WHEP Scholar Chelsea Salas
Drexel University College of Medicine, Class of 2021

In both societal and medical culture there is discrimination against overweight and obese individuals.  Weight stigma stems from an uninformed understanding of how obesity develops.  It presumes that obese individuals are lazy, unmotivated, and lack willpower to control their food intake – that they are undisciplined and less likely to adhere to treatment. Consequently, studies suggest that primary care providers may spend less time educating obese patients about their health, since they perceive it as a waste of time.

Although numerous research studies have concluded that a BMI over 30 increases risk for multiple diseases such as coronary artery disease, stroke, congestive heart failure and diabetes mellitus, BMI alone cannot be the sole measure of cardiovascular disease or an individual’s overall health. Regardless of how a person becomes obese, the external factors causing it, and what risk factors are associated, it is unacceptable for clinicians to stigmatize a person for their weight. Clinicians need to understand the complexity of every individual’s situation, whether it is genetic, socioeconomic or behavioral.

A recent response to the current “weight-centric” health care model and dieting culture is the Health At Every Size (HAES) movement. HAES argues against weight loss for overweight and obese individuals. It instead promotes a holistic approach to eating and physical activity that is weight neutral. Specifically, it involves multiple educational sessions helping people eat according to their internal hunger cues, learning what are healthy foods, transforming their relationship with food and their body, and encouraging exercise not as a means to lose weight but simply as an enjoyable activity.

Although randomized controlled trials are needed to determine if HAES can indeed improve health outcomes without patients needing to lose weight, it sheds light on our health care system’s bias against obese and overweight people. The emphasis on health should be reframed into a holistic one, keeping in mind a patient’s view of their bodies, how their weight may affect their day to day lives, and how weight stigma may be potentially impacting their decisions and mental health. There is much, much more to a patient than the number we see on the scale. We ought to treat them as such.