Obesity Care, Stigma, and Medical Ethics

Yesterday, we had the opportunity to offer (and gain) perspective on stigma and discrimination related to obesity. It came in the rich context of a three hour discussion on “Ethics, Equity, and Stigma in Obesity Treatment and Policy.” The Division of Medical Ethics  of NYU School of Medicine co-sponsored the discussion with the Comprehensive Program on Obesity at NYU.

ConscienHealth’s Ted Kyle presented a few ideas he asked participants to keep in mind as the discussions began.

First is the fact that bias and stigma cause real harm. They make obesity worse because the stigma that people with obesity feel causes unrelenting stress, which activates the body and mind in ways that can cause further weight gain and worse cardiometabolic health.

It is a vicious cycle that amplifies the harm of obesity.

Some people might think that the problem with weight stigma has eased because fat shaming is no longer acceptable.

They are only half right. While these data from Project Implicit tell us that explicit weight bias has gone down for more than a decade, Implicit bias actually went up and stayed high.

This is not to say that explicit bias has gone away, even though its prevalence has gone down. In the discussion that ensued, Dr. Stephanie Albert described the explicit bias that she and other people with obesity experience every day.

Implicit Bias Sneaks Up on Us

Even well-meaning people say things, often couched in language of concern, that are loaded with archaic and stigmatizing language. For example, “morbidly obese” is terminology that is useful only for dehumanizing people. Further, the thought that health professionals must warn patients with obesity about the consequences of their disease in any clinical encounter came up in discussion. Would it be appropriate to repeatedly warn a patient with breast cancer that their situation is dire?

Weight Loss or Health Gain?

Another problem is the tendency to assume that weight defines obesity and weight loss is all that’s required for treating this complex chronic disease.

We could spend the rest of the day on this, but the simple fact is that it’s not that simple. Obesity is a complex, chronic, and heterogeneous disease of excess or abnormal adiposity that harms health. So it is absurd to think that a single indicator – either weight or BMI – can define it.

Medical Autonomy

This brings us to the essential importance of respect for medical autonomy in obesity. One size does not fit all and different people bring different needs and different experiences. A fundamental principle of medical ethics calls for health professionals to be truthful with patients while letting them make decisions about their medical care without coercion.

In the discussion, participants pointed out the need for social and economic policies to reduce factors that are driving higher rates of obesity for everyone. In making these policies, personal autonomy may not be so unqualified as the imperative for medical autonomy.

Our parting thought from this discussion of medical ethics, stigma, and obesity care is that healthcare must change. It must overcome the bias and stigma that confronts people with obesity in healthcare settings. Health stigma is fundamentally at odds with the purpose of healthcare.

Click here to download these slides and here to view the full agenda. You can watch the recording of this full discussion here if you use .S^^4eaz for the passcode.

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December 9, 2023