1. Shippy, Rachel SPT
  2. Arena, Sara PT, MS, DScPT

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In the last 20 years, the obesity epidemic in the United States has reached its highest point in history, with prevalence increasing from 26% to 42% (Centers for Disease Control, 2020). According to the CDC, the annual cost burden of obesity is estimated at $147 billion. This burden is complicated, as individuals who are obese are at an increased risk of medical sequelae including diabetes, cardiovascular disease, sleep apnea, osteoarthritis, and a variety of cancer types (Das & Khan, 2019; Obesity in America, 2018). These conditions may necessitate interventions from numerous healthcare providers, including bariatric and sleep specialists, dietitians, pharmacologists, nurses, psychologists, physical therapists (PTs), and occupational therapists (OTs).


Therapists are vital healthcare providers with a skill set well suited to remediate impairments of mobility, endurance, dressing, bathing, toileting, feeding, and transferring among all individuals, including those who are obese. The impairments and functional limitations brought about directly and indirectly by obesity can impact both home and community independence and can warrant the inclusion of PTs and OTs in the home healthcare (HHC) plan of care.


Obesity can be defined as a body mass index greater than or equal to 30 kg/m2 (Arnold et al., 2015). People with obesity may be reluctant to seek medical care for fear of discrimination from their provider. O'Brien et al. (2010) suggest this may be a result of perceived or actual negative biases toward people with obesity by healthcare providers, fitness professionals, and others who specialize in obesity-related professional services. That 69% of overweight women reported experiencing weight bias from a healthcare provider should bring about pause for self-reflection to healthcare providers (O'Brien et al.). Although this bias may be unintentional, it is important to expose it in order to optimize healthcare for people with obesity.


What can HHC therapists do to reduce bias?

Whether bias exists due to personal experience or it was learned from another individual, it can result in unfair treatment to persons in our care. This may indirectly increase the risk of depression, anxiety, and low self-esteem while potentially interfering with efforts to make healthy lifestyle changes (O'Brien et al., 2010). Fruh et al. (2016) suggest some specific strategies that healthcare providers can do to self-reflect and better understand how they can reduce potential weight stigma bias when providing care to patients with obesity (Table 1).

Table 1 - Click to enlarge in new windowTable 1. Strategies for Reducing Weight Stigma

In addition to self-reflection, there are numerous approaches to address obesity prejudices. Among college students pursuing health promotion/public health degree, prejudices have been decreased after engaging in discussion of controllable and uncontrollable causes of obesity (O'Brien et al., 2010). Online modules have been developed to decrease stigma, which may be beneficial for therapists and other healthcare providers ("Stop Obesity Alliance," n.d., "Weight Bias Guides," n.d., "Who We Are," n.d.). Additional actions include use of supportive and person-first language, where a person is identified as having obesity rather than being obese (Fruh et al., 2016). For example, a person with obesity rather than an obese person. Furthermore, therapists can be mindful of weighing patients in a private area (i.e., away from family members) and only measuring weight when medically indicated. Another strategy is to ensure availability of properly sized equipment including large blood pressure cuffs and extra-large gait belts (Phelan et al., 2015).


The first aim of a therapy encounter is to do no harm, including harm to the self-esteem of a person in our care. Words, body language, and internal biases have the power to encourage or discourage individuals to seek out and comply with therapeutic interventions. Intentional steps on the part of HHC therapists inclusive of self-reflection, education, and implementation of new strategies aimed at reducing bias, are warranted to provide high-quality, patient-centered care. By addressing personal biases, HHC therapists can minimize healthcare barriers encountered by our patients with obesity.




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