Obesity Bias Weighs Heavily for EMS

Obese children and adults face weight bias and discrimination every day in every aspect of their lives including health care. The Centers for Disease Control says 5% of the 93 million overweight Americans are morbidly obese, defined as 100 pounds over ideal weights or a body mass index (BMI) of 40 or higher.
 
Surveys of health care professionals reveal continued and persistent bias against the obese. The surveys show physicians feel that people who are obese are noncompliant, weak and lack self control; 63% of nurses agreed obesity can be prevented by self-control; and noncompliance is thought to be the most likely reason for an obese patient's inability to lose weight. The frustration that clinicians feel when trying to help patients lose weight may contribute to this bias. Rather than acknowledging the limited effectiveness of current weight loss treatments, health care professionals tend to blame their patients for non-compliance and lack of self-discipline.
 
People's perceptions about causes of a person's weight are at the root of obesity bias. It is important to understand that there are many complex causes. They can be genetic, metabolic, hormonal, psychological, physiological, environmental, cultural or a variety of other factors.
 
Persistent discrimination may actually backfire on health care professionals. An overweight person may not seek care because of the fear of bias and humiliation. It's not uncommon for obese people, who have not gotten follow up medical care for chronic conditions, to call EMS when there is an emergency or trauma. First responders must take into consideration that they are dealing with more than just a trauma patient but also a patient with unmanaged and evolving medical issues.
 
Weight discrimination can be subtle or overt. Bias can be communicated in a roll of the eyes, a reference to the "jumbo" or "big-boy" piece of equipment, inappropriately sized medical equipment or the tone in the voice when calling for back-up.
 
There are a variety of ways to be more sensitive to obesity discrimination:
  • Respect the individual and their privacy
  • Treat them with dignity and compassion
  • Avoid remarks or derogatory terms about size of equipment
  • Ask the patient how to make the transport easier for them
  • Plan ahead and communicate the plan to your team and patient when possible Addressing and anticipating issues for morbidly obese patients, including patient movement strategies, will increase safety for you and the patient.