Tackling Healthcare Bias Against Older Adults with Obesity

Many people, including doctors, exhibit a troubling pattern of bias against individuals living with obesity, including older adults. Weight bias is negative attitudes, beliefs, judgments, stereotypes and discrimination aimed at individuals because of their weight. Healthcare providers may not even be aware that a difference in quality of care is taking place. A critical step in tackling such bias is to recognize that it exists, and to articulate ways to avoid it.

The National Council on Aging (NCOA) has taken that step, in partnership with the National Consumers League. Together we launched the Obesity Bill of Rights this past January to advocate for fair treatment in the healthcare system of all people living with obesity, including older adults. The Obesity Bill of Rights establishes eight rights to promote non–weight-biased medical care, based on the premise that all patients should be screened, diagnosed, counseled, and treated with respect and dignity.

We developed the Obesity Bill of Rights after hearing directly from older adults and health professionals during a series of town hall meetings last summer in Oklahoma City, Okla.; Jackson, Miss.; Wilmington, Del.; and Van Nuys, Calif. We found that people were anxious to express their experiences and feelings regarding how they or their family members had struggled with healthcare issues, and the relationship of those struggles with issues related to access, quality of care and treatment.

Many town hall participants who struggled with obesity said they felt stuck because they don’t get the care they need, and many said they had dealt with issues of bias related to race, ageism and weight stigma as well. Some said they felt invisible and hopeless from a lack of support and proper treatment in medical spaces. In Jackson, an older adult man said, “We live sick, and we die quick,” as he had lost several relatives to diet-related obesity, all dying around age 50. It was powerful to hear the stories of older adults and their search for information to be recognized, to get the care that they need, and to feel supported.

‘We know that of 108 million adults who are living with obesity, only 30 million have been diagnosed.’

Each town hall featured a panel of health professionals who reported on their own challenges and insights, including frustration over the limited time they had to spend with patients and lack of training on how to deal with obesity, but also improvements made in some areas to deal with age and obesity issues. One California physician said it is important for the healthcare team to set goals with the patient, helping them take tailored, small steps to getting healthy at their own pace.

Based upon what we learned from these valuable town hall sessions, and other obesity-related research and discussion with obesity specialists, we developed this Obesity Bill of Rights, which aims to ensure that people with obesity have the right to:

  • Accurate, clear, trusted and accessible information on obesity as a treatable chronic disease.
  • Respect by all members of the medical care team when screening, counseling, and providing treatment.
  • Make treatment decisions about health goals and obesity care in consultation with the individual’s health providers.
  • Treatment from qualified health providers, including counseling and ongoing care from health providers with expertise in obesity care.
  • Person-centered care that is personalized, respects the individual’s cultural beliefs, meets their specific health goals, and considers the person’s whole health and not just their weight status.
  • Accessible obesity treatment from health systems, so those with severe obesity receive care in settings that allow for privacy, using size and weight-accessible equipment and diagnostic scans.
  • Coverage for treatment with access to the full range of treatment options for the person's health condition as prescribed by the individual’s health provider.
  • Older adults to receive quality obesity care that comprises a respectful, comprehensive care approach consistent with their personalized medical needs.

We’ve received a great deal of positive feedback since the January launch of the Obesity Bill of Rights, with more than 45 organizations signed on to endorse this initiative. For more information about these supporters, visit Right2ObesityCare.org.

From NCOA’s perspective, we hope it will be a call to action for policymakers and employer retirement plans to think differently about the medical needs of people older than age 60 who live with obesity, and for Medicare to end restrictions on access to the full range of treatments related to obesity.

Obesity leads to more than 230 medical conditions, including high blood pressure, heart disease, certain cancers and diabetes. We know that of 108 million adults who are living with obesity, only 30 million have been diagnosed, and only 2% of those individuals who are eligible for anti-obesity medications have received medical treatments.

We believe that the Obesity Bill of Rights will empower people to seek the care they deserve without stigma or judgment. It offers them the tools to ask for treatment provided with respect and professionalism, which too often are missing from their healthcare experience right now.

We hope the Obesity Bill of Rights will start a national conversation on how to create an equitable healthcare environment in which medical professionals listen to people with chronic diseases and obesity and help meet them where they are to get the care and treatment they need.

Dorothea Vafiadis, MS, FAHA, is senior director at the National Council on Aging’s Center for Healthy Aging, in Washington, DC.

Photo credit: Shutterstock/AlexandrMusuc