Women with obesity report negative experiences with the Norwegian healthcare system
"I was always running around looking for shirts and blood pressure cuffs that werebig enough," says a researcher with a nursing background.
Published
Health problems always explained by weight.
Fear of not being believed when seriously ill.
Feeling unseen as a person because the body gets in the way.
These are the kinds of experiences women with severe obesity share after being hospitalised. The experiences emerge through interviews with 14 women in a new study.
The study was conducted by researchers Nastasja Robstad and Liv Fegran at the University of Agder and published in the Journal of Advanced Nursing.
All participants reported uncomfortable experiences as patients in the Norwegian healthcare system.
Three recurring themes stood out in the study:
1. They felt that healthcare professionals blamed everything on their weight
Patients experienced that their weight received attention regardless of the reason for hospitalisation.
They reported that weight loss was presented as a solution to most of their problems.
Patients felt shame, guilt, and that the situation was their own fault.
2. They felt prejudged
They experienced that healthcare professionals had certain stereotypes when seeing a large person.
Many felt they were placed in a preconceived box defining how an overweight person is perceived.
This aligns well with what healthcare professionals themselves report, says Robstad. Studies show that many indeed hold these attitudes.
3. They felt different
Patients experienced being treated differently by healthcare professionals. Some encountered stigmatising body language, such as grimacing.
They also felt that hospital facilities were not adapted to their needs. This included chairs, beds, or blood pressure monitors that did not fit. Some worried that equipment that did not fit could lead to inaccurate measurements.
"What surprised me, something I had never thought of before, was that the patients were afraid that healthcare professionals might miss the real issue affecting them. They were unsure if they were receiving the correct treatment," Robstad tells sciencenorway.no.
"Not intentional"
Robstad, who has a background as an intensive care nurse, explains:
"We're trained to heal our patients and save lives. But as soon as someone has a high weight, we associate it with danger."
This is where Robstad believes the gap between healthcare professionals and patients lies.
"Healthcare workers do not intentionally stigmatise patients or behave poorly," she says.
It’s simply two different viewpoints and experiences colliding, which can lead to significant misunderstandings, says Robstad.
She believes prejudice and a lack of knowledge are key factors.
"I think the common perception is still that people just need to eat less and move more – that it's a self-inflicted situation. This mindset persists strongly in society and among healthcare professionals," she says.
Narrow chairs
There is significant room for improvement in how institutions are equipped, says Robstad.
Reflecting on her own time as a nurse, she recalls:
"I was always running around looking for shirts and blood pressure cuffs that were large enough. We were always short on supplies."
While there are beds today designed for individuals with obesity, the problem is that there simply aren't enough of them, she adds.
Delay seeking medical help
The patients in the study shared that they fear being hospitalised again – not only because of the illness itself but also because of how they might be treated.
"Many studies show that women with obesity seek medical help later than women of normal weight. They hesitate, and that's very serious," says Robstad.
She emphasises that the 14 women interviewed for the study cannot represent all individuals with obesity. Those who participated may have had particularly difficult experiences that motivated them to speak out.
However, the issue is well-documented in other research.
Also happens in Norway
"Stigma in the healthcare system against overweight and obese individuals is a big problem," confirms Maria Arlén Larsen.
She is a doctor, associate professor at UiT The Arctic University of Norway, and medical director at Lifeness, an app for lifestyle change. She is also the author of En fet hemmelighet: Et godt liv uten strenge dietter (A Fat Secret: A Good Life Without Strict Diets).
Larsen is familiar with Rogstad and Fegran's study and says that many international studies have shown similar results, particularly in the USA.
“This study confirms it’s happening just as much here in Norway,” she says.
She adds that weight stigma is not limited to hospitals.
"It's not about willpower"
"Almost everyone exercises weight stigma to some extent, whether consciously or unconsciously," says Larsen.
But why are healthcare professionals, of all people, so poorly equipped with knowledge on this issue?
"This is barely addressed in healthcare education at all," she says.
Larsen believes that education and attitudes have not kept pace with recent advances in obesity research.
"It's not as simple as losing weight to fix the problem. It's not about willpower. It's an incredibly complex picture," she says.
Larsen also oberves that hospitals are poorly adapted to accommodate larger bodies.
"Not all scales have a high enough capacity. It's terrible for a person when the scale maxes out," she notes as an example.
Feel disheartened
Larsen agrees with Robstad that healthcare workers do not intentionally stigmatise. She thinks it often stems from uncertainty.
"You might feel a bit disheartened when you don't have a good solution for this group or lack the knowledge on how to help," she says.
She believes healthcare workers often offer well-meaning advice, which can inadvertently make the situation worse.
“They might suggest things they think could help the patient, but the patient may have already tried these many times without lasting results,” she says.
The constant pressure of time in the healthcare system is another significant challenge, according to Larsen. This often means that brief but important conversations get sidelined.
We all make mistakes
"Governmental action is needed to raise awareness about this issue. And it must be included in education," Larsen insists.
She also believes we need to acknowledge when we make mistakes and recognise the harm caused by them. She argues that healthcare institutions should incorporate training to help staff reduce stigma.
"More specifically, it should focus on health, not body size. You can't determine how unhealthy someone is just by looking at their weight," Larsen concludes.
———
Translated by Alette Bjordal Gjellesvik
Read the Norwegian version of this article on forskning.no
Reference:
Robstad, N. & Fegran, L. The lived experiences of patients with severe obesity during hospital admissions in Norway: A phenomenological hermeneutic study, Journal of Advanced Nursing, vol. 80, 2024. DOI: 10.1111/jan.16109
Related content:
Subscribe to our newsletter
The latest news from Science Norway, sent twice a week and completely free.
