Rewritten:
This article is the final installment of a three-part series on the obesity crisis. The first part explores why the obesity rate continues to rise despite efforts to combat it, while the second part investigates the potential role of new weight loss drugs in resolving the crisis.
In this article, the focus is on the weight bias and stigma that individuals with obesity face within the healthcare system. The story begins with Mia O’Malley, who experienced prolonged swelling in her legs after giving birth. Despite seeking medical help, her doctors failed to properly address her condition, instead attributing it solely to her weight and advising her to lose weight. Eventually, O’Malley requested a water pill to alleviate the swelling, which proved successful. Through this experience, she realized the need for healthcare providers to view patients as individuals, rather than just their body size. Unfortunately, weight bias is not a new phenomenon in the medical field and has been shown to impede appropriate care and deter patients from seeking medical help.
The negative impact of weight-related stigma in healthcare extends beyond feeling unheard and disrespected. It can also lead to unhealthy behaviors, such as disordered eating, weight gain, and increased alcohol use, as well as an increased risk of suicide. This is concerning, especially considering the rising obesity rates in the country.
Dr. Fatima Stanford, an obesity medicine specialist, highlights the devaluation and belittlement experienced by patients with obesity. Many individuals with larger bodies go years without seeking medical care, as they fear judgment and embarrassment. Studies show that people with obesity are less likely to be screened for certain types of cancer and are more likely to delay seeking medical care due to negative experiences with healthcare providers.
Jen McLellan, an author and plus-size childbirth educator, shares her personal experience of avoiding doctors for over two years due to mistreatment. The negative encounter she had, where her doctor dismissed her breathing difficulties, led her to question the attitude that healthcare providers have toward patients with obesity. McLellan emphasizes the need for healthcare providers to treat patients with dignity and recognize their humanity beyond their weight.
The article also discusses the limitations of current weight-loss advice given by doctors, which often includes generic recommendations to eat less and exercise more. Such advice has been proven to be less effective in achieving long-term weight loss success. Rather, a multidisciplinary approach that considers genetics, hormones, sleep patterns, access to food, and mental health is necessary.
Dr. Angela Fitch, an associate director at the Massachusetts General Hospital Weight Center, emphasizes the importance of understanding that weight management is not solely a matter of character, but is also influenced by chemistry. Different therapies may be required to successfully manage weight, and personalized treatment plans are essential. The article concludes with the example of Kristal Hartman, who, after undergoing bariatric surgery, needed additional interventions to maintain her weight loss.
Ultimately, doctors and patients need to work together to achieve better results. For individuals with obesity, it is essential to find healthcare providers who offer compassionate and comprehensive care, considering all aspects of a person’s health. By addressing weight bias and stigma in healthcare, individuals with obesity can feel more empowered to seek medical help and receive appropriate care.
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This is the third in a three-part series on the obesity crisis. Part One asks a tricky question: Why does the obesity rate keep rising despite our efforts to stop it? The second part examines whether new weight loss drugs it will finally end the crisis.
July 5, 2023 – After Mia O’Malley gave birth in 2018, she retained fluid in her legs, a common occurrence after giving birth. The swelling made walking, sitting, and caring for her newborn painful and uncomfortable. She went for a checkup and her doctor told her that she would eventually go away with regular movement and raising her legs.
Months passed and the painful swelling would not subside, so she saw another primary care physician. O’Malley said the second doctor didn’t examine his legs, but instead implored him to focus on one thing: lose weight. He left with information on which calorie counting apps to download.
As time passed and the swelling persisted, she went back to the second doctor and asked for a water pill to flush out the fluids, something she had seen other new parents discuss online. The doctor complied, and within days, O’Malley’s swelling was gone. She realized that she could have avoided 6 months of potential health risks and overcome pain if her doctor had seen her as a person, not just a larger body.
Weight bias, unfortunately, is nothing new. Many studies for decades they have shown that doctors sometimes look down on patients with obesity and may have a vague understanding of the condition in general. This makes it more difficult for older patients to receive appropriate care and achieve positive health outcomes, as past negative experiences deter some from seeing doctors. And so the cycle continues.
“There are a lot of things that go on in my body that I feel like I have to educate my [health care] providers,” O’Malley said. “I wish it were different.”
Weight stigma in health care runs deep
In some cases, like O’Malley’s, patients don’t feel heard because they doubt their doctors can see past their obesity. At the same time, the weight-loss advice doctors often give—eat less, move more—often doesn’t work. Although some doctors specialize in the treatment of obesity, obesity medicine has been growing since the field was established in 2011, most receive little training in how to talk about and treat obesity.
Then there’s the fact that doctors are human and are not immune to bias. Previous studies have shown weight stigma in patient-provider encounters, with a 2021 plus one study of nearly 14,000 people in six countries showing that two-thirds of people who have experienced weight stigma also experienced it with doctors. The result: they perceived less listening and respect from doctors, more judgment due to body weight, and lower quality of medical care.
There is more. The negativity of weight-related stigma can lead to more unhealthy behavior, including disordered eating, more weight gain, and alcohol useand has been associated with increased risk of suicide.
All of this is bad news for individuals and for public health, as it leaves people living with obesity reluctant to seek help for any health problem, let alone weight control. In a country with skyrocketing obesity rates, that’s not good.
Obesity medicine specialist Fatima Stanford, MD, MPH, an educator and doctor at Harvard Medical School and Massachusetts General Hospital, sees patients ages 2 to 90. Among her diverse patient group emerges a common theme.
“Patients with obesity have been devalued and belittled,” he said. “They often seek treatment under a cloak of secrecy. They don’t want people to know they are being treated for obesity because it must be a sign of failure or their inadequacy for not doing things the ‘hard’ or ‘correct’ way.”
When it gets easier to just not go to the doctor
For many patients with larger bodies, it’s common to go years without seeing a doctor. Studies have shown that people with obesity are least likely be screened for certain types of cancer and are more likely to delay in carelargely due to the negative attitudes they experience in health care settings.
Investigation it also shows that overweight patients visit doctors 23% more often than their underweight counterparts. For patients with obesity, that jumps to 52%, showing how difficult it is for such patients to find a compassionate provider and stay with them.
“It’s not just about hurt feelings,” O’Malley said. “These are people avoiding preventive care appointments, avoiding getting their injuries treated, avoiding their health problems because they don’t want to be embarrassed.”
This rings true for Jen McLellan, author and plus-size childbirth educator.
“Even though this is what I teach full time, I didn’t go to the doctor for over 2 years and during that time I gained the weight that was already there in a bigger body,” he said. “I gained an additional 60 pounds and it really affected my mental health.”
The long hiatus began before the pandemic, after McLellan saw a doctor when he was having trouble breathing. A month before his appointment, he had completed a 5K run and was in good health. He asked his provider for an inhaler, but was told it would “hurt his heart.” The doctor ordered an EKG, which showed no abnormalities, but still refused to give McLellan a prescription for an inhaler.
While driving home, she nearly passed out from lack of air. She ended up going to the ER for an inhaler and was told that she had just had a restricted airway that needed help opening after a bout of strep throat.
“Basically I had to say [to doctors]: Look at me, the human sitting in front of you who has been mistreated by the healthcare system,” McLellan said. “I am a person. I am not a BMI or a number on the scale. Treat me with dignity.
A new path to better results
Kristal Hartman, 45, is a member of the Obesity Action Coalition and has sought treatment for obesity her entire life. She finally had bariatric surgery in her mid-30s.
Before the surgery, she had given birth to twins and her health had deteriorated due to polycystic ovary syndrome and thyroid problems.
“I had young children and had already tried all the fad diets,” Hartman said. “My primary care doctor, who has never experienced obesity, kept telling me to walk a little more, put down my fork and eat a little less. That was pretty much the only advice he gave me on weight control. .”
Studies have shown that doctors’ weight-loss advice rarely includes effective methods and often falls into the generic “eat less, move more” variety.
This doctor was also an internal medicine specialist whose practice was said to be geared toward patients with more complicated health profiles, Hartman said. Eventually, Hartman’s endocrinologist recommended different treatment options, including medication and surgery.
“Even when researchers do very good, controlled studies, only about 5% of people can lose 20% of their weight with lifestyle interventions alone. Forty-eight percent of people can lose 5% of their weight,” said Angela Fitch, MD, associate director of the Massachusetts General Hospital Weight Center. “The most important thing I tell people is that it’s not about your character; It’s all about your chemistry.”
Exercising regularly and eating a balanced diet are good lifestyle choices for everyone, not just those who are obese. But according to Fitch, patients often need another intervention to successfully control their weight.
At the Massachusetts General Hospital Weight Center, Stanford says, it’s all about trying different therapies and seeing how patients respond. Successful treatment involves every part of a person: genetics, hormone levels, sleep patterns, access to food, and mental health. And in her experience, this multidisciplinary approach works.
“The vast majority of my patients, people I’ve been seeing for 10 or 12 years and who have continued care, probably in excess of 90% are successful in their treatment strategies,” he said.
A person’s weight management strategies often have to change over time. Even after Hartman lost a significant amount of weight through bariatric surgery, his weight began to creep up (a not rare experience). She began taking a prescription GLP-1 receptor agonist, a group of drugs that includes semaglutide (Ozempic, Wegovy), to help maintain her weight.
How doctors and patients can get better results together
For the more obese people who don’t have access to a patient-centered, multidisciplinary weight center, and the doctors who don’t provide those specialized services, there are still ways everyone can achieve better treatment outcomes.
For doctors: they are seeing patients with obesity, but do these patients feel “seen”? Is your practice set up to accept and accommodate heavier patients? McClellan suggests looking at areas he may not have previously thought of, such as gowns that fit larger bodies, bigger chairs in the waiting room, and scales with higher weight limits.
Education is key, said Maria Daniela Hurtado Andrade, MD, PhD, an obesity medicine doctor at the Mayo Clinic in Jacksonville, FL. Hurtado Andrade pointed out that new therapies are being developed to control weight loss and some (such as semaglutide) have already been used for years to treat diabetes. “While some providers are willing to start using these drugs, it’s not enough,” she said. She remembers: “We should treat obesity like any other chronic disease, like high blood pressure or diabetes.”
For patients: Check online for lists of “weight neutral” or “fit for size” providers endorsed by other patients with larger bodies. lists as these they are places where patients can add the names and information of providers with whom they have had positive experiences.
Ask questions and stand up for your rights, McLellan recommends, even if you don’t feel comfortable doing so. “Are they going to give me a sheet or a robe that fits my body? Are they using the correct size blood pressure cuff? Are they taking your blood pressure the moment you’re rushed back into a room? (According to the Centers for Disease Control and Preventiona patient should be sitting with their back supported for at least 5 minutes with their feet flat on the floor to obtain an accurate blood pressure reading).
But what made the biggest difference for her was being clear with the doctors and nurses about how she feels right now and how her previous health care experiences contributed to it.
Since incorporating these strategies, McLellan said she was finally able to get the care she deserves from a compassionate provider.
“Said [my doctor], ‘I want to be healthy,’” she recalled. “And we reviewed my lab results together. He had done a full blood panel, and he slid his chair over to me and looked me right in the eye and said, ‘You’re healthy.’”
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