By Joe Nadglowski, president/CEO, Obesity Action Coalition, as told to Alexandra Benisek
In the WebMD webinar “The Impact of Weight Bias,"Joe Nadglowski, president and CEO of the Obesity Action Coalition, answered viewer questions about how discrimination due to body weight can affect your life.
Is weight bias different in different cultures?
We know there are at least perceptions that weight bias is different in different cultures. It might be this idea that living in a larger body is more acceptable in some cultures than others.
But the latest research shows that, because of the internet, Instagram, TikTok, and new technology, there’s this push towards slimmer bodies being the favorable bodies. This is happening everywhere.
We recognize there might be some differences between cultures, but it's something we need to study more. If you actually look at the research on weight bias, there are examples of it existing in just about every culture around the world.
Does fighting weight bias keep people with obesity from losing unhealthy weight?
No. In fact, the opposite is true. If we help people address biases they face, they'll have less stress and pressure. And that makes them more likely to be able to lose weight over time.
We’re not saying obesity is good. Obesity has health consequences – but we need to treat people with compassion. Just like you're not going to blame and shame someone who has cancer, even if they engaged in behaviors that contributed to them having cancer.
Do you think airlines practice weight discrimination?
Airlines are a particular challenge. I do find airlines trying harder. For example, Southwest Airlines has what they call their “customer of size” policy, which allows people to basically have two seats for the cost of one as long as it's planned ahead of time.
But we still hear stories from airlines where certain rules aren't enforced consistently. One of our wishes would be that the Federal Aviation Administration (FAA) would actually set forward standard policies instead of letting the airlines move forward with their own.
Are health care providers educated on the link between adverse childhood experiences (ACEs) and trauma, psych medications, chronic inflammation from chronic stress, food insecurity, sexual abuse, emotional abuse, etc., and obesity?
This is a question I get all the time. One of our challenges is that health care provider education around obesity is lacking. It actually leaves out all of those complicated issues raised, whether that's adverse childhood events or social determinants of health.
One of the things I'm passionate about is that when a health care provider talks to someone about their obesity, we really encourage them to use a trauma-informed approach.
We tell doctors it’s likely their patient had an adverse experience with a health care provider – and this is a complicated issue. We have to take this trauma-informed approach to understand and not make the person feel worse about themselves.
How much does poverty impact obesity? How does it impact weight bias?
Poverty and low socioeconomic status contribute to obesity in general. This is because low-quality foods are available at low cost.
How bias and stigma play into that is interesting.
How do you pull apart the stigma from low socioeconomic status, body weight, race, or gender? But because obesity often affects people of lower socioeconomic status, the stigmas impact them in a greater manner. We probably see that most in terms of compensation.
How commonly do schools include language about weight in their anti-bullying policies?
One of the things I often do is challenge parents to look at their school’s anti-bullying materials. Weight-based bullying is probably a main form of bullying in schools. But the reality is, we don't have good data on this.
However, it’s unlikely that weight-based bullying is mentioned in school policies. I know there are some people who are passionate about trying to change that.
How do you strike a balance between not blaming/shaming, but having a sense of urgency in reducing BMI to improve health?
I think most people who struggle with their obesity and health because of obesity want to do something and have probably tried to do many things. This idea that they aren't trying, and that we need to blame and shame people, is false.
I've talked with thousands of people across this nation and I can count on two hands the number who’ve told me it was a stigmatizing event that motivated them to address their obesity.
For the vast majority of people, it's a compassionate, empathetic, or health-related event that moves them toward change.
I challenge people to look into themselves and think: “Do you really know what this person is going through?” Instead of shaming and blaming them, have an honest conversation with them, to see where they are in their journey.
Do you think the weight charts at doctor offices will change in the future to be more realistic?
I think weight charts are interesting things. I think what's really missing is figuring out the best weight for someone. What leads them to have the best quality of health and quality of life possible?
I don't think that's randomly determined on a chart based on averages. It has to be a very individual conversation. I think weight charts are useless.
Instead, I encourage people to talk to their health care provider and ask if their weight is affecting their health. That should be how people address their weight.
How can I best lead my doctor to address the specific health concerns I made the appointment for, and not have it turn into the "if you'd lose the weight" conversation?
Be direct. If they’re blaming your weight for all of your issues, challenge them and ask: “If I were a thin person or a normal-weight person, how would you test for these kinds of things?’
Now the reality is, obesity contributes to a lot of health issues. So losing some weight may help with certain conditions. Even modest weight loss may help. But I do think it's important that you challenge them to run tests to be sure.
If an adolescent with obesity doesn't complain about bullying, or there's no evidence they're being mistreated by their peers, should we assume they aren't experiencing bias, or that they just aren't talking about it?
I have a lot of optimism in our young people these days. Maybe they're not experiencing much bullying from their friend group. But we have to remember that it's worth regular check-ins.
Have that conversation. Ask if they feel treated differently than their friends because of their body size. Especially if they give you an opportunity to have these conversations.
Watch the online replay of the webinar "The Impact of Weight Bias."
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