Dr Fatima Cody Stanford Explains How Obesity Stigma Creates Vicious Cycle

Patients with obesity often face severe stigmatization from healthcare providers, which can discourage them from seeking help, according to Fatima Cody Stanford, MD, MPH, MPA, FAAP, FTOS, of Harvard Medical School and Massachusetts General Hospital. She explained that the “dismal” obesity education in medical schools can lead physicians to judge obese patients unfairly.

Transcript (slightly modified)

Why do you think physicians are one of the biggest sources of bias against patients with obesity?

I think this is an important issue that you just brought up, because we unfortunately are not educated about obesity in a robust fashion within the medical school environment. We are taught information about calories, we’re taught information about diet and exercise, and really beyond those 2 things, we’re not really taught much about how the brain regulates weight, the different pathways in the brain that regulate food intake, the proopiomelanocortin pathway or the Agouti-related peptide pathway, these pathways that we know influence how someone’s body will look at weight, whether it’s an anorexogenic pathway or the orexogenic pathway, we just don’t learn those things.

Often when I go and do talks to all physician groups about these things that to me are relatively basic in terms of understanding obesity, at very prominent institutions most people are coming up to me like, “I’ve never heard these things.”

Often you’re told to go see your doctor to get help with this, but unfortunately we’re just not very well educated. Either in the medical school environment, once we get to residency treatment, even if we’re going into residencies that appear to be more acclimated to dealing with obesity like family medicine, internal medicine, or pediatrics, the training is dismal at best. We’re not really taught about, I say that we’re taught somewhat about bariatric surgery; very, very infrequently taught anything about medications or kind of a comprehensive treatment.

And so when you’re not taught these things, you’re going to have the same biases that exist in the general population. You’re going to assume that patients that struggle with weight are lazy, are not doing enough, they haven’t tried hard enough. Often if you haven’t struggled with weight, you just aren’t aware that they are trying, and sometimes often much harder than someone that’s of normal weight because we’re just maintaining ourselves within a certain range.

They often give up once they see that a treatment modality that their doctors told them didn’t work. They’re like, “okay, what’s the point of me working out, I’ve tried that and I lost 0.4 pounds over the last 8 months.” That’s disconcerting, but if your doctor’s saying that that’s the way you lose weight and that’s the only way it can happen, and you tried it for 8 months and were unsuccessful, then you assume that, “you know what, I’m just not good at this.”

You then put more self-blame on yourself, the doctor then puts additional blame on you, and so it’s this vicious cycle that creates significant bias and stigma, and often may be the reason why certain patients that struggle with very severe obesity don’t seek our care, because they feel as though their doctor’s just going to put blame on them and make them feel even worse than they did before they came in the office.