Obesity: Changing the conversation

Obesity is a complex medical condition rapidly becoming a global health concern due to its impact on physical health and its link to chronic diseases like diabetes, cardiovascular disease and certain cancers. In addition to these health challenges, social stigma rooted in societal biases has led to prejudice and discrimination that further propagate the condition’s damaging physical and psychological consequences.

In recent years, pharmacologic management of obesity and its comorbidities has significantly evolved. Unfortunately, judgment surrounding obesity and the methods of controlling it remains. As physicians and physicians in training, we play an essential role in the advocacy for these patients and can work together to identify ways to reduce weight bias in medicine.

Recognize that weight stigma causes harm

Just as obesity influences overall well-being, the associated stigma harms the quality of care and health outcomes. Evidence shows that medical professionals, including physicians, are not immune to holding bias against obese patients. As a result, these patients are often treated with less empathy, are considered unpleasant or noncompliant and often spend less time with their health care professionals.

Though this bias can be implicit or explicit, patients tend to recognize and internalize it, which reduces their self-esteem and confidence in their ability to lose weight. Data shows that patients who experience this weight-related discrimination are less likely to participate in health maintenance activities and follow-up appointments. Health professionals must be aware of weight bias and prepared to address this issue in health care effectively. Below are a few ways they can do that.

Understand the stigma associated with pharmacologic treatment

Advancements in pharmacologic formulations have revolutionized the management of obesity and its comorbidities, targeting weight loss and addressing some of the most dangerous associated conditions. Why are such options regarded with judgment both in and out of the clinic?

Misconception #1: Weight loss can be achieved through willpower and discipline alone.

Many genetic, hormonal, metabolic and personal factors can influence an individual’s weight. Though some individuals can lose or maintain weight without medical treatment, this suggestion disregards the complex and multifaceted nature of the condition’s etiology and the potentially lifesaving benefits that medical treatment can provide. As an example, one literary review showed that taking semaglutide helped Type 2 diabetes patients lose weight and also significantly lower their risk of cardiovascular disease and death.

Misconception #2: Medications that lead to weight loss are dangerous.

All medications have the potential for adverse side effects, and options approved for weight management should be used as prescribed. When used under the direction of a health care professional, signs of dangerous consequences can be closely monitored.

Misconception #3: Patients taking medications that cause weight loss are taking the easy way out.

While it is true that some pharmacologic options have provided the benefit of significant weight loss to obese patients, these medications were not designed to replace the development of healthy lifestyle habits but rather to complement them. When combined with a lifestyle program that includes healthy eating and increased physical activity, medications have led to success with weight loss and maintaining a healthy weight. Additionally, a lifestyle program may address additional factors contributing to weight gain such as eating triggers and inadequate sleep.

Explore your own bias

Physicians can continue to modify their practice to better serve their patients by exploring and addressing personal biases. One way to do this is to consider how personal views and ideas regarding size, weight and obesity affect your behavior and practice through self-reflection. Additionally, insufficient knowledge and abilities may also influence negative attitudes. Once identified, providers should seek to further their education on the multifactorial nature of obesity, weight-related health problems and treatment strategies that promote success, patient adherence and better long-term outcomes.

Communicate and collaborate

Another way to address this bias is to improve communication and collaboration with your patient. To facilitate an open line of communication, take the time to practice empathy and active listening to understand your patients’ experiences, their goals and the challenges they face without judgment. Also, remember to use patient-centered language and avoid the use of derogatory terms that perpetuate stigma.

It will be important to remain open-minded and sensitive to the individual needs of your patient to avoid imparting feelings of shame, embarrassment and failure. Strive to foster a supportive environment where all patients feel comfortable discussing their concerns, experiences and treatment preferences without fear of stigma or prejudice. As previously stated, obesity is a medical condition. Clinicians should approach their medical management of obesity in a similar manner to how they handle other chronic conditions like hypertension.

These conversations encourage patient-centered care and acknowledge the diverse needs of patients with obesity. Additionally, patient outcomes are better when patients can form partnerships with their physician and feel empowered to take control of their health. Remember to engage every patient by including them in each step of the clinical decision-making process while continuously evaluating whether weight bias plays a role in diagnostic and treatment decisions.

Reducing the stigma

All people deserve access to high-quality, compassionate health care regardless of their weight or health habits. Physicians and future physicians are critical in reducing the stigma and prejudice associated with seeking pharmacologic treatment options for obesity. By understanding and being aware of weight bias and striving to provide empathetic, nonjudgmental care, physicians can help foster a health care environment that supports patients in managing obesity.

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