Weight has long been a cultural fixation, and more so than ever, it seems, what with our current feverish interest in semaglutides like Ozempic. But an increasing number of size-inclusive doctors are making a concerted effort to not center weight in conversations with their patients.
“My practice is to not focus on my patient’s weight and instead focus on more holistic measures of health, including metrics like blood pressure, glucose control, mood and pain,” says Mara Gordon, MD, a primary care physician in Camden, NJ. Gordon says that this approach helps patients feel more comfortable and less stigmatized, and allows her to work in tandem with them on their health goals. Lisa Erlanger, MD, a family physician in Seattle affiliated with UW Medicine, zeroes in on how her patients feel and function, asking them, setting weight aside, what they think has the biggest impact on their health and how she can support them. “We know that many things can have a huge impact on both wellbeing and health; for example social connections, community involvement, amount and quality of sleep, mindfulness activities, stress reduction, mental healthcare, and appropriate medical care all can improve longevity, blood pressure control and blood sugar levels,” she says.
Weight discrimination and bias in healthcare is rampant, so it’s imperative for doctors to engage in patient-centered, non-judgmental communication. What that looks like, says Rebecca Puhl, PhD, deputy director for the Rudd Center for Food Policy & Obesity, is doctors asking patients for permission to discuss weight, actively listening to their views about health behaviors and being mindful of their word preferences for describing their weight. “The words doctors use matter,” says Puhl. “Certain words or phrases can lead patients to feel stigmatized, judged and blamed, which can jeopardize important discussions about health.” Also it’s critical to consider whether weight even needs to be part of a particular conversation at all. “Doctors should address the chief complaint first and offer treatments that would be offered to a person in a smaller body before discussing weight or weight loss,” says Erlanger.
Just as more doctors need to be mindful about how they talk about weight in their practice, the public at large needs to do the same. Fat-shaming has a long and sordid history, but now, as use of semaglutides becomes more commonplace, a new chapter in the blame and shame game has opened up, with judgment applied to people who choose to use these medicines. As a society we’re not OK with bigger-size bodies and we’re also not OK with people deciding that they no longer want to be in those bodies, unless it’s by a certain means, i.e., exercise and dieting.