Confronting Weight Stigma in Obesity Care, with Scott Kahan, MD, MPH

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When the words bias and stigma are mentioned in medicine, they often refer to disparities related to racial or gender differences in patient care. At the 2022 Annual Meeting of the Association of Diabetes Care and Education Specialists (ADCES), a presentation by Scott Kahan, MD, MPH, director of the National Center for Weight and Wellness, aimed to address the stigma associated with weight and weight. impact it can have on patients 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. Eager to learn more about the history of weight stigma versus the current landscape and how a new emphasis on patient-centered language in diabetes management may influence the fight to eliminate the stigma weight-related in clinical care settings, Endocrinology Network contacted 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 weight stigma and its impact on patients today?

Kahan: 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 in the United States there is so much judgment on people based on appearance and weight is one of those areas that tends to be judge. Studies of weight stigma began in the mid-twentieth century, but have really grown over the past 20-30 years.

We have made real progress. Unfortunately, not enough. Progress has largely been made in terms of minimizing explicit weight stigma, such as simply yelling at someone, “You’re such a big slob!”. Or something like that. We don’t see it as much as we used to, but the implicit stigma of weight, which is much more subtle. Things where we make assumptions and have various beliefs about people that are, again, driven by their weight. Whether it’s their intelligence or their likelihood of complying with medical recommendations. These are quite common and even ubiquitous. This is something we haven’t made much progress on.

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

Kahan: It doesn’t have to be as difficult as it looks. Ultimately, what we want to communicate to patients is that we care about them and want to help them live healthy lives and be able to participate in their lives and not be restricted. Whether it is through their weight and their weight issues, such as diabetes, and certainly not being limited by weight stigma, the important thing to get patients to understand is to communicate that gaining a lot of weight does not is not a healthy thing, communicating these healthy behaviors will improve their lives, their enjoyment of life and their quality of life. Typically, this is done without words – it is done in the tone of our voice and in the way we interact with them. But let them know that carrying excess weight doesn’t make them a bad person, and losing weight doesn’t make them a good person. We want to separate the condition and the behaviors from the value of the person themselves.

Endocrinology Network: How Does Using Patient-Centred Language in Diabetes and Obesity Management Help Reduce Weight Stigma?

Kahan: So I certainly think there’s a lot of overlap. In some respects, the use of patient-centered language in obesity closely follows the use of patient-centered language in diabetes. The emphasis on this started earlier in the field of diabetes. It didn’t start with diabetes, there are many other areas we were in, it’s now second nature to us native speakers.

For example, we don’t call people with depression depressives. It’s just that it’s not natural, and a lot of it, I think, in diabetes, we’ve made a lot of progress. It is no longer common to call people with diabetes diabetics. We are only in the early stages of conveying the importance of using person-centred language when it comes to obesity. So we’ll see where that leads.

I think that’s a really important thing, partly because it’s a really easy thing. There are many things that take time, money and effort. It’s not one of them. It just takes a little attention and a little practice. We don’t hesitate to use people’s mother tongue and that makes a difference. No one likes to be called obese, let alone morbid. Thus, many studies show that the terminologies we use can be more or less motivating for patients. It’s a subtle thing, but it’s an important and valuable thing for all clinicians to consider when interacting with their patients.

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

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