For such patients, an alternative approach to weight loss treatment that has gained increasing attention in recent years is known as “weight-neutral” care (also some- times described as weight-inclusive or nondieting interventions),128 at Every Size approach being the most prominent example.129


with the Health Weight-inclusive or


weight-neutral approaches promote healthy behaviors (such as nutritious eating and physical activity) for the goal of improving health and well-being without focusing on weight loss. They also strive to dispel myths related to weight, to reject sociocultural body ideals, and to increase body acceptance and self-acceptance. Within clinical settings, weight-neutral interventions have shown benefits for inter- nalized weight stigma in some but not all studies,125,130 related aspects of psychological well-being and health.128,130-134


along with improvements in At the societal level,


weight-inclusive messages combat weight stigma by advocating for equal access to high-quality care and the right (and ability) to be healthy and live life fully at any size.129


Experts need more research to fully understand this approach’s long-term impact on weight stigma among patients and the general public. Ultimately, experts recommend patient-centered care to determine the appro-


priate treatment approach for patients based on their individual needs and health goals. Listening to patients, appreciating that different patients may benefit from different treatments, and presenting the various evidence-based options for them to choose from are all critical practices in patient-centered care. Regardless of the treatment approach, health care professionals can prevent weight stigma by focusing primarily on health and changing health behaviors (rather than on body weight, which patients cannot completely or directly control), promoting positive body image, and ensuring that all patients in their practice are treated with dignity and equal respect. Interventions designed to reduce weight stigma and promote weight inclusivity have been delivered by a range of health professionals, including those in psychology, dietetics, and nursing.121-123,125,129


For providers who do not


feel confident in their ability to address psychosocial aspects of weight, however, when a patient reports serious distress related to weight, referral to a mental health professional or a specialist in weight-inclusive care may be appropriate.


Summary


Weight bias and weight stigma are insidious in our society and appear at structural, interpersonal, and intrapersonal levels. The harms of weight bias and stigma for mental and physical health are well established and of high relevance to health care professionals. Unintentional expressions of weight bias by health care providers and perceived stigmatization among patients in health care settings can lead to avoidance of health care and exacerbate health disparities and inequities. Health care professionals must be willing to reflect on their own biases and be aware of how their words and actions may affect patients with a higher body weight. Patient- centered care is critical to ensuring that the treatment approach meets the patient’s needs and does not cause harm. Health care professionals also have a responsibility to advocate for their patients to ensure equal treatment and access to high-quality health care for people of all sizes.


References


1. Puhl R, Brownell KD. Bias, discrimination, and obesity.Obes Res. 2001;9(12):788- 805. doi:10 . 1038 / oby . 2001 . 108


2. Crandall CS. Prejudice against fat people: ideology and self-interest.J Pers Soc Psychol. 1994;66(5):882-894. doi:10 . 1037 / / 0022 - 3514 . 66 . 5 . 882


CHAPTER 3: Weight Bias and Stigma 53


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