asked for and not the reason for the health care visit
- Missing key diagnostic tests due to medical tools not accommodating higher-weight bodies
- Shorter appointment times than lower-weight people
- Fewer referrals to specialists than lower-weight people with similar symptoms
- Longer wait times for surgeries and other medical procedures
Because of this bias, higher-weight individuals may miss out on important diagnostic opportunities, which can have a negative effect on a person’s health. Not having access to a specific diagnostic tool could cause an existing condition to worsen. It could also prevent someone from accessing treatment options that rely on a diagnosis. Additionally, those who experience weight discrimination may avoid seeking medical assistance altogether, which can place their health at further risk.
Shockingly, studies have found that weight-based discrimination is comparable to other risk factors, such as smoking and chronic disease, when it comes to the effect on a person’s health and can contribute to a 60% increase in mortality. A study published in Obesity Reviews suggested that “health-care providers commonly think of people with obesity as lazy, undisciplined, and weak-willed,” a bias that can directly cause harm to patient care.
So, what can be done to address weight bias and discrimination in health care?
Eliminating weight bias, stigma, and discrimination in health care
In 2019, Canada’s chief public health officer, Dr. Theresa Tam, published a report that named weight stigma as an obstacle to effective health care access. As a result, new national guidelines were drafted specifically for health care providers that address this issue.
Some of the suggestions found both in these guidelines as well as other sources include the following:
- Avoid using “demonizing” language and instead opt for “person first” language (“the patient who has obesity” rather than “the obese patient”)
- Avoid shaming a person about their weight
- Treat people with obesity as you would anyone else (humanizing approach)—recognize that weight is only one factor when evaluating a patient for medical conditions; focusing on just weight is not only unhelpful, but it could also cause harm
- Focus on positive changes in a person’s health status (e.g., lower blood pressure, increase in exercise/vegetable intake) than negative (e.g., no weight loss)
- Ensure your setting is inclusive (e.g., chairs that can accommodate higher-weight bodies, medical equipment—such as blood pressure cuffs—that is adaptable to various sizes)
- Include images of higher-weight people in medical educational material (e.g., pamphlets, posters), beyond weight-loss strategies
- Consider whether weighing an individual for every medical appointment is necessary, ask before weighing someone, and never weigh a person in front of others
- Shift the focus (including language) to health, rather than weight
Additionally, criticism is emerging about relying on BMI (Body Mass Index) as an indicator of health, with experts noting that “BMI fails to take into account factors such as how much fat versus muscle a patient has, the distribution of fat in their body (typically, fat around the waist increases disease risk more than fat in other places), and their metabolic health.”
Overall, health care providers are encouraged to be respectful toward their higher-weight patients.
By drawing attention to the issue and the negative effects stigma can have on a person’s health, the hope is that more health care providers will become aware of the issue and opt for neutral language and more inclusive approach to health care services. Often being aware of a potential bias can help reduce it, so the more health care providers are educated on weight-based discrimination, the more they can, hopefully, avoid discriminating against higher-weight and obese people.
Weight discrimination and gender
There isn’t a lot of data about the relationship between gender and weight-based discrimination in Canada. In the United States, more women report experiencing weight-based discrimination than their male counterparts, a statistic that aligns with western society’s preoccupation of “ideal” beauty standards for women (which include being thin). This trend is particularly relevant when we apply it to Canadian statistics that show, overall, more cisgender men are overweight or obese than cisgender women. If Canada is similar to the U.S. in terms of discrimination reports, it is notable that a specific demographic (cisgender women) experience more discrimination when fewer of them are obese, when compared to cisgender men. Of course, it’s also possible that fewer men report instances of discrimination, which is why more research is needed in this area.
The United States has also reported that “ the prevalence of weight-based discrimination has increased by 66 per cent over the past decade, and is comparable to rates of racial discrimination, especially among women.”
We’ve already touched on why relying on the Body Mass Index (BMI) is a problematic measure of health. Additionally, this outdated measure (it was devised over 200 years ago) used a sample of white men to determine what is “healthy” and “average.” Because of this, using BMI as an indicator of health is even more ineffective for women and racialized people.
While the Government of Canada has published the Gender-based Analysis Plus analytical tool, obesity and weight discrimination is not explicitly included in the process. We do know that many women and gender-diverse people experience discrimination and bias in health care settings and society overall
Patient Rights
Every person in Canada has the right to access health care services when needed. Moreover, we have the right to “receive high quality patient care that is free from discrimination, abuse or harm, and be treated with compassion and respect.”
When communicating with a health care provider, a patient should feel part of a team—they should feel listened to and be a part of the decision-making process regarding their level of care.
While health care is a provincial system, there are national patient rights in place. You can find these listed on the Canadian Health Advocates website.
The Government of PEI has its own list of patient rights and responsibilities that include being treated with dignity and respect. You can find these rights listed online.
If you feel you’ve been discriminated against by your health care provider, and if attempts to discuss this with them have not changed the situation or you feel your health would be compromised if you addressed the issue, you can make a complaint to the human rights commission. More information about this process can be found online. On PEI, you can also contact Health PEI for guidance.
Hopefully, as education campaigns address the issue of weight-based discrimination, more health care providers will become aware of the harm this bias can cause and we’ll see fewer cases of weight-based discrimination in health care settings.
It’s important to also remember that health care professionals do want the best for their patients, after all, and once awareness has been gained, changes will hopefully follow.
Published date: April 2025
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