The severity of COVID appears to be increased in people with obesity. This may represent an opportunity to discuss the benefits of lifestyle change with overweight patients. However, if not done appropriately, the opportunity becomes transformed into just one more damaging, body-shaming experience for the patient.
There has been much written and little done about body shaming in the health care setting: “Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors.”
Unfortunately, most physicians think that obesity is basically a behavioral problem related to nothing more complicated than eating too much and exercising too little. Just like other members of our society, doctors and medical students are biased toward obese people and characterize them as “noncompliant, lacking in motivation, and self-indulgent.” As a result, quality of care suffers, since patients avoid care rather than be treated with so much judgment and so little compassion, not to mention useful guidance. In Roxane Gay’s powerful memoir, Hunger, she makes an observation that unfortunately applies to doctors: “When people use the word ‘obese,’ they aren’t merely being literal. They are offering forth an accusation.”
I propose that we make ourselves aware of the stigma we bring to our attitudes about obese patients, even if we ourselves are obese (or especially if we are obese, since internalized bias is almost universal in people with obesity and has such deleterious effects on physical and mental health). This is key if we are to stop treating every symptom in a patient with obesity as being related to only obesity.
I propose that we stop further shaming our overweight patients with directives such as, “You need to lose weight,” as though people have neither brains nor mirrors. Instead, we can help motivate our patients. For example:
- Rather than offering up dire warnings that often lead to people feeling more discouraged and ashamed than ever, instead stress the positive physical and emotional effects of healthy eating and moving – less joint pain, less disease, more energy, and better mood.
- Encourage the patient to set small, achievable goals to improve health and well-being, not just to lose weight. Examples would be to eliminate soda from the home and to increasingly incorporate physical activity into daily life.
We don’t need to be obesity experts, life coaches, nutritionists, and therapists. We do need to be supportive, compassionate, and aware of what resources are available to our patients. We should encourage our patients to follow up with us, even – especially! – if they’re not having success with weight loss. Weight gain is a sign of an ongoing challenge, not failure.
Being obese may be unhealthy, but it’s not a moral failing, and we all share in the responsibility to detach shame from body size.
Janice Asher is an obstetrics-gynecology physician.
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