Takeaway
Obesity is a common, complex, chronic metabolic disease with myriad etiologies. Taking steps to combat stigma can improve the care experience and health outcomes for patients.
Lifelong Learning in Clinical Excellence | June 2, 2025 | 2 min read
By Marci Laudenslager, MD, MHS, DABOM, Johns Hopkins Medicine
“Amanda” was 13 when she began exhibiting signs of polycystic ovarian syndrome (PCOS). Her weight increased despite aggressive lifestyle measures, and her body seemingly developed a mind of its own. Once a carefree child, she was abruptly shoved into adulthood—cast adrift by foreboding winds through the new, foreign landscape of her own tumultuous physiology. She met with one healthcare professional after another, hope disintegrating into despondence with every visit. One time, a clinician reviewed her food diary and remarked “Well if you really ate like this, you wouldn’t look like that.” She feared doctors and avoided care entirely. Until . . .
She was serendipitously introduced to a specialist. For the first time, she felt heard. Believed. She was treated with metformin and exenatide, and within weeks her health improved. At long last, she was able to lose weight without exercising six days a week and eating a mere 1,000 calories a day. Someone had finally looked beyond the scale to see her and the condition that had been smoldering for decades. Her body and life were once again her own.
Amanda isn’t a fictional case nor a composite of cases I’ve encountered over my years of practice. Amanda is me and this is my story.
I wish I was a “unicorn”; that my patient journey was just a perfect storm of unfortunate encounters. My years of practice in obesity medicine, however, have shown me otherwise. Thousands of my patients report being told, implicitly or explicitly, to “just try harder.” Amanda is no unicorn. Hers is the story of millions.
As a physician, I’ve struggled to reconcile how weight bias could still have such a stranglehold on medical care. The answer may lie in education.
Obesity has historically been excluded from medical education. Even today, obesity education is often insufficient, focusing only on certain lifestyle factors and omitting other important etiologies of weight gain. This education gap can only then be filled by biased cultural constructs.
The medical community can and must correct the cultural narrative around weight. Here are a few things we can do to transform obesity care:
Things to know:
1. Obesity is a chronic metabolic disease, not a lifestyle choice.
2. There are myriad non-lifestyle-associated etiologies of obesity (genetics, medications that cause weight gain, and adipose tissue disorders, to name a few).
Things to do:
1. Avoid stigmatizing terms such as “obese” or “morbid obesity.”
2. Use person-first language (“patient with obesity”).
3. Weigh patients in a private space.
4. Provide office furniture that is comfortable for larger bodies.
5. Learn more about obesity (CME, conferences).
6. Take a weight bias assessment.
7. Consult a board-certified obesity medicine physician.
We now have highly effective therapies for obesity and the need for evidence-based care has never been greater. Patients with obesity have historically been undertreated and many have experienced bias within and outside of the medical community. The first step toward improving obesity care is understanding our own biases and rethinking our approach to patients with this disease.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.