May 10, 2023: Health professionals must review their own biases about their patients’ weight, a leading group of experts said this week.
The American Association of Clinical Endocrinology makes recommendations aimed at weight reduction bias, or negative ideas about excess body weight, as well as weight stigma, defined as thoughts and acts of discrimination toward people because of their weight and size.
The statement also asks professionals to survey obese patients about internalized weight bias, or when a person feels negative about themselves because of their weight.
“The real message of the paper is that we have to recognize bias in all its forms, both as physicians and patients, and then the stigma that comes with it,” said Karl Nadolsky, DO, of Michigan State University College of Human Medicine. and leading author of the statement. “And for patients, internalized weight bias is a complication of obesity, but it also contributes to and drives part of the pathophysiology of obesity.”
This new document continues previous work by the American Association of Clinical Endocrinology dating back to 2012, when the group proposed considering obesity as a chronic disease, rather than a cosmetic condition or lifestyle choice. In 2013, the American Medical Association also officially embraced that idea.
In 2017, the group came up with a new term, “chronic adiposity-based disease,” to combine health complications related to excess weight, such as heart disease, sleep apnea, and knee arthritis. Weight loss, then, is used among other treatments to address these complications and not as a goal in itself.
“We are trying to move away from a weight-focused approach and focus more on a person’s health in a very holistic way. … So if someone has complications like type 2 diabetes, sleep apnea and knee arthritis, they have worse outcomes and a more urgent need for intensive medical therapy,” Nadolsky said.
The hope is that this approach, combined with the new document, will help reduce stigma and bias and improve health outcomes.
“We don’t know yet, but we do know that internalized weight bias contributes to barriers to treatment and therapy success, which is then a vicious cycle,” Nadolsky said.
The document also says that health care providers should follow the “5As” for obesity and chronic adiposity-based diseases:
- ASK if you can discuss weight and health impact of chronic adiposity-based diseases.
- EVALUATE health status and complications.
- ADVICE on treatment options based on the severity of chronic adiposity-based disease.
- AGREE on a treatment plan and weight loss goals.
- ASSIST in the ongoing process of weight management with reassessment of goals and treatment options.
Ultimately, the paper says: “Optimal outcomes for patients with ABCD [adiposity-based chronic disease] they require interactions between empowered informed patients who are activated to partner with the healthcare team and a healthcare system prepared with professionals, procedures and infrastructure that provide full access to evidence-based care.”
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