This Doctor Can: Fighting obesity stigma

Dr Stephanie de Giorgio is passionate about ending obesity stigma. In this piece, published on World Obesity Day, she talks about experiencing such stigma first-hand, and what needs to be done to end it all together.

Having obesity isn’t fun; it makes moving through the world very uncomfortable. When you are a doctor, it provides another layer of discomfort. ‘Surely you know better than to allow yourself to get like this?’ ‘Doctors can’t be fat – it means you can’t be very good at your job and will never progress in your career’ – these opinions from both patients and fellow medics.

Three years ago, when I found myself at my heaviest, I had spent years losing and then regaining weight (with that little bit extra) over and over again. I felt like I had failed. I could do pretty much anything I set my mind to, except lose weight and maintain that loss. When I saw my GP, they would sigh and get out the big BP cuff and make me stand on the scales. I wasn’t getting jobs I desperately wanted. Obesity stigma was stinging.

Fate then intervened and I found out I had gallstones. Once I knew I had to have surgery anyway, I seriously considered bariatric surgery for the first time. But first I decided I needed to give myself a crash course in the science behind obesity.

For the first time in years I realised I wasn’t weak willed, I wasn’t lazy and I hadn’t failed

Dr Stephanie de Giorgio

This hadn’t been taught at university or GP training, except for the advice about eating less, moving more and my now most hated phrase: ‘lifestyle changes’. So, I took a weekend and started trawling the scientific and medical literature. There were hormones I had never heard of, theories I wasn’t familiar with and for the first time in years I realised I wasn’t weak willed, I wasn’t lazy and I hadn’t failed. My genetics, the obesogenic environment, my mental health and my physiology had created the perfect storm that meant I had gained the weight and couldn’t keep it off.

Subsequent bariatric, or metabolic surgery, in the form of a gastric sleeve led me to lose a considerable amount of weight, and I began to feel like the me I had always been inside. Three years later I have kept the vast majority of that weight off and my life is significantly different. Life is easier, I feel healthier, my work life has improved, and I celebrate the NSVs (non-scale victories) every day.

There is a still a very odd reluctance among some of our colleagues to accept that the solution is anything more complicated than eating less and moving more.

Dr Stephanie de Giorgio

I am now spending some of my time working with organisations that campaign to reduce the stigma around obesity and overweight as well as trying to share the science behind obesity with other healthcare professionals.

Talk about a tough crowd. There is a still a very odd reluctance among some of our colleagues to accept that the solution is anything more complicated than eating less and moving more. Despite evidence regarding genetics and epigenetics, the metabolic set point and the complex physiology, let alone long-term studies like the Swedish Obesity Study, some doctors continue that mantra. Yes, most people can lose weight that way, but why do some people gain weight in the first place when others don’t, and why is it pretty much impossible for the majority to keep it off long term?

The stigma in wider society against those with obesity and overweight is well documented. Sadly, this stigma finds its way into healthcare. People with obesity are given less time by healthcare professionals, and they are presumed to be less compliant with all treatments – not just those regarding weight. They are less likely to attend for all healthcare appointments, and women are particularly unlikely to attend appointments such as smear tests, due to being treated badly by healthcare professionals in the past. (For example, being asked to lie on the floor because they might break the couch.) We should be better than this, but we are human and just as susceptible to the deeply ingrained societal judgements about those with overweight and obesity as the lay public.

My hope for the next few years is that we can improve the knowledge regarding the science of obesity among healthcare professionals, and that we can work towards proper services both for the prevention of overweight and obesity – and the treatment of those who already have this chronic disease. What we have been doing so far hasn’t worked. Let’s work together to make it better.

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