Confronting weight stigma in obesity care, with Scott Kahan, MD, MPH

When used in medicine, the words bias and stigma often refer to inequalities related to race or gender differences in the care of patients. At the 2022 Association of Diabetes Care and Education Specialists (ADCES) Annual Meeting, a presentation by Scott Kahan, MD, MPH, director of the National Center for Weight and Wellness, aimed to address the stigma of weight and the impact it has on patients may have to address and their ability to achieve treatment goals.

According to the National Eating Disorders Association, weight stigma, also known as weight bias or weight-based discrimination, is defined as discrimination or stereotyping based on a person’s weight. Interested in learning more about the history of weight stigma versus the current landscape and how a new emphasis on patient language in diabetes management can impact the fight to eradicate weight stigma in clinical care, Endocrinology Network reached out to Kahan, and that conversation is the subject of the following Q&A.

Understanding Weight Stigma, with Scott Kahan, MD, MPH

Endocrinology Network: Can you describe the origins of the weight stigma and how it is affecting patients today?

Khan: So, at the most basic level, weight stigma is driven by assumptions and often judgments about people based on their appearance. This goes back forever because in western societies and especially the US, people are judged simply on their looks and weight. Studies on weight stigma started in the mid-20th century but have really taken off in the last 20-30 years.

We’ve made real progress. Unfortunately not nearly enough. Most of the progress has been made in terms of minimizing explicit weight stigma, such as simply yelling at someone, “You’re such a fat guy!”. Or something like that. We don’t see this nearly as often as we used to, but implied weight stigma that’s a lot more subtle. Things where we make assumptions and have different beliefs about people, which in turn are driven by their weight. Whether it’s about their intelligence or whether it’s about their likelihood of complying with medical recommendations. These are widespread and even ubiquitous. It’s something we haven’t made too much progress on.

Endocrinology Network: How difficult is it to address the stigma of weight in clinical practice?

Khan: It doesn’t have to be as difficult as it seems. Ultimately, we want to convey to patients that we care about them and want to help them lead healthy lives and be able to participate in their lives and not be restricted. Whether by their weight and weight issues, such as diabetes, and certainly not to be constrained by experiencing weight stigma, it is important to convey to patients that gaining a large amount of weight is not healthy, to communicate that healthy behaviors will transform their lives , improve their zest for life and their quality of life. Usually this happens without words – it happens through the tone of our voice and the way we interact with them. But let them know that carrying excess weight doesn’t make them a bad person, nor does losing weight make them a good person. We want to separate the condition and behaviors from the value of the person himself.

Endocrinology Network: How does using the patient’s first language in diabetes and obesity management help reduce the stigma of weight?

Khan: So I think there’s a lot of overlap. In a way, the use of patient language in obesity follows the use of patient language in diabetes. The focus on this started earlier in the field of diabetes. It didn’t start with diabetes, there are many other areas that we’ve been in. It is now the first language for us humans.

For example, we don’t call people with depression depressed. It’s just not natural, and overall I think we’ve made a lot of progress in diabetes. It is no longer common to call people with diabetes diabetics. We are still in the early stages of communicating the importance of using human language in obesity. So, we’ll see where this goes.

I think it’s a very important thing in part because it’s a really simple thing. There are many things that take time and money and effort. This isn’t one of them. It just takes a little attention and a little practice. It’s not off our shoulders to use people’s native language and it makes a difference. Nobody likes to be called obese, let alone morbid. So there are many studies that show that the terminologies we use can be more or less motivating for patients. It’s a subtle thing, but it’s an important thing and a valuable thing that all clinicians should consider when interacting with their patients.

Editor’s Note: This transcript has been edited for length and clarity.

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