Perceptions of Obesity: An Opportunity to Improve Patient Safety

Jacqueline Ross, PhD, RN, Analysis and Coding Manager, Department of Patient Safety and Risk Management

A 44-year-old morbidly obese woman (body mass index [BMI] 65.8) had a sleep apnea test that was monitored by a technician on a recording system.

The technician observed that the patient had fallen out of the bed and was unable to get up. Instead of responding, the technician assisted another patient. The patient struggled for almost 10 minutes before she was able to get up by herself.

The patient went back to sleep but awoke later with a prolonged episode of coughing. Again, the technician failed to assist in a timely manner and did not help the patient remove the CPAP mask. When the patient coughed some phlegm onto the floor, the technician chastised her. The patient left after that incident, saying that the staff at the healthcare facility had not treated her with respect.

These episodes were captured on DVD as part of the sleep apnea workup. The technician was fired for his inattention and his unacceptable response to the patient.

This case illustrates an employee’s inappropriate behavior toward a patient and may also indicate a negative attitude toward obese patients. This incident necessitates a closer examination of attitudes.

Being overweight is classified as having a BMI of 25 to 29.9. A BMI of 30 to 39.9 is categorized as obese, and a BMI of 40 or greater is considered morbidly obese. U.S. obesity rates are increasing. According to the Centers for Disease Control and Prevention (CDC), the prevalence of obesity was 39.8 percent for adults and 18.5 percent for children.1 The CDC also reported that every state had an increase in the prevalence of obese adults.

A social stigma is often associated with being obese, leading to negative portrayals in the media, discrimination in the workplace, and difficulties in relationships.2-3 These societal perceptions lead to judgments that obese individuals are lazy, passive, and lack self-discipline.2-4

It is likely that the negativity associated with obesity extends into healthcare settings. Studies have examined healthcare providers’ perceptions of obese patients and obese patients’ experiences with providers in various healthcare settings.

A recent study synthesized qualitative studies and revealed that healthcare providers were communicating, often without knowledge, in an insensitive manner. Providers may hold the patient responsible for their weight, symbolizing obese patients as irresponsible. The analysis further illustrated that many providers frequently failed to provide assistance or offer suggestions to their obese patients. Patients felt that many providers failed to adequately treat their medical problems. A major conclusion was the subtle manner in which obesity can be stigmatized through words and attitudes as many patients felt humiliated when seeking care.5

The Obesity Society offers advice to healthcare providers to help address this issue. The first step is to become aware of any personal bias against obese people. The Obesity Society recommends that healthcare providers ask themselves these questions:

  • Do I make assumptions based only on weight regarding a person’s character, intelligence, professional success, health status, or lifestyle behaviors?
  • Am I comfortable working with people of all shapes and sizes?
  • Do I give appropriate feedback to encourage healthful behavior change?
  • Am I sensitive to the needs and concerns of obese individuals?
  • Do I treat the individual or only the condition?6

Answering these questions can assist healthcare providers in developing empathy and meeting the needs of obese patients. It can also help providers create a positive health experience for obese patients. Here are some specific strategies that healthcare providers can use:

  1. Consider that patients may have had negative experiences with other health professionals regarding their weight, and approach patients with sensitivity.
  2. Recognize the complex etiology of obesity, and communicate this to colleagues and patients to avoid stereotypes that obesity is attributable to personal willpower.
  3. Explore all causes of presenting problems, not just weight.
  4. Recognize that many patients have tried to lose weight repeatedly.
  5. Emphasize behavior changes rather than just the number on the scale.
  6. Offer concrete advice; e.g., start an exercise program, eat at home, etc.
  7. Acknowledge the difficulty of lifestyle changes.
  8. Recognize that small weight losses can result in significant health gains.
  9. Create a supportive healthcare environment with large, armless chairs in waiting rooms, appropriately sized medical equipment and patient gowns, and friendly patient reading material.7

Medical and nursing schools need to educate students about possible bias before they enter healthcare arenas. Current providers need to be alerted to their own possible biases. Acknowledging and understanding personal biases and attitudes can enable providers to improve the quality of care for all patients.


  1. Hales C, Carroll M, Fryar C, Ogden, C. Prevalence of Obesity Among Adults and Youth: United States, 2015-2016. NCHS Data Brief. 2017 Oct;(288):1-8. Accessed November 2, 2017.
  2. The Obesity Society website.
  3. Malterud K, Ulriksen K. Obesity, stigma, and responsibility in health care: a synthesis of qualitative studies. Int J Qual Stud Health Well-being. 2011;6(4):8404-DOI: 10.3402/qhw.qhw.v6i4.8404.
  4. Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res. 2001 Dec;9(12):788-805.
  5. Malterud K, Ulriksen K. Obesity, stigma, and responsibility in health care: a synthesis of qualitative studies. Int J Qual Stud Health Well-being. 2011;6(4):8404-DOI: 10.3402/qhw.qhw.v6i4.8404.
  6. The Obesity Society website.
  7. lbid.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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