The Physician’s Role In The Fat-Shaming Epidemic


 
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By Rami Bailony, MD

Fat shaming has come back into the collective consciousness in a big way, following James Corden’s rebuke of Bill Maher’s comments that “some amount of shame is good.” Corden, as many have pointed out, is spot-on in his assessment: No amount of fat-shaming is going to help solve the current obesity epidemic. It will, in fact, make it much worse.

But perhaps the biggest problem isn’t the off-hand, ill-advised remarks of talk-show hosts. It’s the lackadaisical approach to obesity being taken by many physicians today. Obesity is one of the most pervasive epidemics that modern medicine has ever encountered, but our response as a medical community thus far has lacked urgency and continues to be fraught with gross mischaracterizations and bias.

In the heyday of the HIV and cigarette-related illness epidemics, the medical community played a leading role in fighting stigma and advocating for a broad range of solutions to tackle these challenges. Contrast this to our approach to obesity, where a 2009 study showed that physicians view patients with obesity as less self-disciplined and more annoying than normal-weight patients and that, as patients’ BMI increases, physicians are likely to have less respect and desire to help them. Despite the growing recognition of obesity as a disease, obesity continues to be one of the most underdiagnosed and undertreated conditions during clinical encounters, according to a recent 2019 study.

We like to think that people suffering from obesity have no willpower (i.e., that it’s their fault) rather than a deficiency in hunger and satiety hormones, and such beliefs harbor an implicit bias. I know because I was one of those physicians until five years ago, when I went in for a health check and discovered my cholesterol was 174 and had a body mass index (BMI) of 31. I had was obese and pre-diabetes.

Our approach to the obesity epidemic has been more akin to the medieval approach to leprosy and mental illness. In both cases, the approach of physicians to these diseases aided in the social outcast of those who suffered from them. Obesity is one of the last forms of socially acceptable discrimination. It is the leprosy of the 21st century—a medical condition that is used to justify bias, discrimination, and stigma toward people who suffer from it on a systemic level.

Not only are most physicians doing little to treat obesity as the medical condition it is, but the stigma they’re attaching to the disease in their patients’ minds is actually causing more harm to patient health than the physical effects of obesity itself.

Several studies have reported that weight stigma is associated with an increased health risk. In a 2015 study of 18,771 adults, mortality risk was 60 percent higher among those who had experienced weight discrimination after adjusting for BMI. That is a shocking statistic that is hard to grasp, but it makes sense when you observe on a daily basis the increase in anxiety, depression, avoidance of exercise, social isolation, job discrimination, and decrease in self-confidence that is associated with weight stigma. People who internalize weight stigma have higher inflammation levels, triglycerides, and glucose levels than their same-weight counterparts. These elevated biomarkers, known collectively as metabolic syndrome, make it biologically harder to lose weight, which implies that weight stigma creates both psychological and metabolic resistance to weight loss or treatment.

The stigma we as a society—and we as medical practitioners—place on people with increased weight is driven by the misconception that our weight is somehow a representation of our character. We need to move away from judging ourselves and others according to weight. When people ask me what my team does, I often say we help people manage their weight, but—more importantly—we help them see past their weight. One of the ways we tackle weight stigma is by trying to take a broader approach, teaching our members that weight is the result of complex interactions between environmental, behavioral, psychological, medical, genetic, and microbiomic factors.

It is refreshing to see more mainstream news coverage that looks at these complex factors, rather making it seem like weight loss is just a matter of will power. But it’s physicians, rather than celebrities, who should be on the front lines in these important discussions. As a profession, we must advocate for, not discriminate against, our patients who are challenged by obesity. We are the ones who must set the stage for kinder treatment of people who struggle with weight. In doing so, we will improve not only our patient relationships, but also our patient outcomes.

 
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    • Editor-in Chief:
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      Lin Takahashi
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      Ronald Harvinger
      Lisa Andonis

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