Ah yes, the great American pastime – judging people for their weight.
If you live in a larger body, you know the rules: Lose weight, but do it the “right” way. Starve a little. Sweat a lot. Struggle and fail? Clearly, you didn’t try hard enough. Turn to medication or surgery? Well, that’s cheating.
“It’s shameful that we live in a society where people are already stigmatized for having a higher body weight, and then they’re stigmatized again if they seek medical treatment to lose weight,” says Rebecca Puhl, PhD, a researcher with the University of Connecticut who studies weight-based bullying, bias, and discrimination.
This “double stigma” isn’t just harmful – it’s based on a myth. The idea that willpower alone determines body size is scientifically wrong.
Why Shame Won’t Solve Obesity
In 2013, the American Medical Association (AMA) declared obesity a disease, reinforcing decades of research showing that weight is shaped by genetics, hormones, metabolism, and brain chemistry – things you can’t permanently change through sheer effort.
“It’s about much more than calories in, calories out,” says Brunilda Nazario, MD, a board-certified obesity specialist and WebMD’s chief medical editor.
This shift was supposed to help doctors take obesity more seriously, nudging them toward better treatment options. Some have embraced new tools, combining lifestyle changes with medication or surgery when needed. But others are still stuck in the “just try harder” era.
Nazario recalls overhearing a colleague tell a patient with obstructive sleep apnea to “just exercise, lose some weight, and come see me in three months.”
“Honestly, I wanted to scream,” she says. “That’s not a treatment plan.”
Despite the AMA’s classification, obesity stigma is still alive and well. The result? People who feel judged or shamed about their body or weight loss efforts are more likely to avoid medical care altogether. And the harm doesn’t stop there.
Shame around body size is linked to disordered eating, depression, anxiety, poor body image, suicidal thoughts, and substance misuse. “There are so many ways weight stigma harms people’s health that are very legitimate and very real,” Puhl says. “Stigma is the enemy of public health, and we’ve known that for decades.”
Obesity Is a Health Condition – Not a Body Size
For years, we’ve been laser-focused on one thing: lowering the number on the scale. But weight and health aren’t the same. You can’t tell if someone has obesity – or health complications from it – just by looking at them.
“Obesity is about internal functions of organs and tissue,” Puhl says. “It’s much more complicated than the size of pants a person is wearing.”
Scientists once thought fat tissue was just extra padding – energy stored for later. Now they know it’s biologically active, Nazario says. And when you gain extra weight, especially around your midsection, fat cells don't just sit there – they grow and release chemicals that affect nearly every system in the body.
This chronic, low-grade inflammation impacts your brain, heart, liver, joints, and metabolism. It’s why obesity raises your risk of heart disease, diabetes, dementia, high blood pressure, and even some cancers, she says.
But inflammation is just part of the picture. Obesity affects hormone regulation, gut bacteria, and metabolic processes in ways scientists are still learning about.
“Yet there’s still this underlying belief that it’s a person’s fault if they have a larger body size,” Puhl says. “For some reason, that assumption is so persistent and continues to be resistant to change.”
GLP-1 Drugs: Weight Loss With a Side of Stigma
For decades, Americans have been told that obesity is a crisis. It’s driving up health care costs. It’s shortening lives. Public health campaigns have urged people to take charge of their weight.
But now that effective obesity treatments exist, the response is … complicated.
GLP-1 drugs like semaglutide (Ozempic, Wegovy) and tirzepatide (Monjaro, Zepbound) are hailed as game-changers for obesity treatment. They help people lose weight, but some dismiss them as a shortcut rather than a breakthrough.
Experts hope these medications will highlight the complexity and chronic nature of obesity, shifting the conversation away from blame and shame – and toward science-backed treatment and support.
“On the other hand, weight stigma could persist if medications (like bariatric surgery) are seen as ‘taking the easy way out,’” Puhl says.
Beyond Weight Loss: Pros and Cons of GLP-1 Drugs
GLP-1 drugs were originally developed for type 2 diabetes. They regulate appetite, slow digestion, and improve blood sugar control. Studies show they can help people lose 15% to 25% of their body weight – results that, until now, were only possible with bariatric surgery.
“As far as weight loss goes, these are really, really incredible drugs,” Nazario says. “They’ve brought back a lot of optimism for treating this chronic disease – not only for doctors, but for patients as well.”
But their benefits go beyond weight loss. Early research suggests GLP-1 drugs could lower the risk of heart attacks, slow dementia, and curb cravings linked to substance use disorders. These findings are promising, but studies are ongoing.
Like any medication, GLP-1s have side effects. The most common include nausea, vomiting, diarrhea, and constipation. More serious risks include bone loss, pancreatitis, gallbladder disease, and, in rare cases, stomach paralysis.
Nazario points to ongoing concerns that GLP-1 drugs may slightly increase the risk of depression and suicide. While studies haven’t found a strong link, she says, this is something researchers and the FDA will continue to watch.
People taking obesity medications also need to be mindful of muscle loss. When weight drops, it’s not just fat that goes – muscle does, too. “And in losing muscle, you’re really losing the driver to your metabolism,” Nazario says.
That’s why experts emphasize strength-training and proper nutrition alongside medication use.
To Treat or Not to Treat?
If you live in a larger body and accept or celebrate your size, that can be a big win for mental health. But you may wonder if seeking medical treatment for obesity means giving in to societal pressure to be thin. Experts say these ideas don’t have to clash.
“As a society, we’d be much further along if we could be more respectful of people of all body sizes,” Puhl says. “But a person can love their body and still want to address potential health risks.”
For children with obesity, the stakes can feel even higher. Some doctors now prescribe GLP-1 drugs at younger ages to combat conditions like prediabetes and high cholesterol.
Critics worry this pushes children toward medication too soon. But others say early intervention could spare them years of health complications and stigma.
While weight loss drugs shouldn’t be used purely for aesthetic reasons – especially in kids – they could be a valuable tool for youth at high risk for obesity-related diseases. “But that decision is so individual,” Puhl says.
What Happens Next?
Obesity is a biological disease that requires long-term treatment, yet it’s still not treated with the same respect and compassion we give other chronic conditions.
Nazario puts it plainly: “We don’t shame people for having a heart attack. Why do we still shame people for having obesity?”
To make progress, we need to start by removing blame and self-blame around body size, Puhl says, and doctors need better training in treating obesity and managing stigma.
If you have obesity and your doctor dismisses your concerns, find another one. Organizations like the Obesity Medicine Association and the Obesity Action Coalition can help connect you with trained specialists.
But the evidence is clear: Obesity is a disease. The real question is, when will the rest of society start treating it like one?
Show Sources
Photo Credit: EyeEm/Getty Images
SOURCES:
Brunilda Nazario, MD, and board-certified obesity medicine specialist, internist, and endocrinologist; chief physician editor, medical affairs, WebMD.
Rebecca Puhl, PhD, professor, Human Development & Family Sciences, deputy director, Rudd Center for Food Policy & Health, University of Connecticut.
Current Obesity Reports: “Obesity Stigma: Causes, Consequences, and Potential Solutions.”
Nature Medicine: “Mapping the effectiveness and risks of GLP-1 receptor agonists.”
JAMA Network: “GLP-1 Receptor Agonists and Suicidality – Caution is Needed.”
Scientific Reports: “The risk of depression, anxiety, and suicidal behavior in patients with obesity on glucagon like peptide-1 receptor agonist therapy.”
