Endocrinologists Target Stigma in Obesity Care

Yesterday at the AACE 2023 annual meeting and in Endocrine Practice, this society of clinical endocrinologists unveiled a new consensus statement on obesity. The core message is unmistakable: endocrinologists should prioritize reducing the harm of stigma in obesity care. Karl Nadolsky, lead author, presented this new consensus at the meeting and tells ConscienHealth:

“This is a holistic and patient-centered biopsychosocial chronic care model with specific guidance on the potential of shifting the diagnostic paradigm to focus on health, rather than weight, while acknowledging that internalized weight bias and stigma are both drivers and complications of obesity.”

Bidirectional Relationship of Stigma and Obesity

This new consensus makes it clear that the causal relationship between stigma and obesity is bidirectional. Stigma attaches itself to the condition of obesity. But the relentless experience of stigma and its internalization also causes and complicates the progression of obesity. Beverly Tchang, an obesity medicine physician, reflected on Nadolsky’s presentation, saying:

“The bidirectional relationship between weight bias and obesity is unequivocal. I’m moved by the enormous consensus among multiple professional societies, physicians, researchers, healthcare, and public health professionals, on how important this is.”

Furthermore, she tells us that she agrees with the emphasis on moving beyond weight and BMI in framing obesity. But she would like to see it move further, beyond the focus on adiposity. Because obesity is a disease with its origins in the brain, stemming from the failure of neurohormonal systems that regulate adiposity.

Internalized Weight Bias

Monica Agarwal, an author of the new position statement, reflected on the importance of recognizing internalized weight bias:

“Internalized weight bias is a deeply personal struggle. This emotional burden, borne in silence, affects mental and physical health. As we strive for compassionate obesity care, we need to provide support and empathy to those affected.”

A Priority for Patient Advocacy

Recognition of stigma as a critical barrier to health is front and center in our work, with ConscienHealth’s Ted Kyle also serving as an author for the new consensus. CEO Joe Nadglowski of the Obesity Action Coalition sees this as an important milestone for patient-centered obesity care:

“Stopping weight bias has been a priority for the OAC since its founding 18 years ago, so quite naturally we are happy to see endocrinologists prioritize reducing stigma in obesity care. Healthcare is one of the most troubling sources for the stigma our members feel and we’re delighted with the leadership AACE is offering to overcome it.”

Click here for the new consensus paper and here for Nadolsky’s presentation of it. For recent insights on conceptualizing internalized weight stigma click here.

Karl Nadolsky at AACE 2023, photograph by Beverly Tchang / Twitter

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May 5, 2023