The burden of bias: Patient experiences and providers' perspectives on weight bias

Weight bias is pervasive, occurs in a variety of contexts, and is associated with a range of suboptimal outcomes, including delays or avoidance in seeking health care, misdiagnosis, and denial of services. The aim of this study was to quantitatively describe the relationship between experiences of weight bias and eating behaviors of patients in a lifestyle medicine program and qualitatively describe healthcare providers' insights about weight bias.

This study utilized an explanatory sequential design that drew on one-time survey data collected from 109 patients of a Plant-Based Lifestyle Medicine (PBLM) Program in New York City in 2019. Ordinary Least Squares and logistic regression models examined the association between weight bias and healthful plant-based eating and emotional eating after adjusting for sociodemographic characteristics. Qualitative data come from asynchronous interviews with five healthcare providers from the PBLM program completed in 2024 which were analyzed using rapid coding.

Survey participants were on average 53 years old, 67.0% female, 68.6% Black, Indigenous, and other people of color (BIPOC), and 56.2% reported experiencing weight bias. Weight bias was associated with 4.07 fewer points on the healthful plant-based eating measure (95%CI: 6.86, -1.27), and participants had 5.06 times the odds (95%CI: 1.76, 14.59) of emotional eating compared to those not reporting weight bias. Interview themes were: (1) Weight bias negatively influences patient lives, (2) Weight bias is negatively associated with patients' mental health, (3) Promising weight-inclusive approaches, and (4) Recommendations for providers to address weight bias.

Experiences of weight bias were associated with suboptimal eating behaviors and poor mental health. Providers observed their patients experience harm in connection with weight bias, suggested weight-inclusive approaches, and identified recommendations that would mitigate weight bias in healthcare environments including routinely screening for weight bias, training providers on weight inclusive care, incorporating mental health services into care teams, and creating size inclusive spaces. This study demonstrates that weight bias is linked to deleterious outcomes and the importance of weight-inclusive care delivery and environments.