Fatima Cody Stanford, M.D., Obesity Medicine Physician Scientist at both Harvard Medical School and Massachusetts General Hospital, Boston, MA, has dedicated her medical career to addressing the growing problem of obesity in the United States and she had a great deal to say on the subject in multiple sessions at Pri-Med Southwest 2022.
Speaking on varied topics that ranged from the burden of obesity on our society to the latest thinking on treatments, Dr. Stanford returned again and again to concerns about language and long-standing standards associated with obesity, presenting a criticism of many aspects of the way we deal with obesity in the U.S. today.
The Problem with BMI.
One topic Dr. Stanford took up was the largely indefensible way in which we have long measured obesity: BMI. Noting that BMI gained ground in the U.S. in the 1940s when it was first used by insurance companies to help calculate life expectancy, Dr. Stanford called the assessment “imperfect and indirect.” She also said that the BMI parameters we measure ourselves by today are still those developed in the 1940s, when the U.S. population was far less diverse.
Weight Bias Akin to Racial Bias.
“I think we continue to have a bias against patients with obesity,” Dr. Stanford said. Comparing the way much of U.S. society looks at overweight people to racism, she said that even many physicians view overweight people with a stigma.
“Some view them as ‘a waste of time,’ she said, speaking of patients who are overweight. “Even clinicians with obesity themselves have anti-obesity attitudes.”
“Morbid” No More.
Objecting to the way many people have traditionally spoken about obesity, Dr. Stanford advocated these rules:
- “Obesity” is a disease and that’s okay, but we should not call a person “obese”. Instead, such an individual is “a person with obesity.”
- Similarly, while it’s okay to say that a patient is overweight, people should not be described as “overweight patients.”
- And, the phrase “morbid obesity” should be retired.
“Let’s change ‘morbid obesity’ to ‘severe obesity,’” Dr. Stanford said, noting that we don’t commonly use the term “morbid” in connection with any other disease. She also shared a new term that has been gaining ground in recent years: “Diabesity,” which was coined to describe the coexistence of diabetes and obesity, and their intimate relationship.
Finally, Dr. Stanford noted that the primary issue in all of these considerations is the health of the affected patients:
“We need to overcome the stigma of weight in the treatment of obesity, as the stigma creates stress in the patient, which often contributes further to weight gain.”