Overcoming Internalized Weight Bias

Weight bias is a major barrier to engagement in health services. A new intervention at Cleveland Clinic aims to address this barrier by enhancing self-efficacy and empowering women to improve their health, regardless of weight.

Designed and led by Karen Cooper, DO, MPH, Director of Weight Management for Cleveland Clinic’s Ob/Gyn & Women’s Health Institute, Be Well Plus™ is a population-based program designed to counteract negative self-image and enhance self-efficacy in women whose body mass index defines them as obese (≥ 30 kg/m2).

“I observed that women with obesity seeking medical weight management describe a lot of weight-related shame,” Dr. Cooper says. “I wanted to create a program where these women are empowered to choose health in an environment in which there is little room for criticism.”

Participants attend monthly, physician-led shared medical appointments (SMAs). Each SMA begins with a brief medical assessment that documents participants’ height, weight blood pressure and current medication use. Then, they engage in conversations about issues not routinely addressed with medical care providers.

“We delve into topics that include body image and self-esteem, eating disorders and emotional triggers, wellness and self-care, lifestyle factors that result in better health and letting go — but always with a focus on empowerment. When we discuss body image and self-esteem, for example, it is really about moving from negative to positive views of body image. Our focus is on progress, not perfection,” notes Dr. Cooper.

The value of the SMA approach

These patients have a lot in common, which Dr. Cooper says helps to encourage interaction. In the first three sessions, 19 women participated. Their average age was 64 years (mean, 30-77) and their average BMI was 37 (range, 28-43).

“SMAs help patients to fell less alone,” Dr. Cooper explains. “With everyone having the common denominator of obesity, they have similar experiences. When a patient shares an experience, others may feel validated and share stories about similar events. They leave feeling like, ‘This doesn’t only happen to me.’ Be Well Plus participants become aware that they are not alone in their challenges of obesity control and societal rejection, and feel validated as a result.”

The problem of internalized weight stigma

Women are more likely than men to suffer from weight stigma or weight-based discrimination, which can unfavorably affect psychological and physical health, research suggests. Weight bias and discrimination occurs in many settings, including popular media, interpersonal relationships, educational institutions, the workplace and, regrettably, healthcare organizations.

Within healthcare, physicians are a top source of weight stigma. In one study, 69% of individuals with overweight/obesity experienced weight bias from physicians, and 52% of individuals reported experience weight stigma from doctors on multiple occasions.

“We know that internalized weight bias can increase symptoms of depression and anxiety, lower self-esteem and lead to pathological eating disorders. These patients may experience more barriers to self-efficacy, and may avoid seeking necessary and appropriate health-care services. The goal of our program is to help women feel good about themselves beyond their weight, shape or size,” Dr. Cooper says.

“If you’re feeling badly about yourself, you are much less likely to show up at the doctor’s office, which can have negative consequences. This is why we designed this program – not to promote weight loss directly, but as a harm reduction and health optimization program. We aim to inform women about, address and help remove the negative influences of weight bias and stigmatization, which may hinder achievement of their health goals,” Dr. Cooper concludes.