Are We Moving the Needle on Weight Bias?

Twenty years ago, when I first became aware of the issue of weight bias as an important barrier to effective obesity prevention, treatment and research policies, there wasn’t really much in terms of research, evidence, or advocacy to go on. Back then, my friend and colleague (and fellow Canadian) Rebecca Puhl, then at the Rudd Center for Food Policy, was virtually the lone “she-wolf” in the wilderness trying her best to attract attention to this topic.

Reading her papers and speaking to my patients and colleagues, it was clear to me then, that in order to move forward in terms of respectful and meaningful obesity prevention policies, improving access to obesity treatments, and increasing funding allocations towards obesity research, tackling weight-bias and discrimination needed to be a central focus for the newly created Canadian Obesity Network (now Obesity Canada). 

Just how far along we have come in terms of broader awareness of this issue is nicely outlined in a paper by Adrian Brown and colleagues in a paper published online in eClincal Medicine as part of The Lancet Discovery Science series. 

The paper summarises the current evidence to support the pervasiveness, impact, and implications of weight bias in the context of policy, healthcare, media, workplaces, and education.

I was, of course, particularly tickled by the fact that the authors chose to highlight our efforts in Canada (e.g. the EveryBODY Matters Collaborative) to tackle weight bias on multiple fronts using complementary as well as consistent and persistent strategies, which have to date resulted in notable changes within Canada and beyond.

At the end, the authors propose short- and medium-term recommendations to address weight stigma in an effort to end weight stigma and discrimination accross society.

These include, changing the narrative around obesity and recognising it as a chronic relapsing disease, the need for a non-weight-based definition of obesity that focuses on health rather than size, the importance of using proper language, and reframing health policies to address the wider determinants of health with a focus on health behaviours rather than weight loss. 

At a clinical level (not extensively discussed in this paper), I would humbly add, we need policies to ensure that every person living with obesity has the same access to evidence based treatments that must include behavioural modification, medications, and bariatric surgery, in a manner comparable to treatment access for other chronic diseases like diabetes or hypetension. 

Although we still have a long way ahead of us, the authors do well to celebrate and highlight the progress that has been made on several of these fronts and will hopefully continue to happen in the foreseeable future.

Berlin, D