Shira Hirshberg , MS , RDN , LDN , a dietitian in Providence , says many clinicians tell her that patients ’ “ risk for heart disease and diabetes is lower if they ’ re smaller , so it ’ s ethically problematic for me not to recommend weight loss .” But such advice is not free of risk , and often causes harm . Physicians “ don ’ t see the impact , because the patient leaves their office and cries in their car ,” Hirshberg says .
Krista Handfield , LICSW , is the director of Size-Inclusive Health Care at Thundermist Health Center in Rhode Island . She launched the initiative in 2019 , she says , so that “ people experiencing weight stigma could have a better experience in health care .” One of the first things she tells providers , in trainings at her own and other medical offices , is that “ weight stigma is a health issue , and it leads to negative health outcomes independent of a person ’ s weight .”
That ’ s less radical than it may sound . Regardless of a patient ’ s size , the “ mere perception of oneself as being overweight ” correlates with increased blood pressure , cholesterol , triglycerides ( fats ), and blood sugar , according to a 2018 paper in BMC Medicine . Diseases associated with obesity , like hypertension and diabetes , can result from such stress-related factors . People who experience weight stigma are more likely to develop mood and anxiety disorders as well as eating disorders . In sum , a 2015 analysis concluded , they have a nearly 60 percent greater chance of dying — independent of any risk factors .
Emily Panza , PhD , an assistant professor of psychiatry and human behavior ( research ) at Brown who studies how discrimination relates to obesity , says that people who experience stigma from doctors or other providers — due to sexual orientation or race , for example , as well as weight — are at risk , and not only because it discourages them from seeking care .
“ The real stress of experiencing weight stigma , the physical effect that that has on the body and then all of the ways in which people try to cope with that stress — chronically , over time , all of those factors can add up ,” Panza says . On top of the stress itself , if someone ’ s coping strategies tend toward overeating and not exercising , that compounds the harm .
Celeste Corcoran , MD , sees this in children . “ Their weight is a source of their bullying ,” the assistant professor of pediatrics says , “ which lowers their self-esteem , which lowers their motivation to change , which creates more weight gain from stress , and we ’ re in a vicious cycle .”
THUNDERMIST FAMILY PHYSICIAN CHELSEA GRAHAM , DO , REMEMBERS being told in medical school that “ you ’ re doing a good job as a doctor by pushing weight loss .” But she also recalls the words of a patient who had been pressured by other physicians to lose weight : “ Don ’ t you think I would have done that by now if it was that easy ?”
That ’ s the thing : it ’ s not . For the majority of people , diets simply don ’ t work in the long term — after two to five years , nearly everyone gains back the pounds they lost , and sometimes more . Yet even as research consistently identifies factors affecting weight that have nothing to do with willpower , like genes , stress hormones , metabolism , and environmental toxins , the “ calories in = calories out ” myth stubbornly persists .
“ Hunger is a very complex , mediated phenomenon ,” Corcoran says . “ If it was all calories in and calories out , lifestyle treatment would be 100 percent effective .”
Corcoran runs the HEALTH Clinic at Hasbro Children ’ s Hospital ,
“ Hunger is a very complex , mediated phenomenon . If it was all calories in and calories out , lifestyle treatment would be 100 percent effective .”
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