Intellihealth’s Dr. Louis Aronne and Dr. Katherine Saunders talk with Dr. Scott Kahan about the issue of obesity stigma and practical strategies for fighting our implicit biases.
Even among providers dedicated to obesity medicine, implicit bias often plays an outsized role in caring for people with obesity. That’s why Dr. Scott Kahan has dedicated much of his career to education and advocacy around obesity stigma and treatment policy.
In this episode of Weight Matters, Dr. Louis Aronne and Dr. Katherine Sanders talk with Dr. Kahan about the issue of weight bias and the steps both providers and the public can take to address those biases.
Understanding the Source of Weight Stigma
When talking about weight stigma, Dr. Kahan believes it’s important to acknowledge the fact that these issues are deeply rooted in our culture and society.
“Living in our thin-obsessed and often fat-shaming society, I think it’s hard for almost anyone to not have some degree of weight bias,” he explained. “It’s just so common.”
For many providers — especially those who are passionate about helping people manage their weight — that bias is implicit rather than explicit. This could look like believing that obesity is someone’s fault or thinking that all people who struggle with their weight are lazy.
“You could hear subtle things in the way they talked about patients or the way that they talked to patients that just didn’t seem very respectful,” Dr Kahan observed about other providers he interacted with earlier in his career.
Because these stigmas are so prevalent, Dr. Kahan argued that we should make it our goal to first notice and acknowledge our biases. That way, we can better prevent them from impacting our actions and conversations.
How Weight Stigma Impacts Care
Many people who have struggled with obesity and the stigma surrounding it will begin to internalize the belief that their weight is something to feel ashamed of and that they need to fix on their own.
“That makes it harder, on the one hand to successfully manage weight, we have lots of studies that experiencing weight stigma tends to make more weight come on,” Dr. Kahan explained. “But on top of that, experiencing weight stigma makes you feel like crap. It makes you feel devalued and like less of a person, like you don’t have a place in the world.”
Research shows that less than 2% of people with obesity receive guideline-driven treatment, and that internalized bias likely plays a key role in the disparity. Additionally, Medicare and other healthcare payers don’t cover many of the evidence-based obesity treatments, an issue that likely stems from bias among policymakers and payers.
“Pharmacotherapy is not covered,” he shared. “It was only a few years ago that Medicare decided to cover counseling and primary care for obesity, and it was only a little over a decade ago that Medicare decided to cover bariatric surgery.”
Combating Bias with Education
To fight weight bias and stigma, Dr. Kahan believes that education is the best weapon.
“Whether it’s patients themselves or healthcare providers, the most basic thing we can all do is to learn more about obesity: the science, the physiology, the evidence,” he shared.
When you understand that obesity is a disease and learn more about the challenges people face when trying to lose weight, it’s much harder to hold on to those biases.
Dr. Kahan also believes education will help drive the much-needed policy change around obesity and health insurance.
“I think it’s one of the most important things we can do over the next few years to help address the obesity epidemic.”
Follow Weight Matters wherever you get your podcasts to never miss an episode. To learn more about Dr. Sanders and Dr. Aronne’s work to transform specialized treatments for chronic conditions through the best in medical science and advanced digital technologies, visit www.intellihealth.co/podcast