Obesity, or the abnormality in the regulation of energy that leads to abnormal accumulation of fat in our body, is becoming another epidemic. It is commonly diagnosed using the Body Mass Index (BMI). BMI is utilized as an initial assessment of a person’s overall health, as the higher BMI is, the higher the likelihood of a person developing conditions like heart disease and diabetes.
“It may not be the best tool to really assess the amount of body fat, but it’s readily available and relatively easy to use,” said Al-Marie Grace Logrono, M.D., internal medicine physician with Marshfield Clinic Health System.
Unfortunately, because of BMI assessments, Dr. Logrono explains that many people feel body shamed at regular appointments and in their everyday life. More than half of people with obesity have experienced bias or being stereotyped, according to the National Library of Medicine study on obesity stigma and bias.
“Your provider may recommend losing weight to lower risk of developing weight-related conditions,” Dr. Logrono said. “Depending on how that conversation takes place and the words used, you may experience obesity bias that has a negative impact on your health.”
Ashamed of weight
In a comprehensive study in collaboration with Deloitte Access Economics and Dove, weight discrimination was documented in the U.S. economy and society. The results showed that each year, 34 million people in the U.S. ages 10 years and older experience discrimination based on their weight that is severe enough to have impacts on their health, quality of life, job opportunities and our economy.
With feelings of shame around your body and weight, you may be less inclined to schedule your primary care appointment if you had a negative experience around your weight.
“It would be beneficial that as a patient, we establish with a provider who can meet you where you are, build the trust and have open conversation about weight,” Dr. Logrono said.
Studies have shown that not all patients are able to discuss their weight with their providers. In addition, only a few percentage of patients with higher BMI have follow ups with their providers.
It has been noted that engaging in weight conversation can be challenging, but Dr. Logrono said efforts are underway to increase awareness of this, and to try to encourage providers to screen patients for weight problems and offer intervention or counseling, as recommended by the US Preventative Task Force in 2017.
Eating disorders/binge eating
“People deal with stigma or shame in different ways,” Dr. Logrono said. “Though some may have some positive coping ways, such as self-talk or seeking social support, some people may resort to eating. Eating has been common coping strategy in response to stress.”
Once you feel shame about your body and weight, this may lead to an eating disorder like binge eating disorder (BED). This is when a person tends to have recurring episodes of eating large amounts of food for a duration of time, and feeling out of control while eating.
While this is actually considered a disorder, BED is commonly affecting millions of people in the U.S. and can lead to mental and physical health consequences.
“Getting screened for eating disorder is one step in addressing weight problems,” Dr. Logrono said. “There are treatments for this, most importantly behavioral therapy, in addition to medication.”
Low motivation/Gives up
Another typical side effect of obesity bias is giving up.
You tried dieting. You woke up early to workout. You started to drink more water. However, a month or so in, you aren’t seeing results. You dropped some weight and then gained a few more pounds.
At this point, you may start to feel defeated. You might become unmotivated and lose your consistency with the healthy habits you put in place.
Dr. Logrono recommends having an open discussion with your provider, to seek other factors affecting weight and how to navigate around the weight plateau.
Whether you are busy mother of two, an overworked employee or elderly with a heart condition, you and your provider can map out what works best for you.
Any of the above negative impacts can lead to depression and anxiety around your weight.
Prolonged sadness, unexplained crying, worry or anxiety, negative feelings and sleep problems are just a few common signs of depression.
People experience depression differently, and treatment is different for each person, too. You should seek help from your provider, along with friends and family, for support.
Wellness behaviors that can help improve mental health can also have a positive impact on your overall health. These include 30 minutes of activity five times a week, 7-9 hours of sleep per night, a balanced diet of vegetables, fruit, lean protein and whole grains, along with relaxation time like hobbies, sports or volunteer work you may like to do.
Your provider can help with obesity bias
Once you find a provider who fits your needs and who you can trust, Dr. Logrono recommends having an open conversation with them. Be honest about ways you may have felt discriminated against in the past.
As Dr. Logrono mentioned, providers are increasing their awareness to obesity bias. This has led to weight-inclusive approaches to medicine rather than overly focusing on BMI in clinical encounters.
Weight-inclusive approaches focus on overall well-being, rather than weight alone, and on health-promoting behaviors that will impact overall health with or without changing BMI.
Dr. Logrono said this approach is not much different than what many providers are taught to follow. Continued promotion of behaviors like physical activity, limited sweetened beverages is still encouraged. However, the focus isn’t on weight loss or preventing weight gain. It is instead encouraging healthy habits.
Additionally, she recommended awareness of these negative effects of obesity bias can help.
“It’s important to increase awareness of these negative effects of the obesity bias on health, and in what ways it can be avoided,” she said. “We especially want to educate people that obesity is a medical condition, an abnormal physiology, and not a problem of a person’s willpower.”