“Close your eyes and visualize a successful lawyer—better yet, an award-winning lawyer,” the presenter said to several hundred FNCE® attendees. I imagined a 40-something white guy in a blue suit, in good shape, with nice hair, and at least average height. I never once considered that the speaker, Patty Nece, JD, was describing herself. Why? Was it because she was a woman, was it the context of the presentation, or was it because of her size? She made me think about bias … especially weight bias.
Fat shaming, bias, and weight-related stereotypes pervade politics, Hollywood, medicine, and even dietetics. A review published in 2015 showed that nutrition professionals tend to stigmatize those with excess weight. Understanding potential biases is crucial for RDs because we’re often asked to help people with obesity, and our assumptions about those with excess weight can impact how effectively we communicate with them. In addition, the words we use when we write about the topic create or reinforce social norms.
Bias vs Discrimination
Weight bias or stigma generally refers to negative attitudes we have about others because of their weight. By comparison, weight discrimination is unfair treatment of someone because of weight. Bias and discrimination are connected because our attitudes often shape our actions, even without our awareness. Measuring attitudes is always a bit tricky, but if you’re interested in knowing more about your own potential biases, you can take an online implicit association test.
So what can we do to make sure our attitudes and communication style help create an environment for healthful behaviors?
Understand That Harsh Words Make Things Worse: A number of studies have shown that shaming or causing someone to feel bad about their weight generally leads to worsening of eating behaviors. When it comes to medically based treatments, about 20% of people said they would avoid future medical appointments if their doctor stigmatized them about their weight. Insensitive and harsh words, such as referring to the client as “fat” or implying he or she is lazy, that we justify as “being honest with the patient” rarely actually help the patient.
Use Person-First Language and Preferred Terms: Person-first language means putting people first rather than their disability when speaking or writing. For instance, referring to “a person with obesity” rather than “an obese person” is preferred in written and oral communication. In addition, those with excess weight prefer certain descriptive words. Terms such as weight, BMI, excess weight, weight problem, and unhealthy body weight are more desirable than fat, fatness, large size, obesity, and heaviness. If you are not sure what terms your client may prefer, ask him or her.
Exhibit Warmth and Empathy: Showing that you care is more important than the language you use; but if you care, you’ll show it in the language you use. Other important aspects of our communication style include reflective listening (“So let me make sure I understand what you are saying”), responding to your client’s concerns rather than your own agenda (“What would you like to get out of today’s session?”), and statements of concern (“I’d really like to help you with this; do you have ideas of what I can do?”). If your patient is seeing you for a reason other than weight, but you feel it’s an important topic to discuss, ask permission to discuss it with them. Lastly, don’t forget to smile, shake a client’s hand, and share in some laughter.
As RDs, we have the opportunity to treat people well and change the culture that stigmatizes those with excess weight. If you would like to get more involved in promoting healthful attitudes around weight and healthful behaviors, check out whyweightguide.org and consider joining the Obesity Action Coalition.
I want to thank Patty Nece, along with Dr. Scott Kahan and Joe Nadglowski, for their thoughtful FNCE® presentations on this topic. Special thanks to Patty for her advocacy and reviewing the above information.
— David B. Creel, PhD, RD, HSPP, is a psychologist and an ACSM-certified clinical exercise physiologist. He works as a clinician and researcher at St. Vincent Bariatrics in Carmel, Indiana. He’s author of the book A Size That Fits: Lose Weight and Keep It Off, One Thought at a Time and blogs at drdavidcreel.com.