The Storm

A Perfect Storm of Bias in Medical Care for Obesity

It’s rare to find a robust conversation about medical care for obesity and the bias that gets in the way. But that’s exactly what the 1A podcast delivered yesterday. Fatima Cody Stanford, Lulu Garcia-Navarro, and Kamilah Weems joined the show to talk about the perfect storm of bias that gets in the way of good medical care for people living with obesity.

Stanford described the pathophysiology, while Garcia-Navarro told a story of humiliating bias directed at her by a physician. Then Weems detailed some of the work ongoing to elevate the standard of care for people living with obesity.

The Pathophysiology of This Disease

One of the unfortunate reactions to bias is to engage in fanciful reasoning to deny that obesity is a real health problem. But Stanford went right to the heart of the matter:

“The reason it’s a disease is because there’s actually pathophysiology in the body that governs how much we eat and how much we store. That happens all within the brain. The brain has signalling down certain key pathways to tell it to eat more and store more. Or eat less and store less.”

The popular conception of obesity is completely wrong. This is not a disease of size. It is a disease of abnormal or excessive fat tissue. That fat tissue is regulated by complex processes that start in the hypothalamus of your brain.

Humiliation and Transformation

Garcia-Navarro previously described her humiliating experience with weight bias from a physician and how she turned it around into a personal breakthrough. However, in this podcast we got more of the backstory. And it turns out that the seeds for this breakthrough came from an interview that Garcia-Navarro did with Dr. Stanford:

“I want to say one thing first of all, which is that Dr. Stanford actually changed my life. I interviewed her during the pandemic on why people with obesity should get priority for the vaccine. It wasn’t until she explained that obesity is a disease that I started my journey into understanding my own issue. That speaks to the power of a knowledgeable and empathetic doctor.

“What was so amazing about my interaction with Dr. Stanford is that I had been told all my life – through society, through what I read – that the problem is us. If we were only better, more restrained, we wouldn’t have this problem. I did not fully understand that I had a condition. I thought it was a personal failure.”

Armed with this insight, she was able to prevail in interactions with a healthcare provider who tried to tell her she hadn’t “proven” she was dedicated enough to receive treatment. As difficult as that experience was, she came out on the other side of it with the treatment she needed to better control her condition.

Emerging Standards for Better Care

Completing the story is Kamilah Weems, who is Director of Strategic Initiatives and Partnerships at the Association of American Medical Colleges. Weems is working to disseminate core competencies for obesity care that the AAMC help to develop in collaboration with the Stop Obesity Alliance at George Washington University. These standards include an awareness of the noxious influence of both implicit and explicit bias in obesity care.

It’s heartening to hear smart people describe, with crystalline clarity, the issues surrounding obesity care and the lived experience of seeking that care. Well worth your time to listen.

Click here for the podcast and here for more on Garcia-Navarro’s story.

The Storm, painting by Edvard Munch / WikiArt

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June 24, 2022