When a hospitalized patient can’t be weighed accurately or an imaging table won’t support their body size, the issue often goes unspoken. But for clinicians and patients alike, these seemingly small obstacles carry an outsized message: The system wasn’t built with everyone in mind.

Obesity bias is pervasive across healthcare, and its impact inside hospitals is particularly acute. From the language used in progress notes to the availability of properly sized gowns, beds, wheelchairs, and blood pressure cuffs, subtle inequities shape care experiences in ways that patients feel immediately — and that can affect diagnostic accuracy, workflow, and trust.

Research underscores the problem’s scope. A 2023 narrative review in the Annual Review of Public Health found that weight bias among healthcare professionals remains widespread and has shown little improvement over time. Clinician-held stereotypes, such as that people living with obesity are noncompliant, less disciplined, or uninterested in health continue to influence treatment decisions, communication, and even triage priorities. Similarly, a 2019 scoping review in Obesity Science & Practice found that people living with obesity were more likely to delay or avoid healthcare services, report lower trust in their providers, and experience poorer communication and satisfaction with care. 

Finally, a March 2015 narrative review in BMC Medicine reported that exposure to weight stigma can lead to stress, care avoidance, and poorer long-term health outcomes.

“Back in 2013, the American Medical Association gave obesity a designation of a disease,” said Taraneh Soleymani, MD, an obesity medicine specialist at Penn State Health. “But as a society, we haven’t come to accept it. That lack of acceptance shows up in the health system, where patients can experience weight bias.”

Soleymani said that these biases can cause clinical blind spots.

“If obesity is automatically viewed as the explanation for every complaint, clinicians may miss other diagnoses or delay needed workups,” she said. “The person-first approach is crucial — treating obesity as a chronic disease while also treating the patient as a whole person.”

Bias in the Room

Clinicians may not always recognize how their own assumptions, or the hospital environment itself, affect care for patients living with obesity.

“The physical plant of most hospitals is prone to bias without clinicians necessarily being aware,” said Evan Nadler, MD, MBA, an obesity medicine specialist and founder of ProCare Consultants and ProCare TeleHealth. “Every waiting room should have chairs without arms, or even better, bariatric chairs, so that people with obesity can sit comfortably even if they aren’t patients at the hospital.”

Nadler said that even small moments can reinforce stigma. 

“Wheelchairs or stretchers to take patients around the hospital may not all be suitable for larger bodies,” Nadler said. “If you overhear that the ‘bariatric wheelchair’ needs to be retrieved so you can be wheeled to x-ray, you’re reminded how different you are as a patient.”

Nadler said that most imaging equipment has weight limits, and MRI machines sometimes have openings that can’t fit patients with higher BMI. He said that there are sometimes options for machines that can fit everyone, but that these machines are often more expensive, and hospitals don’t want to spend extra money to replace what they have just to accommodate larger patients. This can mean that bariatric patients go without imaging for nonbariatric-related complaints, simply due to their weight.

Bias can also appear in policies, Nadler said.

“Every patient with a BMI over 40 might be required to get cardiac clearance for an orthopedic surgery even if the injury was obtained while running a 10K race,” he said.

“Once the clinician has diagnosed obesity, every diagnosis is relayed back to the obesity,” he added. “A patient with a new worst headache of her life might be sent for an outpatient polysomnogram to rule out sleep apnea instead of an urgent CT to rule out a brain aneurysm.”

To counteract that, Nadler said hospitals should focus on systems that normalize equitable care rather than segregating equipment or workflows. Nadler said in his former role as director of the Childhood Obesity Program at Children’s National Hospital in Washington, DC, his team started a committee for the care of patients with obesity that included representatives from all departments, so they could write policies to ensure best care. 

“In retrospect, I wish we’d included patients, too,” Nadler said. “Their lived experience would have helped inform our decisions.”

A Subtler Undercurrent

Carolyn Jasik, MD, a bariatric medicine specialist who’s the associate chief clinical officer at Verily, a precision health company that’s owned by Alphabet Inc., said many of her patients describe feeling singled out from the moment they arrive at a hospital.

Jasik said the feeling her patients convey to her is that of a subliminal whisper calling them out for being overweight from the moment they walk through the doors. She said that her patients understand that the feeling they’re getting may be unintentional, but they say that it’s pervasive nonetheless.

“When they are seen by providers, regardless of the concern, it always seems to go back to weight,” Jasik said. “For example, they are being seen for knee pain and the doctor will say before the diagnostic process is complete, ‘Your knee pain may be from your weight, but if not, it is definitely made worse by that.’ This can actually lead to misdiagnosis in some cases.”

“In clinical environments where the person is not seeking weight-loss advice, the clinician will offer it unsolicited,” Jasik said. “The unstated message is ‘your weight is the most important thing to fix, regardless of why you are here.’ On the flip side, there can be excessive praise or congratulations for any sign of a healthy choice. For example: A patient is in the radiology suite for a mammogram and has a water bottle and the clinician says, ‘Isn’t water such a great and healthy choice for a beverage over juice or soda?’”

Many studies have quantified the kind of bias that Soleymani, Nadler, and Jasik said their patients encounter. A 2022 systematic review in Frontiers in Psychology found that weight stigma within healthcare systems is extensive and influences diagnostic accuracy, provider communication, and patient trust. A 2023 systematic review in Obesity Reviews reported that more than half the patients living with obesity recalled “inappropriate comments” from providers and “physical barriers or obstacles” during hospitalization. A 2022 narrative review in Annual Review of Public Health found that the design of hospital spaces often reinforces stigma, particularly when bariatric equipment is labeled or stored separately from standard supplies.

Together, the evidence shows that stigma not only harms patient experience but also leads to measurable disparities in care. This review published in 2019 in Primary Health Care Research & Development showed that patients who experience weight-related stigma are more likely to delay or avoid seeking care, report lower trust in their clinicians, and have worse mental and physical health outcomes, among other adverse effects. 

Practical Fixes: Systems and Self-Reflection

Over the past 5 years, a number of best-practice studies and clinical frameworks have emerged to provide guidance for hospitals and clinicians treating patients living with obesity to serve these patients with both clinical accuracy and empathy. These initiatives aim to reduce structural and interpersonal bias through a combination of environmental design, communication standards, and reflective clinical practice.

Published in November 2020, the joint statement from The Obesity Society and the Obesity Action Coalition on reducing weight bias in healthcare environments recommends that hospitals routinely audit facilities for comfort and accessibility, ensure all patient care areas include bariatric-rated transport equipment and seating, and develop procurement policies that account for a full range of body sizes. The guidelines treat inclusive infrastructure as a patient-safety priority rather than an optional add-on.

Patients living with obesity in a systematic review published in August, 2023, by Obesity Reviews suggested that providers should see them “as a person first” and involve them in treatment decisions. Participants in the review also echoed the need for physical-environment changes, including seating, equipment, and gowns designed to accommodate a wider range of body sizes.

Finally, a review published in the April 14, 2025, edition of Current Obesity Reports found that training programs for healthcare teams were most effective when they incorporated not only educational modules but also empathy-based storytelling and direct structured interactions with patients living with obesity.

“Hospitals can’t just buy one bariatric wheelchair and consider the problem solved,” Nadler said. “Equity means readiness — making sure inclusive equipment, policies, and language are woven into everyday care, not stored in a closet for special occasions.”

All considered, these frameworks suggest that hospitals can achieve meaningful change only when they treat weight bias as a systems issue as well as a behavioral one and work toward combining inclusive design, continuous self-reflection, accountability across the care team, and respectful language toward patients living with obesity.

Jasik reported being employed by Verily and as such having a financial relationship with the company. She reported holding stock from a former employer, Omada. Nadler had no disclosures. Soleymani reported receiving honoraria from Novo Nordisk for speaking engagements.