This time of year, we are bombarded with self-improvement messages in all forms. These messages can not only affect our wellbeing, but also contribute to deeply held biases and beliefs around the worthiness of our own bodies and those of others.
Megan Brydon, a Medical Radiation Technologist at IWK Health is researching how weight stigma and anti-fat bias is demonstrated in attitudes and perceptions of healthcare providers, and ultimately how those can cause harm. She recently published Weight bias: A consideration for medical radiation sciences in the Journal of Medical Imaging and Radiation Sciences.
What prompted you to write the commentary?
As a large bodied person, anti-fat bias is something that has been on my radar for a while. Recently the MRI technologists where I work were testing a new protocol for a new MRI scanner, and I volunteered to be a test patient. Even though the new MR scanner is large bore (70cm), the table, the coil and the patient share this space. I worried about whether I would fit, and how embarrassing it would be for me if I was unable to fit, especially in front of my (wonderful!) colleagues. In the end, I didn’t end up even trying. This was a low stake situation for me as it was not related to my health, and in an environment that I am typically comfortable in, but I still avoided to save myself from potential shame. This aversion can be amplified in patients who are not only worried about fitting in but have been shamed by the healthcare system in the past.
Has weight bias been discussed in much depth prior to this?
This is a fairly new topic in healthcare from an accessibility standpoint. Large bodied patients have been living with and very aware of weight bias for a very long time. Weight-bias is rooted in the incorrect presumption that a person’s body size is a result of calories-in versus calories-out, and by extension that large bodies are the result of lack of willpower or personal failing. But we know that is reductive and simply not true. Science has demonstrated that a person’s body size is associated with a number of factors from genetics to environment.
What biases currently exist?
The scary thing about weight-bias is that it can lead to something called “Weight Distraction” where health providers bias against large bodied persons prevents them from assessing the health needs of patients, beyond their weight. Patients can end up with very-delayed diagnosis or even misdiagnosis as a result of this.
In medical radiation sciences (diagnostic imaging and radiation therapy), there is another layer to the bias, where our actual equipment may not accommodate large bodies sizes. This can be the scanner bore size (the tube you go in for images) and the table weight limit. Within the broader healthcare context, this can include small waiting room chairs, small wheelchairs and limited hospital-gown sizes. On the periphery, booths in a cafeteria might be small, and the alternative chair seating might have low weight limit. Parking spaces might be small, making exiting vehicles difficult. There are so many physical aspects that a large bodied person considers when seeking healthcare. These physical restrictions can also lead to avoidance or even inability to access essential health services.
Below is a real example of chair sizing. The purple one is the original chair, and the green one is its replacement. You can see that while the overall size of the chairs are comparable, the new one is smaller. In this case, the like-for-like replacement is smaller and less accommodating. Small changes like this can have a big impact on the comfort of patients.
What changes can be made to current practice?
The encouraging thing is that there is a lot of room for improvement. When I raised the issue of the smaller chairs, we were able to obtain five new larger chairs for our waiting rooms. While this doesn’t address the fact that the replacement chairs are smaller, it does provide a suitable alternative for patients. That said, with a third of the population living in large bodies, it is not a leap to think that a third of the equipment should be able to accommodate these needs.
I also sit on the accessibility action committee at the IWK where I represent a size-inclusive perspective. This is a wonderful group with members from various departments across the health centre working to improve access for patients.
The Alberta Health System has launched a Bariatric Friendly Hospital Initiative in association with the University of Alberta that is directly aimed at improving care for large bodied patients. The seven standards of a bariatric friendly hospital are interactions free from weight bias, care providers knowledgeable care needs for large bodied patients, weight recorded in standardized location, timely access to appropriate equipment that is safe and comfortable, care providers knowledgeable and competent for lifts/transfers, respectful communication, and care provider access to bariatric supplies.
How can practice improve for the benefit of the patient?
We know that large bodied patients may avoid accessing healthcare, and it is our responsibility as healthcare providers to make interactions safe. When people delay care or are subject to weight distraction, they tend to present in the health system with greater acuity or advanced disease processes, which causes harm. Ensuring safe access to care from compassionate health providers is essential for best care.
How can practice improve for the benefit of the health provider?
Having equipment and resources that are insufficient for accommodating a breadth of patient needs is difficult. Understanding that body size is one of any number of considerations that may warrant a modified or adapted care plan can help reduce feelings of bias and overwhelm. Advocating for suitable and sufficient equipment and resources is necessary if our departments are going to be prepared to provide best care. Challenging our biases helps us recognize limitations in our care provision and improve as healthcare professionals.