Over the last two weeks in classes, we have been discussing how to best approach sensitive topics with patients who struggle with issues such as alcohol abuse, smoking, gender identity and difficult lifestyle changes. One aspect that we did not discuss in depth was how to examine weight issues within the context of healthcare. As many people may be aware, weight stigma is extremely pervasive across the media, health and employment settings. What is weight stigma? Weight stigma is based on negative stereotypes that individuals who are overweight or have obesity are lazy, unmotivated, non-compliant, lacking in self-discipline, sloppy and less competent than normal weight individuals. Upon further reading, it truly shocked me how prevalent weight stigma is and how deeply it can affect people who struggle with their weight. Not only can weight stigma have significant negative psychological effects (depression, anxiety, low self-esteem), but some research also suggests that exposure to weight stigma has very negative physiological effects (increased risk of chronic disease, elevated stress response, increases in binge eating). Each of these things on their own are detrimental, but when combined with the inherent difficulties of weight loss and management, they work to create a significant barrier to treatment for individuals who are overweight or have obesity. In newspapers, movies, books and reality TV shows, individuals who are overweight or have obesity are often presented in an unflattering and stigmatized light. Think: “The Biggest Loser”. After watching 40 minutes of this extremely popular television show (~4.5 million viewers per season!), individuals in a study expressed higher negative attitudes towards overweight individuals, a greater belief that weight is controllable and a greater dislike of individuals with obesity. Health messages like this contributes to the growing problem of weight stigma Well you may ask, why is this problematic? Isn’t weight controllable on an individual level? Not entirely and for some people, not at all. The reason is that there are many uncontrollable factors when it comes to weight management and obesity. Environmental factors, socio-economic status, other co-morbid medical conditions often are all involved. These ‘other’ variables are typically not discussed in the media, where viewers and consumers are led to believe that weight is controllable with a enough effort and willpower, diet restriction and a vigorous amount of exercise. But it is just not that simple, as the plethora of research trials on weight loss interventions will show you. Weight loss is so variable from individual to individual and weight is extremely hard to keep off over time. Just like some other diseases (mental health issues, HIV/AIDS), stigma is a huge barrier to treatment to individuals with obesity. In order to help people with obesity to get treatment and reach a state of better health and wellness as a population, we need to reduce this stigma. It is crucial to treat individuals who are overweight or who have obesity with the compassion, respect, support and treatment that they need and deserve just as the healthcare system would for anyone struggling with another chronic disease. References for further reading if interested: Puhl, R.M. & Heuer, C.A. (2009). The stigma of obesity: a review and update. Obesity, 17, 941-964. Schvey, N.A., Puhl, R.M. & Brownwell, K.D. (2014). The stress of stigma: exploring the effect of weight stigma on cortisol reactivity. Psychosomatic Medicine, 76, 156-162. Norah MacMillan is a first year medical student at UL GEMs.
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