After showering, applying deodorant twice, and cranking up her car’s air conditioning against the summer heat (“I will not be the sweaty, smelly fat girl,” she thinks), Eva arrives at the doctor’s office ready to get to the bottom of what ails her: a newly swollen, tender abdomen, growing breathlessness, and debilitating fatigue.
Given her previous interactions with healthcare providers, Eva practices what she’ll say when she reaches the clinic: “I know I am fat. But this is not because I am fat.”
But clinic staff presume she has diabetes and hypertension. They raise their eyebrows when she steps on the scale. And the waiting room chairs are as tight as the nurse practitioner’s smile and her degrading use of the word we.
As in, “Have we maybe been eating our feelings? Your BMI is 39.6. We don’t get to that size on accident.”
“I speak about weight bias as an actual factor that furthers these patients’ disease processes. Healthcare providers need to recognize that their weight bias actually hurts their patients.”
“We often talk about contributors to someone’s obesity—genetic factors, emotional factors, and personal factors,” explained University of Virginia DNP student Habibah Williams, NP, MSN, AGACNP-BC, the lead clinician at Virginia State University’s Student Health and a nurse practitioner who often treats patients with weight issues, “but I speak about weight bias as an actual factor that furthers these patients’ disease processes. Healthcare providers need to recognize that their weight bias actually hurts their patients.”
For her doctoral scholarly project, Williams created a seven-week intervention to educate healthcare staff—”from the physicians to nurses to receptionists”—to affect awareness and change. She’s deployed and is currently testing “We Matter” among 20 clinic staff to determine its impact. In addition to the intervention’s educational and self-assessment components, Williams, with University of Central Florida nurse and PhD student Aislinn Woody, also created a unique fictional narrative—Eva’s story, told in the first person—to build consciousness of the experiences obese and overweight patients face.
“Bias is slick and sneaky.”
After the seven-week intervention is administered, Williams will assess participants’ knowledge and weight biases. Her ultimate hope is to scale the intervention up so that, like other routinely certified healthcare competencies, such awareness is repeatedly built among those whose job it is to provide compassionate, non-discriminatory health care without regard to a patient’s weight status.
In mid-November, Williams and Woody earned the American Association of Colleges of Nursing’s 2021 “PhD-DNP Collaboration Excellence Award” for their work. The two will present the intervention—“Evaluation of an Educational Intervention to Effect Obesity Bias”—and their findings at AACN Doctoral Education Conference in Naples, Fla., in January 2022.
Williams is the first UVA student to earn the competitive national AACN collaboration award, which is bestowed annually and comes with a cash prize.
“DNPs are charged with identifying the best evidence, folding it into practice change, and improving outcomes,” said Beth Quatrara, assistant professor and DNP program director, “and Habibah is following the DNP path. We are incredibly proud of her work to trial strategies to reduce obesity bias with the goal of removing roadblocks so that all obese patients can receive compassionate care that enhances their health.”
Williams hopes to build healthcare staffers’ awareness and ownership of weight bias—and to affirm that living with obesity doesn’t reflect a personal moral failing. She also firmly believes biases can be intentionally unlearned.
“Bias is slick and sneaky,” she said. “Many of us say we don’t have weight bias, but in many cases, we’re not aware that it’s going on. And non-overweight people don’t understand just how much the person with obesity internalizes the behaviors, which has a snowball effect on their weight journey.”