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 study led by the University of Leeds reveals that people living with overweight or obesity 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.
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 at the University of Leeds, said: “Our findings have clear implications for the perceived quality of healthcare that people living with overweight or obesity experience in England.”
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.
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 3 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.
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.”
‘Overweight’ is person-first terminology which is used to describe a medical condition a person has rather than what a person ‘is’.
Disparate healthcare experiences of people living with overweight or obesity in England is published in EClinical Medicine.
Novo Nordisk funded the research referred to in this article and has funded the article's production and the open access article charge. The funding source had no role in the conceptualisation of the study, its analyses and interpretation and had no influence over the design and content of this article. The research was conceived and designed by the lead author, who has full editorial control and responsibility over this article. The full data set was accessed by SWF, ML, AG and MK, who made the decision to submit the article for publication.
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Subject of Research
Disparate healthcare experiences of people living with overweight or obesity in England
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