Navigating bias and stigma when anti-obesity treatments fail

Key takeaways:

• Both patients and providers can feel stigma and weight bias when an anti-obesity treatment fails.
• Making small changes, like using person-first language, can make a big difference.

NATIONAL HARBOR, Md. — Navigating ineffective weight management treatment is a sensitive process that requires acknowledgement of bias from both patients and providers, according to presenters here.

Lori A. Wenz, AGNP-C, BC-ADM, FOMA, a nurse practitioner at Western Colorado Weight Care, and Susan M. Bowlin, DNP, FNP-BC, ACNP-BC, CBN, a nurse practitioner at Priority One Weight Loss, discussed what happens when an anti-obesity treatment fails.

Treatment failure can occur for a multitude of reasons, including hormonal shifts, genetics, the gut microbiome and more, they said. Yet, providers still sometimes judge patients for their lack of improvement, which can contribute to weight bias and stigma.

“When judgment replaces care, patients are given personal experience instead of evidence. They’re offered opinions over outcomes,” Wenz said. “When judgment replaces care, patients are blamed for their disease.”

Although a patient’s response — or lack thereof — to a treatment is “no fault of their own,” it is not uncommon for patients to experience this judgment, Wenz said. Surveys have indicated that up to 80% of patients with obesity reported experiencing weight stigma in the health care setting.

“Our interactions with patients don’t occur in a vacuum,” Wenz said. “We’re going in to see patients with our own personal biases, our own experiences — and patients come with the same.”

The bias and stigma contributing to ineffective treatment responses can come from patients, too, Wenz said. Many will blame themselves for their perceived shortcomings.

“People often believe that eating a certain amount of calories is tied to either discipline or willpower, but really this is a false narrative,” Wenz said. “Appetite is a biologics function regulated in the brain. Body weight is regulated by numerous problems communicating between the gut, adipose tissue and the brain.”

Wenz stressed that, when talking about obesity, “words matter, especially when we are communicating with patients and documenting our charts.

“Yet, there’s no consensus definition for a relapse or exacerbation of obesity when we’re treating patients with anti-obesity medications. Some people may choose to use weight recidivism, weight relapse, weight regain,” she added. “Whatever the term you choose to use, you should always avoid the use of the word ‘failure.’ Patients are not failures. Some treatments fail, but patients are not failures.”

As another example, rather than calling patients “obese,” providers should opt for “people with obesity.”

“Obesity treatment is multifaceted, often multidisciplinary, but always individualized and patient centered,” Wenz said.