This blog post was written by Githmi Welhenge and Kaylyn MacDonald, Summer interns at Obesity Canada for summer 2023.
The Weight of Living™ initiative by Obesity Canada is where individuals living with obesity can share their lived experiences. Obesity Canada also offers an area on its website where anyone can report any biases and/or discrimination they have experienced in their life. We took time to review both initiatives and the submissions we have received to date.
While reviewing the Weight of Living™ submissions, some of the key themes we found were familial influence, and social stigma. The Bias and Discrimination Reporting Form, revealed varying types of bias and difficulties accessing treatments. While we looked at them separately, there were many shared experiences.
Living with obesity is an individual experience however, shaped by many similar factors. A few individuals shared that their family’s influence played a significant role in shaping their perception of obesity from childhood. One individual shared growing up in a stressful and toxic household, which led them to turn to food as a source of “solace and comfort.” For some, the family history of obesity made them more susceptible to weight-gain, creating an additional layer of pressure and concern from their families. This led family members to take an active role in monitoring their health through restrictive diets and constant warnings about their weight. One person shared that this experience was particularly hurtful, as they were constantly compared to their “skinnier” siblings and faced pressure to lose weight. Another individual wrote that they were put on a 1200-calorie diet and served “diet food” while the rest of the family enjoyed regular meals, leading to feelings of isolation and exclusion.
In addition to their families, many individuals emphasise that their peers often lack understanding of obesity as a chronic disease. Consequently, they have been subjected to judgement, ridicule, and discrimination based on their size. One person recounted being excluded from social activities in high school because of their weight, writing, “I was repeatedly left out of social events, often when a drive was required. I needed more room in the vehicle and was often excluded to allow another person in the car.” Additionally, they mentioned receiving inappropriate comments about their size at restaurants. Many others shared experiences of embarrassment caused by the lack of suitable seating in businesses and offices. Moreover, Taiwo Akinwusi had a job offer rescinded because of their weight. They share that “there was a particular job offer that I got through my performance at the intermediate levels but at the final selection, which was a physical interview, the employer categorically told me that [He is] sorry I will not be fit for the job because they want healthy looking staff and my body weight will not allow me to be prompt as required of me.” Unfortunately, Taiwo Akinwusi is not the only individual to face discrimination due to their weight because many others reported the bias and/or discrimination they experienced through our Bias and Discrimination Reporting Form.
There were several reported factors that impacted the individuals who reported instances of bias and discrimination experience living with obesity. Some individuals experienced difficulties or lack of coverage and access to treatments, while others faced extreme bias within the medical system and with company policies, as well as discrimination within the workplace.
Difficulty in accessing obesity management and treatment options was reported by a number of the participants of the Bias and Discrimination Reporting Form. One individual stated, “[they are] on the waitlist for the Edmonton Bariatric Clinic, which is about a four year waitlist currently. My family doctor has put me on Ozempic in the meantime. I have been on Ozempic for the last 16 months. My insurance, which is Sunlife, won’t cover any medications used for weight loss.” A common concern that individuals trying to gain access to treatment have faced is the lack of coverage for obesity medications, or if the insurance company will cover the medication, it is only within set BMI parameters or if certain comorbidities are present. The Canadian Obesity Clinical Guideline recommends using metabolic, physical and psychological parameters to determine a suitable obesity treatment plan; BMI alone is not an effective tool to capture the health risks associated with excess body weight. Gaining access to medication is extremely difficult, one individual who is a member of the Canadian Armed Forces attempted to access obesity medication,was denied and was directed to apply through a different process to gain access. In the end the individual paid out of pocket to access the medication due to the numerous obstacles they faced trying to gain access to the proper medication. Obesity is a chronic disease and treatment can be life saving. Another individual shared how, due to their weight, they were charged a premium for their life insurance while their partner, who had other health concerns, was granted life insurance with no added costs, stating “I was charged premium for my obesity, with no other health indicators of disease. My skinny husband has high cholesterol, high liver enzymes and had kidney cancer and no, I repeat no premiums for his insurance.” To pay additional costs or out-of-pocket, for evidence-based treatments is not sustainable and requires insurance companies and employers to re-evaluate their coverage.
There were a number of instances regarding discrimination within the medical system as the thoughts and opinions of the practitioner can lead to a reduction in the quality of the experience a patient has, therefore potentially hurting patient outcomes and reducing satisfaction of the care received Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Several people have reported to Obesity Canada that various doctors, regardless of their specialty, ignore their health concerns or refuse to provide treatment due to their weight. One individual shared their five-year-long battle to get their tonsils removed due to obstructive sleep apnea, where they faced doctors telling them to lose weight and that their issues would resolve, sharing how “After 18 months of infection after infection, my GP referred me to a local ENT to see if I was a candidate to have my tonsils removed. During my first consult with the ENT, he told me that losing weight would solve the issue and to come back to see him when I had lost 40-60 lbs. At the time, I was 5’4″, weighed 185 lbs, and measurements of my neck circumference were smack in the middle range for ‘healthy women’.” Another individual recounted their experience with their chronic back pain and how, at a pain clinic, “after going 3 times the doctor told me my pain was in my head and that all I needed to do was lose weight because I am obese and that I was in pain longer than he was a doctor”. These experiences are two of many and are not uncommon shared experiences for people living with overweight/obesity who participated in the reporting form.
Some individuals faced bias when trying to access healthcare due to their weight and corporations policies. A few shared their experiences of being denied access to care and treatments based on weight or BMI cutoffs set by certain healthcare facilities or hospitals. One individual shared how they had to attend all their prenatal and postnatal appointments and give birth in a different city because their local hospital would not provide access to care due to their BMI not meeting the hospital’s cutoff. They shared how “It meant that I could not receive pregnancy care locally and needed to drive 45+ minutes to Peterborough for all appointments and deliver at the Peterborough hospital. It meant greater expense due to gas and additional time off work for travel for my husband and I… It was incredibly frustrating that their decision to deny me care locally was based on a useless measure and an arbitrary cut off rather than my actual medical status (e.g., I experienced no complications such as GD or HBP, the anesthesiologist had no difficulty with epidural).” Another individual shared how their family member was denied hospice care due to the facility’s weight restrictions, adding that they were “refused entry into the Hospice because they have a policy that they do not accept patients above 350lbs”. The policies of these facilities caused people unnecessary stress and highlighted the need for the modification of the discriminatory policies towards individuals with larger bodies.
Most of the individuals who reported bias and discrimination, a select few underwent discrimination in their respective workplaces. One individual’s employer mandated everyone to wear the same shirts for a special day at work but didn’t order from a company with inclusive sizing, thus excluding a portion of the staff. The individual highlighted that when “I asked that if we were expected to wear it at work, could we add an alternative style that comes in larger sizes and a fabric suited to larger people. A few other staff members (slim ones who are very empathetic) said they felt uncomfortable having a school goal based around equity when this situation clearly didn’t follow the concept of allowing for diversity–obviously I stood out as the only staff member not wearing the shirt–I got called a “rebel” and explained that I’m wasn’t being a rebel.” Another individual’s employer took away their sick days, sharing “I had a direct supervisor tell me that I was no longer allowed to take sick days without a doctor’s note to prove I was sick so that it would encourage me to “take better care of myself”. Like being my size was something I chose…I actually have a medical condition that caused my weight issues.” Instances like this are not uncommon and an individual who participated in the Weight of Living™ initiative by Obesity Canada also experienced workplace discrimination as well, as previously highlighted above.
We asked these individuals about their vision for improving the lives of Canadians living with obesity. Many of them expressed a hope that their stories would bring about positive change by shedding light on the challenges they face. One individual shared that they wanted others “To educate people. To accept people. To understand that there may sometimes be an underlying reason for the obesity. It may be physical, medical or emotional/mental.” Taiwo Akinwusi, who had lost a job offer due to discrimination, emphasized, “My vision is for the government to take obesity serious[ly]… if attention and action is on obesity they will certainly save cost and better life expectancy of citizens.”
We are calling for comprehensive obesity education in school curriculums to prevent social isolation and bullying. Within workplaces, seminars and workshops should be implemented to educate employers and employees of obesity as a chronic disease and steps to reduce bias and stigma. In addition, further research and education should be provided to health care practitioners (HCP) regarding pregnancy, as well as pre/post-partum care for individuals living with obesity. Moreover, to reduce bias and discrimination in healthcare, HCP should be encouraged to use self assessment tools such as Implicit Association Test to be aware of their attitude and behaviours toward individuals living with obesity and better implementation of Canadian Obesity Clinical Guideline.
We urge all levels of government in Canada, insurers, employers, and healthcare systems to revise their policies to consider obesity a chronic disease and support appropriate access to evidence-based obesity management. Ensuring fair coverage for all treatments, addressing bias within the medical system, and modifying discriminatory hospital policies will significantly enhance the quality of care for individuals with obesity. Employers must create inclusive and supportive workplace policies where employees of all sizes are respected and provided with equal opportunities.
Together, let’s work towards a society that is more compassionate, equitable, and understanding, empowering individuals with obesity to lead fulfilling lives free from discrimination and bias.
References
- CMAJ 2020 August 4;192:E875-91. doi: 10.1503/cmaj.191707
- Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity reviews : an official journal of the International Association for the Study of Obesity, 16(4), 319–326. https://doi.org/10.1111/obr.12266
Image credit: https://ecpomedia.org/image/sweden-friends/ (European Coalition for People Living with Obesity)
