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  • What is weight-based stigma?

  • How can I become aware if I have a weight-based bias?

  • What are the key factors in addressing advocacy at the patient level?

  • How can I help colleagues become advocates for obesity prevention and treatment?

  • What are the components of obesity-related advocacy at the hospital level?

This chapter will address the following American College of Graduate Medical Education competencies: interpersonal and communication skills and professionalism.

Interpersonal and Communication Skills: This chapter will help the pediatric health care provider enhance effective exchange of information and collaboration with patients and families as well as with other health professionals to accomplish advocacy goals.

Professionalism: Professionalism is important in advocacy just as it is in clinical care. This chapter will help the pediatric health care provider understand and counter weight bias as a component of commitment to professional responsibilities, acting on ethical principles, and sensitivity to diversity and values of respect.


Imagine what it would be like to unfairly be poorly treated for a characteristic that is visible 100% of the time. How would you feel, what would you think, and if this characteristic were something you could change, would this poor treatment motivate you to do so? Weight-based stigma refers to negative weight–related attitudes and beliefs that result in a wide range of negative assumptions about, and victimizing behaviors toward, individuals who have overweight or obesity. These negative assumptions, stereotypes, biases, and prejudices can be evidenced verbally (eg, bullying, derogatory remarks, names, and/or pejorative labels), physically (eg, hitting, grabbing, or other acts of aggression and violations of personal space), or by relational aggression (eg, intentional social exclusion, spreading of rumors). The National Child Traumatic Stress Network (NCTSN) deems bullying and victimization as a form of trauma, akin to abuse and neglect.1 In its more severe forms, weight-based victimization can be considered discrimination.2,3 For adolescents, the rates of weight-based discrimination are comparable to rates of discrimination due to perceived sexual orientation, and more frequent than rates of discrimination due to race, religion, or disability.4,5

Children and adolescents can experience stigma and victimization across many environments, including school (eg, teachers and coaches), home (eg, family members), and social (eg, peers). Both children and adults can also experience stigma within the health care environment. Negative weight–related attitudes and beliefs toward adult patients with obesity have been evidenced by physicians, nurses, psychologists, dietitians, and medical students, including providers who specialize in obesity.6

These beliefs maintain that adult patients with obesity are lazy, nonadherent to recommendations, undisciplined, unsuccessful, unpleasant, and have little willpower.7 One study of British health care providers revealed beliefs that adults were overweight primarily due to physical inactivity, overeating, food addiction, and personality characteristics. These providers also perceived adults with overweight as having reduced self-esteem, reduced sexual attractiveness, ...

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