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For Doctors

Why Obesity Is the Leprosy of the 21st Century – and How We Can Fix It

Dr. Rami Bailony
/ November 13, 2019

Back in September, many people cheered as James Corden fired back at Bill Maher’s fat-shaming comments—and his notion that “some amount of shame is good” among overweight people—by pointing out that these attitudes do little to help people who struggle with their weight on a daily basis. And indeed, it is nice to see someone holding celebrities accountable for insensitive remarks regarding obesity and the complex struggle that so many people face with regard to their weight. 

The problem is that while a vocal online minority applauded Corden’s rebuke, a silent majority stood by, quietly agreeing with Maher’s assessment and passively perpetuating the deep stigma that surrounds obesity in our society today. Corden himself described the stigma quite succinctly: “There’s a common and insulting misconception that fat people are stupid and lazy, and we’re not.” 

The problem is that obesity stigma is more than just a simple misconception. It’s dangerous. It’s one of the few remaining forms of socially acceptable discrimination. Think of it as the leprosy of the 21st century—a medical condition that is used to justify bias, discrimination and stigma toward people who suffer from it on a systemic level.

Believe it or not, the stigma of obesity has a far greater negative effect on the health of people with obesity than the extra weight does. This is true on several levels, including: 

  • Mental health: Research has shown that the psychological impact of being obese leads to a higher prevalence of depression among people with obesity.
  • Professional health: A recent study found that people who are overweight are paid on average $2,512 less than their normal weight counterparts.
  • Physical health: People who internalize weight stigma—meaning, the people who hear what people think about overweight people and believe it to be true—have more health problems than their same-weight counterparts who do not internalize the stigma. Furthermore, people who are discriminated against because of their weight have a 60 percent higher mortality risk than people with the same body mass index (BMI) who have not experienced discrimination. In other words, weight discrimination—not just the weight itself—can shorten a person’s life.

The idea that obesity is a result of laziness or a lack of willpower is patently false. I am an obesity specialist who runs a digital health program for people struggling with weight. Every day we see individuals who are doing everything right—eating healthy, exercising daily—and still seeing their weight trend up. Often the reasons for this are medications they are on, their hormone levels, environmental factors, or metabolic resistance.

Obesity isn’t a choice. It’s a disease. And it’s one I’ve struggled with personally. Five years ago, I went in for a check-up and discovered my cholesterol was 174 and I had a BMI of 31. I had obesity and pre-diabetes.

My own weight loss success was not a result of shame. Quite the contrary: The shame made it harder. What made my weight loss possible was the knowledge that what I was dealing with was not a character flaw, but rather a serious medical condition—and a treatable one at that. My treatment took a broader approach to the challenge of obesity. It started quite simply: with the acknowledgement that weight is the result of complex interactions between environmental, behavioral, psychological, medical, genetic, and microbiomic factors. In other words, I left the stigma at the door, and then I rolled up my sleeves to determine which factors were playing the greatest role in my weight. 

Proper obesity treatment is multi-faceted—spanning diet, exercise, lifestyle and often medications—and each facet must be tailored to the individual. That’s the approach I took in my own weight loss journey, and it’s the approach I take with each and every one of my patients. And believe me, it works. 

The problem, of course, is that while we can strive to control our own self-images, we can’t control the attitudes and discriminatory actions of those around us. This piece requires a lot of education, and it’s going to take more than just a fleeting exchange between late-night talk show hosts about the problem of fat shaming. As a physician, I’m encouraging fellow practitioners to stop being a part of the problem and start being a part of the solution—much like the vital role doctors played in fighting stigma and advocating for solutions to tackle the HIV and cigarette-related illness epidemics. 

As with any form of discrimination, we all have a role to play in fighting obesity stigma and its dangerous effects. As both a physician and someone who has experienced the ill effects of obesity stigma firsthand, I’d encourage you to be a voice for change. Call out weight discrimination when you see it, and encourage those around you to see obesity for what it is: not a weakness of character, but rather a complex medical condition that—with the right approach and supportive surroundings—we can manage and treat successfully. 

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