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Specific pathways by which discrimination can impact health are described in more detail later in this chapter. Broadly, stigmatizing comments from health care professionals, overlooking health problems unrelated to weight, and denial of care for persons with obesity represent three examples of weight‐based discrimination in health care that have adverse consequences for health [28].

A high proportion of patients report feeling judged or stigmatized by their doctors due to their weight [29]. Health care professionals and trainees across disciplines – including medicine, nursing, nutrition/dietetics, psychology, and even obesity and eating disorder specialists – report weight‐biased attitudes toward patients with obesity [4,30,31]. These biases can be explicit (i.e. conscious) or implicit (i.e. unconscious; [28]). For example, physicians report having less respect for patients with obesity, viewing them as unmotivated, and holding low expectations for their treatment adherence. Biases can be communicated to patients blatantly with derogatory comments when discussing weight, recommendations that ignore the challenges of weight loss, reluctance to perform certain types of screenings, or dismissal of other more pressing health concerns in order to focus exclusively on weight [4]. Expressions of weight bias by health care professionals can be subtle as well, such as through reduced use of patient‐centered communication strategies [28]. The office environment can also contribute to patients’ discomfort in health care settings. Clinics may lack appropriate equipment for patients of diverse sizes, such as gowns, blood pressure cuffs, high‐capacity scales, and wide‐based chairs. Some practices also place scales in hallways or waiting rooms rather than exam rooms, exposing patients’ weight information in a public space. These environmental factors may make patients feel self‐conscious or embarrassed about their weight, thus leading them to avoid preventive health care visits [32].

Patients with obesity also face discrimination when they are denied care for certain medical procedures. For example, women with obesity have reported being denied fertility treatments due to exceeding BMI cutoffs established by clinics [33–35]. The rationale given for this discrimination is the increased health risks associated with obesity. However, this type of policy has been criticized for relying solely on BMI (and not other metrics of health) and infringing upon women’s rights to bear children simply because of their weight [34,35]. Patients with obesity may also be deemed ineligible for several types of surgeries – such as knee replacements and even bariatric surgery – unless they can lose a certain amount of weight, despite a lack of evidence that weight loss prior to such procedures improves postoperative outcomes [36,37]. Again, the justification relies on health risks and equipment limitations but is considered discriminatory because it denies access to care to people on the presumption that they should be able to control their weight [38].

Related to this point, insurance companies in the United States and abroad do not provide coverage for many standard obesity treatments [39]. Weight loss interventions are often deemed “cosmetic” or non‐essential, despite established evidence of their efficacy and robust health benefits [39,40]. The lack of coverage may also reflect the persistent misconception that weight is entirely within an individual’s control and, therefore, obesity does not warrant resources to treat [41].