This evolving conversation is tipping the scales toward more comprehensive treatment.
In both the medical community and general society, being classified as overweight or obese can often come with an unfair bias. Many assume that those with obesity are lazy, eat too much unhealthy food, and simply don’t try hard enough to lose weight.
However, there are many factors that may contribute to weight, like:
- Racial inequities that make healthy living difficult. This includes food deserts, costs of healthier items, pollution in urban settings, and access to health care.
- Genetics and biology, which cause or increase the risk of diseases from birth.
- Generational trauma, where emotional baggage gets passed down from generation to generation. It can increase the risk of unhealthy coping strategies like smoking and substance abuse.
- Oversimplification of health: Many who carry more weight than what was once considered “normal” may also have a clean bill of health in every other area: including blood pressure and sugar levels, cholesterol, and waist circumference.
- Stress increases cortisol levels, which in turn causes inflammation and weight gain that's unlikely to budge with just food and exercise.
Where Obesity Bias Comes From—And How It Shows Up in Medicine
A BMI that is classified as obese technically only factors in one’s height and weight. Notably, the creator of the index modeled the standards on populations of “average” men (mostly white). Since then, researchers have found that BMI is less accurate at predicting illness in women and Black folks. Beyond sex and race differences, people can be the same BMI, look vastly different, and be superficially judged as “healthy” or not.
Yet, many who seek treatment for vague or under-researched health issues are told to lose weight first. This is true even when weight isn’t a clear culprit for their symptoms. Studies show that when patients feel that their doctor is judging their weight, they are more likely to engage in unhealthy behaviors to cope. They’re also less likely to return for health care, even if they are suffering from other symptoms of illness. In fact, one study even suggests that weight discrimination itself can shorten life expectancy, perhaps more than the weight itself.
How Can People with Obesity Advocate for Themselves at the Doctor’s Office?
If you are struggling to be heard and seen about any medical issue:
- Speak up in the moment during your visit with the medical team if you have specific concerns. This can help use your limited time with your doctor more efficiently.
- Seek a second opinion if you do not feel that your care team is accurate in understanding your body. Try not to get discouraged. Reach out to friends or colleagues you trust with similar insurance to find a doctor they recommend.
- Continue to give your doctor or medical group feedback (if you want to continue in their care). When your current long-time physician knows your medical history, it's understandable if you don’t want to change. You may feel uncomfortable bringing up how these weight conversations made you feel at first. But it's worth an attempt to improve the dynamic with a doctor you otherwise trust.
Many care teams recognize that weighing how you feel in your body can be more important than what you weigh. Be sure that together you are addressing lifestyle changes like nutritious eating, increasing movement, and reducing stress in your daily life—and, if needed, running potentially life-saving tests to understand how your body is functioning. Learn more about how doctors treat obesity beyond lifestyle changes here.
- Blackburn H, Jacobs, Jr D. Commentary: Origins and evolution of body mass index (BMI): continuing saga. International Journal of Epidemiology, Volume 43, Issue 3, June 2014, Pages 665–669.
- 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
- Sutin A, Stephan Y, Terracciano A. Weight Discrimination and Risk of Mortality. Psychol Sci. 2015 Nov; 26(11): 1803–1811.
- Jackson CL, Wang NY, Yeh HC, Szklo M, Dray-Spira R, Brancati FL. Body-mass index and mortality risk in U.S. blacks compared to whites. Obesity (Silver Spring). 2014;22(3):842-851. doi:10.1002/oby.20471
- Sabin JA, Marini M, Nosek BA. Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLoS One. 2012;7(11):e48448. doi:10.1371/journal.pone.0048448
- Cardiovascular and Metabolic Heterogeneity of Obesity: Clinical Challenges and Implications for Management. AHA Journal. 2018;137:1391–1406
- Assessing Your Weight. Washington, D.C.: Centers for Disease Control and Prevention, 2020. (Accessed on June 29, 2021)
- Eknoyan G. Adolphe Quetelet (1796–1874)—the average man and indices of obesity. Nephrology Dialysis Transplantation, Volume 23, Issue 1, January 2008, Pages 47–51, https://doi.org/10.1093/ndt/gfm517
- Downsizing obesity: On Ancel Keys, the origins of BMI, and the neglect of excess weight as a health hazard in the United States from the 1950s to 1970s. Wiley Online Library. (Accessed on June 29, 2021)