“We’ve come to have this societal expectation that
losing weight should be easy,” says Puhl. “We see so
many messages from the diet industry and media that
you can achieve quick weight loss with a plethora of
conventional options, and doctors and patients often
have very unrealistic expectations.”
Jody Dushay, M.D., an endocrinologist and the
director of the Wellpowered Wellness and Weight
Loss Program at Beth Israel Deaconess Medical
Center in Boston, agrees. “I have seen patients have
significant improvement in blood sugar, cholesterol,
blood pressure, and nonalcoholic fatty liver disease
with 3 percent weight loss—just 7 to 8 pounds for
someone who weighs 250 pounds,” she says.
Research suggests that dietary changes and
increased exercise alone can lead to better health
measures for people with diabetes, whether they
lose weight or not, says Glenys Oyston, RDN, a
registered dietitian who uses an approach to diabe-
tes management that avoids focusing on diets and
weight loss. “What might people try to do when
they attempt to lose weight? Increase their nutri-
ent-dense foods, eat balanced meals, address any
overeating issues, increase exercise,” she says. “All
of those things improve insulin sensitivity on their
own. I see people improve their blood sugars with-
out any significant weight change. By not focusing
on weight, they feel more relaxed about being able
to care for themselves, instead of feeling judged.”
We’ve come to have this societal expectationthat losing weight should be easy.
“I see people improve
their blood sugars
without any significant
weight change. By not
focusing on weight,
they feel more relaxed
about being able to
care for themselves.”
Ò
White-CoatWeight StigmaOne of the most common places where people with
high weight report facing bias is the doctor’s office.
“One doctor said that he wished he could drop me in
the middle of the jungle so I would have to hunt for
my food and get exercise,” recalls Lisa Schieri, who was
diagnosed with type 2 diabetes 27 years ago. Anastasia
has felt stigmatized too. “My regular doctor is great—
he talks about diabetes management, not weight. But
I had a painful cyst one time and had to see an on-call
nurse practitioner instead,” she recalls. “Out of the blue
she says, Have you ever thought about losing weight? No,
that’s never crossed my mind, lady. C’mon: I live in
today’s world and have diabetes, what do you think? I
cried in the car after.”
Such painful interactions can erode the doctor-
patient relationship and lead people to avoid future
medical care. Stigmatizing experiences about weight
may even contribute to additional weight gain, says
Puhl. In a 2013 study of 6,000 adults with a range of
BMIs, those who experienced weight stigma were up
to three times more likely to get or continue to have
obesity over time than people who didn’t report any
weight discrimination.
Physicians know that it’s important to counsel pa-
tients about their weight, but most have little direct
education in nutrition or behavior change and are
juggling too many patients to take the time to dis-
cuss real solutions. “The generic advice from a doctor
to ‘try again or try harder’ is not at all helpful,” says
Dushay. “If something is not working, continuing
on that path with more conviction won’t force it to
work: if I don’t put the right fuel in my car, even if I
overflow the tank with gallons of that fuel, the car
won’t run. People may benefit from more nutrition
education, more specific advice about shopping or
planning meals, or more access to higher-quality
food—all of which a good registered dietitian can
provide—yet there is very frequently resistance to
referring someone to a dietitian.”