People living with overweight or obesity are experiencing stigma and discrimination from healthcare workers as well as uniformly worse healthcare than the general population, researchers say.
A new Leeds study reveals that people have faced rude and derogatory comments about their weight from doctors and healthcare workers – on top of a healthcare postcode lottery with levels of provision differing across England's regions.
"Overweight" is person-first terminology that is used to describe a medical condition a person has rather than what a person "is".
Our findings have clear implications for the perceived quality of healthcare that people living with overweight or obesity experience in England.
The researchers worked with artificial intelligence company Scaled Insights and feedback gathering platform PEP Health to collect and sort feedback comments left online by these patients.
The results showed that they were experiencing worse levels of care across eight internationally-recognised quality markers.
Lead researcher Dr Stuart Flint, Associate Professor of the Psychology of Obesity in Leeds' School of Psychology, said: "Our findings have clear implications for the perceived quality of healthcare that people living with overweight or obesity experience in England."
Postcode lottery
The researchers assessed 5,675 patient feedback comments about GP and hospital care posted online between 1 January 2018 and 31 December 2020.
The patients all said they were living with overweight or obesity and were posting on the NHS UK website, Google, Facebook and/or Twitter.
Using a specially designed artificial intelligence model, the comments were scored according to eight healthcare quality markers:
- fast access to reliable health advice;
- clear information, communication and support for self-care;
- effective treatment delivered by trusted professionals;
- emotional support, empathy and respect;
- continuity of care and smooth transitions;
- involvement of, and support for, family and carers;
- involvement in decisions and respect for preferences;
- attention to physical and environmental needs.
Lower levels of care were reported across all eight metrics by people who identified as living with overweight or obesity. Particularly low scores were seen in fast access, effective treatment and emotional support.
The researchers observed regional variation in perceived quality of care, where the speed of access was notably low in the West Midlands and London. Emotional support was lower compared to other regions in Yorkshire and the Humber, and London.
Discrimination
Meanwhile, many patients described experiencing weight stigma and discrimination in healthcare settings, experiencing a lack of dignity, empathy and compassion from healthcare professionals as well as others such as reception staff. Many people reported that they had rude, derogatory and disrespectful interactions.
One patient described being very distressed and pleading for help with weight issues, saying: "The doctors response to this was to take a cake out of his drawer and say "Look, that's been there for three days and I haven't eaten it". I then got a 10 minute lecture on will power and how he was such a driven person and had risen from poor beginnings and now had his own surgery and all through will power. Thanks for that. Cos it hadn't occurred to me to not eat the cake."
Another patient who attended his GP with a knee problem said: "I felt I was in a pressed for time environment and had to get on with it ASAP. Then, just as I was about to leave, the doctor said losing some weight might help. I was livid with how insensitively they approached this - almost as an aside at the end. I am 6 feet 4, around 20 stones and have been walking between five and 10 miles a day for the last 10 years for work. I consider myself big but fit."
Using Scaled Insights' Behavioural AI approach, the researchers established that patients' personality attributes and values could predict the quality of their healthcare experience, with for instance attributes of depression and insecurity associated with poor quality of care experiences.
Action needed
Dr Flint said: "Healthcare policymakers, including NHS England, should consider and take actions to address the lower level of care that these patients are experiencing, in order to support the NHS guiding principles of providing a comprehensive service available to all.
"Furthermore, action is needed to address weight stigma and discrimination, which has a negative impact on engagement with health as well as physical and mental health."
