Exploring Weight Bias in Cancer Care

By Stephanie DeMeyer, MA, Elaine S. DeMeyer, RN, MSN, AOCN®, BMTCN® - Last Updated: November 28, 2022

Removing weight bias across the cancer care continuum (screening to end of life) is a clear path toward health equity. Although bodies come in all shapes and sizes, there is still a prejudice toward people who are obese or underweight, known as weight stigma or weight bias. Consider the following examples:

A man who is overweight cancels his third annual checkup in a row—he doesn’t want to hear his doctor talk about weight loss again. As a result, he lacks screening for prostate cancer.


A long-term survivor with a heightened metabolism often hears her family say, “Eat a hamburger  once in a while.” Her primary care doctor frequently screens her for eating disorders and misses the potential lack of interest in food due to fear of cancer recurrence.

Since obesity can increase the risk for various types of cancer, most oncology nurses frequently will manage patients who are overweight during their careers. However, they will likely also care for patients who are underweight since cancer and its treatment often causes weight loss.

What Is Weight Bias?

Weight bias “deals with personal stereotypes toward people considered overweight [or underweight] . . . that can lead to discrimination in everyday life.” What is considered “overweight” or “underweight” may vary from culture to culture and even within a country. Health care professionals use measurements such as body mass index (BMI) to define ideal weight.

Nurses and other health care team members may have biases toward individuals who do not fall within defined weight parameters. As a result, weight bias can have harmful effects that can negatively affect the quality of patient care, well-being, and potential outcomes.

How Can Oncology Nurses Uncover Their Own Weight Bias?

When caring for patients whose BMI falls outside of the “healthy or “normal” range, it is crucial to understand your own biases so that you may address them. Examine your perceptions of people who are overweight or obese and those who are significantly underweight. Ask yourself: ”What impact does my upbringing, background, and beliefs have in talking to patients who are overweight or underweight?”

Consider reflective journaling as a tool to raise self-awareness and self-reflection of weight bias. In addition, journaling can increase your understanding and empathy in patient-care interactions.

Continuously watch for signs of bias in yourself or coworkers. Note any derogatory comments or jokes. Look for signs of nonverbal expression such as disgusted looks or rolling of the eyes. Bring weight bias to management’s attention because it is a form of bullying.

What Is the Psychological Impact of Weight Changes?

People who previously had a healthy BMI and looked physically fit may have drastic weight changes and other visible side effects after cancer. As a result, cancer survivors may experience weight bias in a way they have not before. They may become self-conscious about their appearance and start to feel unlovable or have other negative feelings.

Patients experiencing weight changes may struggle with body dysmorphia. Body dysmorphia is the feeling that something is “wrong” with one’s body—when patients’ images of themselves do not match their physical appearances. It is a disconnect between perception and reality.

Body dysmorphic disorder (BDD) can cause distress, anxiety, and behavioral changes (overeating or undereating, overexercising, calorie counting, etc). This preoccupation with appearance or focus on body weight may lead to distress that affects everyday activities and quality of life. Consider recommending a therapist, counselor, or support group to help patients cope.

Recognizing weight bias in cancer care is the first step in reducing weight bias to optimize patient health. For health equity care, use “people-first” language. For example, oncology nurses already use the term “patient with cancer” instead of “cancer patient.” Use that same concept with weight changes—“individual with obesity” or “person who is underweight.” Admitting to your weight bias can be a humbling experience as an oncology nurse. You may uncover feelings of inadequacy, lack of confidence, or even anxiety in caring for patients with significant weight changes. However, you can develop a plan to address a bias once you recognize it.



Does Body Weight Affect Cancer Risk?

What Is Weight Bias?

Reflective Journaling of Nursing Students on Weight Bias

Body Dysmorphic Disorder

Reducing Weight Bias in Health care

Weight Bias: A Clinical Concern That Cannot Be Ignored