Our Perception of Obesity Needs an Overhaul

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As a nurse practitioner and a woman with obesity, I can share far too many experiences in which I was made to feel either invisible or shamed by providers in various specialties during physical exams.

What I mean by invisible is simply this: with a BMI that was encroaching on severe obesity, being in an exam room where my weight wasn’t even mentioned during a routine visit made me think the person couldn’t or didn’t want to see me.

My father repeatedly had the same experience. And for those providers who did mention my weight, they did so in a manner that made me feel shamed. One cardiologist actually pointed his finger at me and said I needed to eat less and move more. I wanted to yell, “Really? I never thought of those things!” Rarely was I asked what my activity or eating were actually like — it was just assumed that I was not doing any activity and was over-eating all the time.

It wasn’t until 2013, when the guidelines for obesity were being created by the American Heart Association, the American College of Cardiology, and the Obesity Society, that I learned obesity is a disease, not a lack of willpower. From that moment on, I began to advocate for all my clinician peers and people living with obesity to understand and embrace this reality. I began to see that treating obesity starts not with a prescription, but with an overhaul of perceptions.

For people with obesity, those perceptions start when they walk into a clinic. The conversation about obesity will be difficult to start — for patient and provider alike — if the waiting room isn’t accommodating and welcoming to people of larger size.

The staff of every clinic also needs the education to understand obesity and the bias and stigma that those of us living with it have had to deal with. Kindness and empathy at the reception desk can make the conversation in the exam room so much easier for everyone involved. It is amazing how just having the scale in a private area and a gown that is large enough to cover “everything” can make a patient with obesity recognize that this practice acknowledges their worth as a person.

For clinicians, starting the conversation about a person’s weight should be done with the same tone as you would talk about blood sugar. Research has demonstrated that patients prefer the words overweight, increased BMI, unhealthy or healthy weight, eating habits, and physical activity instead of words such as diet, exercise, fat, or my least favorite, “you are obese.” STOP Obesity Alliance offers a great resource for starting and having these conversations.

Additionally, person-first language is critical. For example, we no longer label a person as diabetic but instead say the person has diabetes. The same is critical for obesity. As an obesity specialist, I would take the word “obese” out of the dictionary and find a way to normalize the name of the disease, “obesity.” The word obesity can be difficult initially to say with patients, but helping them understand it is a disease is critical to continuing the conversation and removing blame from the equation.

For the conversation to be most effective, physicians, NPs, and PAs must be educated on the chronic, relapsing nature of the disease and the evidenced-based approach for treating obesity. It has three foundational components: eating, activity, and behavioral techniques to sustain the changes in eating and activity. The supportive components of pharmacotherapy, devices, and surgery are appropriate for many people living with obesity, but education to understand which patient these are appropriate for becomes important.

We have four current guidelines or algorithms to guide us in evidenced-based treatment. As you learn more about the disease of obesity, you begin to see quickly that treating obesity is about mitigating or preventing the more than 200 obesity-related complications. It is so much more than “weight loss” therapy, and we need to make sure our patients understand that.

With 70% of Americans having pre-obesity (overweight) or obesity, it is critical that all healthcare clinicians are creating a safe harbor in their practices for patients to receive treatment without the bias and shame that has been a norm for most of us.

What can you do to make your practice a safe place for people living with obesity? First, do a scan of your practice to assure it is welcoming. The American Association of Clinical Endocrinology has a collection of office tools to assist with this. Next, find your voice and the appropriate language to bring up a person’s weight tomorrow in your practice. Let the patient know you can help them with treatment strategies that work and can impact their overall health — not just the number on the scale. The time is now to start the conversation.

Angela Golden, DNP, FNP-C, is a family nurse practitioner and owner of the NP Obesity Treatment Clinic.

Disclosures

Golden disclosed participation as an advisory board member and promotional speaker for Novo Nordisk, Acella, and Currax; a role as an advisory board member for Gelesis and Lilly; and an advisory role for Alfasigma.

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