Unconscious bias in weight management 

By Janelle Coughlin, PhD, Johns Hopkins Medicine 

Jackie is a 36-year-old visiting her primary care clinician for the first time since becoming a mom. She entered pregnancy at her highest lifetime weight, having experienced weight recurrence after a weight loss a few months before becoming pregnant. She then gained 12 pounds more than recommended during pregnancy and is now nine months postpartum. She hasn’t lost the weight she gained during pregnancy, placing her in the obesity BMI category for the first time in her life. This comes with heavy disappointment and shame, particularly since she works in the health field and was an athlete in the past.  

Her doctor, a male about 20 years her senior, hears her concerns and tells her how he’s lost weight by reducing / eliminating carbohydrates and thinks it’s the very best way to lose weight. In his excitement about low-carb eating, Jackie stays silent and doesn’t share that she’s lost weight successfully with low-carb eating in the past, but after adding back carbs gained back all the weight and more. She listens, smiles, and thanks him, but doesn’t share her medical background and knowledge, past weight loss experiences, or fears about medical comorbidities. She leaves in tears and decides she’ll never bring up weight with her doctor again.  

Most medical professionals are aware that about two-thirds of the U.S. population is overweight or obese. And yet, many medical professionals don’t receive formal or extended training in obesity treatment. Perhaps even fewer have engaged in a personal assessment of their biases toward individuals with overweight and obesity. 

Unconscious bias 

None of us are immune to bias—we all have biases, blinders, and limitations. Thankfully, most of us take pride in our compassionate care of patients and avoid overt bias. However, even well-intentioned statements and actions can be harmful to patients if they include unconscious bias. A common consequence is that patients avoid further care. 

Engaging in a curious personal inquiry about our biases requires a desire to increase self-awareness and honesty and to behave in a way that empowers versus shames others. Consider the below questions to check in on your own belief system about individuals with elevated body weight. 

1. Do you tend to assume individuals who are of higher weight aren’t engaging in healthy eating or physical activity?  

2. Do you gravitate toward thinking that overweight / obesity are simply conditions of willpower and choice?  

3. Do you often associate overweight / obesity with laziness, personality deficits, and/or apathy?  

4. Do you tend to treat overweight / obesity by simply providing patients with information about weight loss? 

5. Do you tend to assume you have the answers and possess a greater wisdom than those with overweight / obesity? 

These are only a few examples of questions that can help you explore your tendency to operate from a stigmatizing position when it comes to elevated weight and obesity. The reality is many individuals who struggle with weight exercise regularly, make healthy food choices, and have lost weight, sometimes very large amounts, several times in their lifetime. Obesity isn’t a mental health condition and, although individuals with obesity tend to have higher rates of psychiatric illness than those with BMIs that fall in the normal weight category, obesity is a medical condition with complex etiology. Furthermore, most individuals know how to lose weight (in fact, only a small percentage don’t possess knowledge about steps they can take to lose weight). A curious inquiry into barriers and obstacles to weight management is often a more fruitful intervention than providing information.  

Further readings and resources on stigma in healthcare and weight bias:
 

Stigma in healthcare 

https://qi.ipro.org/health-equity/stigma-toolbox/ 

https://implicit.harvard.edu/implicit/user/demo.canada/ca.static/takeatest.html 

“Eliminating Explicit and Implicit Biases in Health Care: Evidence and Research Needs”

Weight stigma 

https://www.obesityaction.org/action-through-advocacy/weight-bias/weight-bias-resources/ 

https://weightstigmaawarenessweek.org/resources 

https://uconnruddcenter.org/research/weight-bias-stigma/ 

https://www.cspi.org/sites/default/files/2025-10/cspi_counteringWeightStigmaBestPractices_3.pdf 

https://stopweightbias.com/ 

https://www.ted.com/talks/ali_zentner_the_end_to_fat_shaming_begins_here_jan_2020 

https://www.nofatshame.com/
 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.