May 10, 2023 – Health care professionals should check their own biases about their patients’ weight, a leading group of experts said this week.
The American Association of Clinical Endocrinology makes recommendations aimed at reducing weight bias, or negative ideas about excess body weight, as well as weight stigma, defined as thoughts and acts of discrimination toward people due to their weight and size.
The statement also asks professionals to survey patients with obesity about internalized weight bias, or when a person feels negatively about themselves due to their weight.
“The real message from the document is that we have to acknowledge bias in all forms, both as clinicians and patients, and then the stigma that comes with it,” said Karl Nadolsky, DO, of Michigan State University College of Human Medicine and lead author of the statement. “And for patients, internalized weight bias is a complication of obesity, but it also contributes and drives part of the pathophysiology of obesity.”
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This new document continues the American Association of Clinical Endocrinology’s previous work dating back to 2012, when the group proposed considering obesity as a chronic disease, rather than a cosmetic condition or a lifestyle choice. In 2013, the American Medical Association officially adopted that idea as well.
In 2017, the group came up with a new term, "adiposity-based chronic disease," to combine the health complications linked to excess weight, such as heart disease, sleep apnea, and knee arthritis. Weight loss, then, is used among other treatments to address those complications and not as a goal unto itself.
“We’re trying to shift away from a weight-centric approach and focusing more on a person’s health in a very holistic way. … So if someone has complications like type 2 diabetes, sleep apnea, and knee arthritis, they have worse outcomes and a more urgent need for intensive medical therapy,” Nadolsky said.
The hope is that this approach, combined with the new document, will help reduce stigma and bias and improve health outcomes.
“We don’t know that yet, but we do know that internalized weight bias contributes to barriers to treatment and success of therapy, which is then a vicious cycle,” Nadolsky said.
The document also said health care providers should follow the “5A’s” for obesity and adiposity-based chronic disease:
- ASK if you can discuss weight and the health impact of adiposity-based chronic disease.
- ASSESS health status and complications.
- ADVISE on treatment options based on the severity of adiposity-based chronic disease.
- AGREE on a treatment plan and weight loss goals.
- ASSIST in the continuous process of weight management with reassessment of goals and treatment options.
Ultimately, the document says, “Optimal outcomes for patients with ABCD [adiposity-based chronic disease] necessitate interactions between empowered informed patients who are activated to partner with the health care team and a prepared health care system with professionals, procedures, and infrastructure that provide full access to evidence-based care.”