Why has the obesity rate continued to rise despite our efforts to stop it?
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 in for a check-up, and her doctor told her it would eventually go away with regular movement and elevating her legs.
Months passed and the painful swelling wouldn't subside, so she saw a different primary care doctor. O'Malley said the second doctor didn't examine her legs, but instead implored her to focus on one thing: losing weight. She left with information on which calorie-counting apps to download.
As time went by 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 obliged, and within days, O'Malley's swelling was gone. She realized she could have avoided 6 months of potential health risks and pushing through pain if only her doctor had seen her as a person, not just a bigger body.
Weight bias, unfortunately, is nothing new. Many studies over decades have shown that doctors sometimes look down on patients with obesity, and can have a hazy understanding of the condition overall. This makes it harder for bigger patients to receive proper care and achieve positive health outcomes, with previous negative experiences deterring some from seeing doctors at all. And so the cycle continues.
"There are a lot of things that happen in my body that I feel like I have to educate my [health care] providers on,"O'Malley said. "I wish that was 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 that doctors tend to give — eat less, move more — often doesn't work. While some doctors do specialize in obesity treatment — 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 not immune to bias. Previous studies have shown weight stigma in patient-provider encounters, with a 2021 PLOS One study of nearly 14,000 people across six countries showing two thirds of those 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 health care.
There's more. The negativity of weight stigma can lead to more unhealthy behavior, including disordered eating, more weight gain, and alcohol use, and it has been linked to higher suicide risk.
All this is bad news for people and for public health, as it leaves people living with obesity reluctant to seek help for any health issue, much less for weight management. 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 from as young as 2 years old to upwards of 90. Among her diverse pool of patients emerges one common theme.
"Patients with obesity have been devalued and belittled," she said. "They often seek treatment under cloak of secrecy. They don't want people to know they're being treated for obesity because it must be a sign of failure or of their inadequacy of not doing things the 'hard' or the 'right' way."
Resource: Medscape Medical News © 2023 WebMD, LLC - Batya Swift Yasgur, MA, LSW
