Reviewer: Kacey Chae, MD (Johns Hopkins University School of Medicine)
Description: This book, a collection of chapters written by authors of various disciplines, explores weight-based bias in healthcare settings. It is divided into two parts: the first part discusses the negative impact of weight-based bias and the second part explores strategies on improving healthcare education against such biases.
Purpose: The purpose of the book is to discuss the weight-based stigma and discrimination faced by individuals with higher weight, particularly in healthcare settings. Furthermore, the book aims to explore interventions in healthcare education to promote a weight-inclusive approach to pedagogy. The topics span the history of medical equipment to weight-based stigma in medical records and textbooks. There have been other books written about weight biases, but not many focus on health education. The book does make a strong case about the prevalence of weight-based bias by covering perspectives from different disciplines, such as psychology, dietetics, social science, and medicine. I do think part II could use more robust discussion, particularly by including practical approaches in medical education, an area that is not well-covered in the book.
Audience: The intended audience of the book, according to the authors, is practitioners and scholars with an interest in health education or caring for patients with higher weight in varied disciplines, such as medicine, nursing, social work, nutrition, physiotherapy, psychology, sociology, and education. I agree with the intended audience of the authors, but for the book to be used for healthcare professions students and providers, I would have liked to see more representation of physicians in the authorship. Upon my review of the contributing authors and their accomplishments, many holds PhDs and have contributed to the field of critical studies on body weight. However, I would have liked to see more authors who are practitioners in health care and have also done work in medical education, which is an important perspective to include in this book.
Features: The book uses the framework of Critical Theory to highlight the perspective of weight-based bias and stigma prevalent in health care. The first part of the book spans patient care narratives, discourse on the history of medical equipment, and intrinsic bias in the patient medical record. The book unpacks how the connection between weight and health is complex; furthermore, other factors, such as health behaviors, weight stigma, and social determinants also play important roles in that relationship. The book further discusses the BMI being a poor predictor of one's health and weight loss not necessarily having a positive impact on one's health. In the chapter about medical equipment, the author cites works that connect eugenics and its influence on design of medical equipment. While I agree with some of the statements in the book that BMI is an imperfect predictor of health and that the connection between weight and health are complex, I would have also liked to see the inclusion of evidence that supports the health benefits of weight loss for a more balanced perspective. In such a discussion, it is also important to include perspectives of physicians with expertise in caring for patients with higher weight. I also found the argument connecting eugenics and design of medical equipment a bit of a stretch. In fact, one of the authors referenced in support of this theory did not fully connect the findings to eugenics. The second part of the book offers ideas on promoting weight inclusivity in healthcare education. The authors discuss narrative medicine and lived experience education as one approach to combatting weight-based bias. Another chapter discusses incorporating concepts of Health At Every Size (HAES) in psychotherapy to treat patients with disordered eating. The book uses the framework drawn from Critical Theory and Fat Studies to explore weight-based bias and stigma in health care, which is a much-needed area of education. There are other books that delve into weight-based bias (e.g., Weight Bias: Nature, Consequences, and Remedies (Guilford Press, 2005), but not many explore it in the context of healthcare education, which is the unique feature of the book. While some chapters were educational, I found some views presented in the book to be a bit extreme with omission of evidence that supports opposing points of view. For example, the book claims that the health benefits of weight loss lacks evidence and that there are many diseases in which elevated weight is protective. However, there is data that supports lowering of blood pressure, improvement in lipid profiles, and reducing the risk of diabetes with the amount of weight loss achieved, as supported by clinical guidelines from professional societies (i.e. U.S. Preventive Services Task Force, American Heart Association/American College of Cardiology, The Obesity Society, and American Association of Clinical Endocrinologists/American College of Endocrinology).There are some disease states in which higher BMI can be protective, but this is a nuanced discussion and I would suggest that the authors include clinical perspectives from physicians.
Assessment: Due to the nature of multiple authorship of the book, there were some redundancies, particularly, in the discussion surrounding weight-based bias and stigma. If this book were to be used in healthcare education, I would suggest using certain chapters/excerpts of the book for the unique perspective it offers, but is not a stand-alone textbook to teach the topic.