Obesity Bias

It's no secret that my weight has fluctuated through the years - primarily the years I was previously in clinical practice as a nurse-midwife. As the mother of six, it wasn't my pregnancies and breastfeeding experiences that seemed to challenge my waistline the most, but more the stress and sacrifice of being a midwife, taking 24/7 call, and managing everyone else's needs while ignoring my own. I've lost 60 pounds in the last three years, and while my #diet has changed very little, my movement has increased significantly, but more than anything, my #stress and sleep have changed dramatically. It is these latter two issues that I believe have allowed me to shed the most weight, but this did require a huge life change for me.

As I've come to better understand obesity along my own journey - the underlying epigenetics, various body shapes and why, #hormones, stress, #inflammation, movement, grounding, #mindfulness, relationships, environmental exposures, diastasis recti, deep breathing, and even pharmacologic support - what really surprised me was the profound obesity bias among clinical practitioners.

Currently, as a professor in integrative health and wellness and even a family nurse practitioner program, I see bias even among my very compassionate and knowledge-forward students. The very archaic belief that calories in and calories out are the essence of obesity still prevails and along with that is a great deal of judgement. Sadly, none of the academic programs I have either endured myself or taught within discuss obesity bias, although education is key.

Factors associated with overweight and obesity are incredibly complex, including metabolic, genetic, behavioral, emotional, neurological, hormonal, environmental, cultural, and socio-economic influences, yet family practice providers often hold negative attitudes and beliefs toward individuals with obesity. Our profession, sadly, does have a discriminatory belief or behavior-based perspective on the weight of an individual. This occurs in many medical settings and can impact patients' willingness to seek healthcare.

Research has found that implicit bias, an automatic, uncontrolled reaction or bias, occurs among exercise professionals and healthcare providers when they work with obese clients. They present with #antifat attitudes and stereotype, even stigmatize those who are overweight, assuming they are lazy, unintelligent, and even worthless (Schwartz, Chambliss, Brownell, Blair, & Billington, 2018; Panza, Armstrong, Taylor, Puhl, Livingston, & Pescatell, 2018).

Nurses, our frontline workers, are not exempt from holding this bias either. One study found nurses with this bias believe these individuals lack self-control and are more exhausting and stressful to work with as patients, preferring not to care for them (Brown, 2006; Tanneberger, & Ciupitu-Plat, 2018; Phelan, Burgess, Yeazel, Hellerstedt, Griffin, & van Ryn, 2015). Medical providers have reported changing their medical practices and choices of treatment dependent upon the individual's weight, particularly when female. There are reports of providers declining to perform pelvic exams, delaying clinical breast exams, and offering fewer mammograms than are offered for women with lower overall body weights. This overall stress causes the client to share less about their health concerns further causing detriment to their long-term health.

When our clients don't feel safe with us or recognize bias, they aren't going to ask about weight loss options; too often the practitioner assumes the client is obese because they are lazy so aren't going to engage in a weight loss program anyway, so they ignore the topic entirely. If it is discussed, the approach is often accusatory and condescending. Heart-breaking!

This conversation happens with each and every client who joins our practice, because to be completely honest, many of our clients with smaller body sizes have exceedingly high body fat compositions and low muscle mass anyway. This discussion and personal awareness is part of every wellness evaluation, and we discuss how we might approach optimizing health.

Our yoga classes also embrace all bodies. Let's face it; I don't have the more stereotypical yoga body. I have to lift my belly to twist into a few poses. Yoga pants don't compliment my physic. I wear them anyway, but I am constantly cognizant of the potential my shirt may rise too high. I also suffer a bit of imposter syndrome. While I know my muscle mass is high and my body fat is healthy, my body shape does not represent that of a fit person, so I can't help but feel like my teaching yoga is a bit of a fraud. My body has been swimming in cortisol for many decades which packs the pounds around the waistline. Know that this is common and it is my desire to help each of you embrace your shape, optimize it for your own health, and love who you are, wherever you are at in your journey.

Obesity, though, is a chronic disease. This is not entirely about poor personal choices and being obese is not healthy, even if your healthcare provider says so in effort to reassure you and avoid the more common obesity bias. A healthy lifestyle is imperative for longevity and vitality, but epigenetics is key. Our environment mixed with our genetics is what determines how our body will express its stress and inflammation. Consider that our adipose tissue is a dilutor of our toxins, so the greater our inflammation and stress, the more fat we will carry to protect us from these harmful chemicals. As well, our gut microbiome regulates weight, as does our neurochemistry and hormones. It is not as easy as what we eat and how much we move, although these are important.

Working with obese clientele needs to be a person-centered evaluation and management should be individualized, as it would be with any other disease. What is the underlying cause? True to the typical functional wellness approach, we must dig in and determine the root cause of obesity, using an integrative approach to its healing. Our physical healing program is about true lifestyle changes, emotional health, mind-body connection, and intuitive living and moving.

Eden is committed to serving women, men, and children of all sizes and shapes. Often clinical sites lack proper blood pressure cuffs so without proper fit, results are erroneously elevated. Gowns aren't always available that fit larger sized clients, leaving clients, particularly larger individuals, feeling exposed. Although who feels secure under those paper drapes anyway!?! We have eliminated those entirely and provide our clients custom-made linen drapes. We also have blood pressure cuffs of all sizes, in every room. There is no need to be moved or for proper equipment to be brought into the room, creating awkward scenarios. We are equipped for all bodies.

Our practice does not utilize stirrups - for anyone. These are not necessary for any aspect of a pelvic exam, even IUD insertion. Our office has a variety of speculum sizes as well, which significantly impacts the comfort of the pelvic exam and the effectiveness of the testing. This is an expensive investment, so often skipped by conventional settings.

Lack of privacy is an issue as well, in many conventional practices. Not only do most not have scales for larger clients, but they are not located in a private place or nurses will read these measurements aloud, making the client feel uncomfortable or self-conscious. Our office has a body composition scale in each private room. We want to evaluate more than your total weight. We want to understand your body composition.

There are a plethora of approaches to weight loss. Our practice has a unique approach in that we dig in - epigenetics are evaluated - and we work with each individual to create an integrative plan. However, we don't stop there. We dig into the misconceptions regarding our weight, and we work to identify what is underlying our health and wellness emotionally, spiritually, and physically. No single approach will work for everyone. This is not a quick fix, but a life transformation. We can help you implement what best resonates with your life experiences and dreams for your future. We are walking that same path with you.

Doctor Lane meets with clients weekly via zoom to discuss progress, challenges, and offers yoga and meditation classes, even hikes to get grounded. Her partner, and Eden's practice manager, also has experience with weight loss so this is near and dear to our heart. We are complex people in a very challenged world, with overly demanding lifestyles. Let us meet you where you are at and help you work towards your best self.