Weight stigma… it’s real and it exists not only within our society but also within our healthcare system. We must acknowledge it and work towards eradicating it. Unfortunately, the truth is, there’s many people within the healthcare system that don’t want to eradicate it. They believe, within their heart of hearts, that obesity is going to kill people. They believe that just a simple number can truly tell them more about their patient than any conversation can tell them. It’s what they’ve been taught. And really, it’s what all of us in healthcare have been taught from the time we began our schooling. We’re taught to have a weight bias, to judge our patients based on their weight and BMI. We’re told that it can predict their health status years down the line – a higher BMI means higher risk of heart-attack, stroke, diabetes, and many other diseases, right? Actually, not really. The biggest predictor of these conditions is behavior. How do you treat your body? How do you handle stress? How much sleep do you get on a regular basis? Do you smoke, use drugs, or drink excessive amounts of alcohol? These things aid in predicting disease, along with genetics.
When a doctor sees a high BMI, generally one of the first things they do is recommend weight loss (dieting and exercise). However, dieting is one of the biggest predictors of a weight problem-not vise-versa. We in the healthcare community suggest a modest weight loss of 10% to aid in reducing the complications of some disease states. “…As a result of these and other consistent findings demonstrating modest results of most weight loss interventions, there is recognition in the scientific community that existing dietary programs and medications can produce no more than an average of 10% weight loss. This evidence has prompted agreement among a number of expert panels and scientific groups that health care providers should counsel patients to set a goal of 10% reduction in total body weight rather than struggle to attain ideal body weight.”* But dieting (or even “lifestyle changes”) actually predicts weight gain! “Patients who have lost weight through lifestyle modification typically regain 30% to 35% of their lost weight during the year following treatment, and regain most (if not all) of their lost weight within 5 years.”*
The point is… dieting and lifestyle modifications just don’t work. Behavioral changes to better serve your life and well-being can and do work, but the person must be willing to make changes – not for weight loss but for body kindness and mental, spiritual peace. In the process of becoming a “healthier” person, weight loss in and of itself really can’t be a primary goal. One, because it’s not something we can actually control. And two, because seeking weight loss generally takes us further away from our own intuition when it comes to eating and exercise. We can’t listen to our body’s needs when we’re focused on an outside number. And reaching a goal weight of some sort isn’t guaranteed to make anyone any better off. “It is also important to note increasing research documenting a considerable percentage of overweight and obese persons who are metabolically healthy and non-overweight individuals who exhibit metabolic and cardiovascular risk factors.”*
Furthermore, weight stigma in and of itself wrecks havoc our health. It often exacerbates eating disorders and disordered eating. It belittles a person and pigeonholes them based solely on their weight and/or BMI. Binge eating disorder is one of the most common eating disorders, and simply suggesting weight loss to someone who is struggling with this problem will only cause them further pain and suffering.
I speak of this matter not only in regards to physicians, but to all of us within the healthcare system-nurses, nurse practitioners, dietitians, therapists, and others. It is so important to begin to assess individuals based on their behaviors and taking into account all of their history, including diet history and their relationship with food. Dieting predicts weight gain, including weight gain greater than a person’s original weight. Hence, when we ask someone to go on a diet, we’re basically telling them that their set point weight will eventually be even higher than it is today. We are worsening a patient’s health by suggesting a diet of any kind.
This post is just a droplet in the sea of weight stigma problems. (I’ll likely post plenty more on this topic.) I urge you to take some time to listen to some Health At Every Size/ Weight Positive podcasts, read some blogs/ articles in this area, and really begin to educate yourself and understand this issue.
Here’s just a FEW places for you to begin reading further into weight stigma, the non-diet approach, Health At Every Size, and intuitive eating…
Blog: The Real Life RD with Robyn Coale (dietitian, nurse, and nurse practitioner)
*Obesity Stigma: Important Considerations for Public Health. Am J Public Health. 2010 June; 100(6): 1019-1028. doi: 10.2105/AJPH.2009.159491 PMCID: PMC2866597. Rebecca M Puhl, PhD and Chelsea A. Heuer, MPH.