Communicating with Plus-Size Pregnant Women

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Implicit Bias Against Plus-Size People Is Real

A pregnant woman seated on a sofa with a health care provider, discussing information on a tablet computer.Providers want to deliver quality care with respect, honesty, and compassion to everyone in their care. But evidence suggests that some providers hold an implicit bias against people with overweight or obesity.

This bias may prevent effective communication and harm the physician-patient relationship.1 Bias may cause some providers to blame people for their weight or to believe such patients waste the provider’s time.2,3 Providers’ implicit bias may also lead to delays in diagnosis and treatment because they may spend less time and develop less of a connection with plus-size women. Women who feel stigmatized or judged by their providers may delay or reject getting care.4,5

How to Identify Implicit Weight Bias

The American College of Obstetricians and Gynecologists (ACOG) recommends that providers self-check for implicit weight bias by asking themselves:

  • Do I make assumptions regarding a person’s character, intelligence, professional success, health status, or lifestyle behaviors based only on weight?
  • Am I comfortable working with people of all shapes and sizes?
  • Do I give appropriate feedback to encourage healthful behavior change?
  • Am I sensitive to the needs and concerns of plus-size individuals?
  • Do I treat the individual or only the condition?6

The ACOG website offers the full self-check for implicit weight bias external link.  

Take steps to prevent any bias from interfering with respectful, high-quality care. Use this tip sheet to help guide your conversations with plus-size pregnant women. Remember that women want to have a healthy pregnancy; they are often eager to learn how to improve their outcomes.

Work with plus-size pregnant women to develop their healthy pregnancy plan. Encourage them to complete the Pregnancy Action Plan, and review it with them during upcoming visits.

Find more resources for healthcare providers and plus-size pregnant women on our Resources page.

Citations

  1. Schwartz, M. B., Chambliss, H. O., Brownell, K. D., Blair, S. N., & Billington, C. (2003). Weight bias among health professionals specializing in obesity. Obesity, 11(9), 1033–1039. doi: 10.1038/oby.2003.142
  2. Puhl, R., & Brownell, K. D. (2001). Bias, discrimination, and obesity. Obesity, 9(12), 788–805. doi: 10.1038/oby.2001.108
  3. Hebl, M. R., & Xu, J. (2001). Weighing the care: Physicians’ reactions to the size of a patient. International Journal of Obesity and Related Metabolic Disorders: Journal of the International Association for the Study of Obesity, 25(8), 1246–1252. doi: 10.1038/sj.ijo.0801681
  4. Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4), 319–326. doi: 10.1111/obr.12266
  5. Gudzune, K. A., Beach, M. C., Roter, D. L., & Cooper, L. A. (2013). Physicians build less rapport with obese patients. Obesity, 21(10), 2146–2152. doi: 10.1002/oby.20384
  6. American College of Obstetricians and Gynecologists (ACOG). (2019). ACOG Committee Opinion No. 763: Ethical considerations for the care of patients with obesity. Obstetrics & Gynecology, 133(1), e90–e96. doi: 10.1097/AOG.0000000000003016
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