喵咪社区

For patients with obesity, diet and exercise attempts have a 98% failure rate. So why is there a stigma in medicine around discussing treatment options for obesity?

One of the biggest hurdles in treating the obesity epidemic is the stigma around discussing and treating obesity like what it is: a chronic disease.

鈥淥besity is one of the last remaining stigmas socially, but one of the highest remaining areas of stigmatization in medicine,鈥� says Kamran Samakar, MD, general surgeon and director of the 喵咪社区 Metabolic and Bariatric Surgery Program, part of the 喵咪社区 Digestive Health Institute and 喵咪社区. 鈥淚f you look at studies and you ask patients with obesity, 鈥楧o you wish your primary care doctor or your other doctors discussed this with you?鈥� around 75%-80% of these people 鈥� a resounding majority 鈥� will say, 鈥榊es, I wish they would talk to me about treatment options.鈥欌��

His takeaway advice to physicians? 鈥淒on鈥檛 be scared to talk to your patients about obesity.鈥�

Sensitivity and stigma training for obesity

The clinicians and staff with Keck Medicine are routinely trained on how to address obesity sensitivity and stigma. 鈥淲e do this to make sure people understand how to speak about obesity in a way that鈥檚 very sensitive, nuanced and patient-centered,鈥� says Samakar, who specializes in bariatric and gastrointestinal procedures.

If you鈥檙e an independent physician, are available on how to have medical conversations about obesity with patients. This foundation helps physicians become savvier, sophisticated and sensitive when discussing the topic, which can be difficult or highly personal to a patient.

Improving your approach benefits all. 鈥淭hese conversations are overlooked and underemphasized,鈥� Samakar says. 鈥淎s a result, lack of conversations, or bad conversations, can be a barrier to proper care for the disease.鈥�

How to recommend obesity treatments

While bariatric surgery is the most durable and effective treatment for obesity, Samakar鈥檚 advice is to not immediately recommend bariatric surgery to every patient right off the bat.

鈥淭alk to your patients about obesity, and let them know there are options,鈥� he says. 鈥淣ot everyone necessarily needs to have bariatric surgery, but we have tools available to treat obesity like any other disease. The most important thing is to let patients know they deserve treatment and that it鈥檚 available to them. From there, the exact treatment route can be personalized to their needs.鈥�

Many patients have fears about treating their obesity, whether that鈥檚 fear around having surgery or of side effects from weight loss medications like semaglutide or tirzepatide. One of the most important things doctors can do in this situation is to remind their patients that all these side effects are less dangerous than letting obesity go unchecked, Samakar says.

鈥淲hen you look at the risks associated with obesity and obesity-associated metabolic diseases, you鈥檙e more likely to have a lower quality of life, more likely to have cardiac events and more likely to have premature death if you do nothing to treat it,鈥� Samakar says. 鈥淭hose are all significantly greater risks than the risks presented by the treatment of obesity.鈥�

Discussing all concerns openly, including statistics of complications from bariatric surgery, can actually help encourage patients to seek treatment, he adds.

鈥淭he risk of significant bleeding that requires a return to the operating room is less than 1%,鈥� Samakar says. 鈥淭he risk of death from bariatric surgery at an accredited center in the United States is less than one in 1000. These are very good numbers compared to the data for complications from obesity.鈥� By contrast, the most common causes of death in the United States are cardiac disease and cancer 鈥� both of which are strongly related to obesity.

鈥淚 remind patients that doing nothing to treat your obesity is actually doing something to your disease: it鈥檚 letting it go uncontrolled,鈥� he says.

Treating obesity holistically

The most important place to start in these conversations is to focus on a comprehensive treatment plan. 鈥淲e don鈥檛 just want to focus on one aspect of obesity, such as making the number on the scale go down,鈥� Samakar says. 鈥淲e want people to have a functional experience that鈥檚 improved.鈥�

This might mean yes, the number on the scale goes down, he says. But it鈥檚 also crucial to focus on non-scale victories that relate to quality of life. For example, if the patient can finally play with their grandchildren, or walk up the stairs, or go to Disneyland with their family and not have to sit down every hour, he explains.

Helping patients view the benefits of obesity treatment through a broader lens is more likely to help them succeed in the long-term.

鈥淲e need to help people curate the things they must do to live healthier lives apart from only prescriptive recommendations to sleep better, eat better and stress less,鈥� Samakar says. 鈥淎t obesity centers such as the 喵咪社区 Digestive Health Institute, we address the disease from a holistic angle so that we aren鈥檛 just giving patients a short-term fix. Instead, we can offer them a multipronged treatment approach that considers all aspects of care, including occupational or physical therapy to help increase muscle mass, dietary and lifestyle modifications through nutritional counseling, and pharmaceutical and surgical interventions for weight loss.鈥�

And remember: Even if your words around obesity treatment aren鈥檛 perfect, patients have a way of knowing the intent behind them. This matters more, Samakar says.

鈥淢ost patients are able to understand and feel your intention,鈥� he says. 鈥淪o, if you鈥檙e coming from a place of wanting to help your patients achieve better health, I think overall that鈥檚 the intent we are looking for and the most important point to remember when discussing obesity treatment with your patients.鈥�

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Mollie Barnes

Mollie Barnes is a digital writer and editor for 喵咪社区.

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