Weight Stigma

The U.S. Food and Drug Administration recently approved a new medication for weight management in adults with obesity (FDA, 2023). This is just the latest advancement in the management of obesity. With each new development comes a new wave of opinions on the use of these medications and other weight management techniques. In the summer of 2023, the dialogue centered around the shortage of weight management medications which are also used to treat diabetes. At the time, much of the focus was on people using these medications for weight management “taking” them from those who needed them to manage diabetes. This highlights how these two diseases are viewed differently, and exposes weight stigma that is prevalent and harmful (Tomiyama et al., 2018). Why do we view diabetes as a disease to be treated with medication, but view obesity as a disease to be treated with willpower?

The American Medical Association defined obesity as a disease in 2013 and reaffirmed the policy in 2023 (American Medical Association, 2023). While obesity is defined as a disease, stigma persists. In early 2023, six U.S. organizations released a consensus statement focusing on improving obesity treatment and reducing weight stigma.

• Obesity is a highly prevalent chronic disease characterized by excessive fat accumulation or distribution that presents a risk to health and requires life-long care. Virtually every system in the body is affected by obesity. Major chronic diseases associated with obesity include diabetes, heart disease, and cancer.
• The body mass index (weight in kilograms/height in meters 2) (BMI) is used to screen for obesity but it does not displace clinical judgment. BMI is not a measure of body fat. Social determinants, race, ethnicity, and age may modify the risk associated with a given BMI.
• Bias and stigmatization directed at people with obesity contributes to poor health and impairs treatment.
• Every person with obesity should have access to evidence-based treatment (Academy of Nutrition and Dietetics, 2023).

Continued stigmatization of those who experience obesity does nothing to support treatment. On the contrary, evidence suggests that weight stigma, especially in healthcare settings, results in poorer patient outcomes (Tomiyama et al., 2018). Training is needed to reduce weight bias, especially in healthcare professionals. We can start by remembering that obesity is a disease. It should not be treated as a failure of willpower. Instead, it is a complex chronic condition that requires intervention including medical nutrition therapy, physical activity, pharmacotherapy, and surgery.

References

Academy of Nutrition and Dietetics. Press Release: Obesity Care Organizations Develop Consensus Statement. January 31, 2023. Accessed November 10, 2023: https://www.eatrightpro.org/about-us/for-media/press-releases/countrys-leading-obesity-care-organizations-develop-consensus-statement-on-obesity

American Medical Association. Recognition of Obesity as a Disease H-440.842. Accessed November 11, 2023: https://policysearch.ama-assn.org/policyfinder/detail/obesity?uri=%2FAMADoc%2FHOD.xml-0-3858.xml

Tomiyama, A., Carr, D., Granberg, E. et al. How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Med 16, 123 (2018). https://doi.org/10.1186/s12916-018-1116-5

U.S. Food and Drug Administration. FDA News Release: FDA Approves New Medication for Chronic Weight Management. November 8, 2023. Accessed November 10, 2023: https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management