Weight bias in healthcare, and what being heard sounds like.

Weight bias is common, and it isn't in your head

Weight bias means negative assumptions about a person because of their size: that they haven't tried, or that every health problem comes back to their weight. Weight stigma, or obesity stigma, is what happens when those assumptions show up in how people are spoken to and treated.

If you've ever left an appointment feeling smaller than when you walked in, you're not imagining a pattern. The 2020 Canadian adult obesity clinical practice guideline, published in CMAJ, says plainly: "People with obesity experience pervasive weight bias and stigma." It adds that this bias contributes to worse health, independent of weight or BMI.

That's the reason the conversation works differently here. See how the program works: five steps, and each one tells you who you're dealing with.

It changes the care people get, not only how they feel

Bias isn't just uncomfortable. The CMAJ guideline states that "Biased beliefs about obesity also affect the level and quality of health care that patients with obesity receive." Obesity Canada's guideline chapter on weight bias puts it simply for patients: "Weight bias may affect quality of healthcare for individuals with obesity."

One way it shows up: a concern gets put down to weight before anything else is checked. The guideline chapter asks health care providers to "avoid making assumptions that an ailment or complaint a patient presents with is related to their body weight."

Bias can also turn inward. The CMAJ guideline recognises that internalized weight bias, which it describes as "bias toward oneself", can affect behaviour and health. It's one reason so many people put off asking for help with weight at all: they've already heard the lecture in their own head.

What Canada's guideline asks of every clinician

This isn't a matter of manners. The guideline sets out specific recommendations, and they're a useful checklist for any appointment:

• Check their own assumptions. Health care providers "should assess their own attitudes and beliefs regarding obesity" and think about how those may affect care.
• Drop the judgmental words. Providers "should avoid using judgmental words", images and practices with patients living with obesity.
• Ask first. The guideline recommends that providers "ask people for their permission before discussing weight or taking anthropometric measurements." Obesity Canada's chapter adds: "Ask permission before weighing someone, and never weigh people in front of others."
• Look for the root causes. Assessment should address the root causes of weight gain "with care to avoid stigmatizing and overly simplistic narratives."
• Measure success by health. The guideline suggests redefining success "as healthy behaviour change regardless of body size or weight."

What a respectful appointment sounds like here

You shouldn't have to brace yourself for an appointment. Here's what it sounds like with us, step by step. The lines are examples of the kind of thing you'll hear, not a script.

Before anyone sees you. You start online, in your own time. A person from our team calls to set up your video visit, and your history is taken there, once.

At the video visit.

• "Is it all right if we talk about your weight today?" You decide what you share, and when.
• "What have you already tried, and what happened?" Your history comes first, so nothing gets repeated for the sake of it.
• "What does a normal week look like for you?" Sleep, work, food, movement and stress, because the plan has to fit your real life.
• "What would you like to be different?" Your goals, in your own words. Not every goal is a number.
• "What questions have you been saving up?"

No lectures. No shame. You decide what you share, and when.

After the visit.

• "Here's what your labs show." Your results, explained in plain words.
• "Here are the benefits, and here are the side effects." Both come first, and whether to start anything is your decision.
• "This isn't the right fit, and here's why." If the answer is no, you hear it straight, with what to do instead.

At every check-in. "How are you feeling?" comes before any number. Check-ins cover how you feel, side effects and whether the plan needs to change.

If you've felt judged before, you can say so

You don't need to have lost weight first, or to arrive with the right words. Obesity Canada's guideline is direct about this: "Experiencing unequal treatment because of your size or weight, for example, is not acceptable." Its advice to patients is to "Talk to your healthcare provider about your experiences with weight bias."

That goes for any clinician you see, including your family doctor. And it goes for us. If something in a visit doesn't sit right, tell your Nurse Practitioner. Saying it is part of the care, not a complaint about it.

Why this page says "people living with obesity"

Words carry assumptions. Canada's guideline uses person-first language throughout, "people living with obesity" rather than labels, because a person is not their weight. We write the same way, and it's how you'll be spoken to.

It also treats obesity as a chronic disease rather than a character flaw. If that framing is new to you, is obesity a disease? explains what the guideline means by it. If years of diets have left you blaming yourself, yo-yo dieting explains why the weight comes back, and why it isn't you.