While obesity is a chronic, complex disease that can affect anyone, it impacts men and women differently. Although the proportion of men and women with excess weight is about equal, the severity is different—more men have overweight and more women have severe obesity. Given the significant health consequences associated with severe obesity, this shift in severity is compelling.
As healthcare providers, it’s important to understand the spectrum of factors at play when treating patients with obesity. There are a number of ways to provide care support for women with obesity—from starting conversations to collaborating on treatment options.
Women at Greater Risk for Weight Stigmatization Than Men
Weight stigma is prevalent in both genders. In employment settings, men and women with obesity are less likely to be hired or get promoted than their peers with normal weight. They also experience lower wages and an increased risk for job termination. Although men and women are both vulnerable to weight discrimination, research from Frontiers in Psychology suggests that women, especially those who are middle-aged and/or with lower levels of education, seem to experience higher levels of weight stigmatization than men, even at lower levels of excess weight. For example, men tend to report considerable weight discrimination around a BMI of 35 or higher, while women experience a notable increase at a BMI of just 27.
Men with overweight tend to be perceived as wise or experienced, while women’s credibility tends to decrease with excess weight. Research examining political candidates found that female candidates with excess weight received lower ratings of reliability, dependability, honesty, ability to inspire and ability to perform a strenuous job than female candidates without excess weight. Male political candidates who were affected by excess weight, on the other hand, received more positive ratings than male candidates not affected by excess weight.
Women More Focused on Calorie Counting & Dietary Restrictions
There are unique challenges and differences in treating women with obesity that are important to understand. Women, especially peri- and postmenopausal women, tend to have lower levels of muscle mass than men of the same age. This negatively affects their body composition, metabolism and overall energy and well-being. Many women struggle to get adequate dietary protein intake, which also adversely affects energy, metabolism, and satiety.
Women tend to be much more focused on calorie counting and dietary restrictions than men and are likely to associate weight gain, or failure of weight loss, with moral failures or character deficits. Additionally, women tend to be primarily responsible for food planning, buying and preparation within households, which can contribute to behavioral fatigue regarding healthy eating.
Treatment Options Are Rarely Evidence-Based
Lifestyle factors increase a person’s risk for developing most chronic diseases, such as high blood pressure, high cholesterol, osteoarthritis, and even many cancers. When a person has one or more of these chronic diseases, conversations with healthcare providers typically focus on treatment and how to preserve or increase QOL. However, with the disease of obesity, most conversations revolve around the perceived cause of the disease (ie, the patients’ lack of willpower, and/or failure to comply with dietary and/or exercise recommendations).
To add insult to injury, if treatment options are discussed or recommended, they are rarely evidence-based, typically consisting of a referral to a commercial weight-loss program. If recommended or available, disease management programs administered by healthcare providers specially trained in treating obesity are often denied by medical insurance. Most anti-obesity medications are not covered by traditional healthcare plans, despite compelling evidence that they can effectively improve the disease of obesity and obesity-related comorbidities. This reinforces the message that obesity is a character problem and is not worthy of medical attention and treatment.
People with obesity are aware that they have excess weight. Telling a patient they have excess weight as though it’s new information is demeaning. Following that statement with a glib prescription to “eat less and move more” is even more demeaning. Patients don’t always want to talk about their weight when they are at a doctor’s office—especially if they are there for another specific reason. Before broaching the subject of a patient’s weight, it’s important to ask permission to address weight and respect the patient’s answer.
As healthcare providers, we have a responsibility to provide our patients who suffer from obesity support rather than judgment. The language we use when discussing obesity is critical in changing this notion. Here are some tips to consider:
- Use people-first language. Words have power. People have obesity, just as they have cancer or diabetes. Saying “obese people are discriminated against” is demeaning. We don’t say “insurance should cover wigs for cancerous people.” We say, “insurance should cover wigs for people with cancer.”
- Acknowledge that patients don’t want to have obesity. Most people with obesity spend a tremendous amount of time, effort, and money attempting to treat their disease. While society tends to label people with obesity as lazy or unmotivated, people who persevere in seeking treatment despite a lack of progress typically have a great deal of tenacity or grit. Acknowledging this and providing recommendations or referrals for evidence-based treatments, such as intensive lifestyle interventions and/or anti-obesity medications can be life-changing for these patients.
Debunking Obesity Myths and Misconceptions
- Exercise has not been shown to cause weight loss directly. Exercise causes wellness and is probably the most important thing we can do for overall health, longevity, health span, and mood—but it does not cause weight loss.
- Calorie restriction by itself is rarely successful in causing sustained weight loss. The calories-in, calories-out model is simplistic, outdated, and incorrect. Food is a combination of calories and information. Unless the type of food is changed, the body will react predictably to calorie restriction by lowering its metabolic rate in an attempt to create homeostasis. Telling someone to simply “eat less” is akin to telling someone in poverty to “spend less.”
- Current anti-obesity medications on the market are not dangerous. There are a variety of FDA-approved medications to treat excess weight. Just as with other medications, there are occasional adverse reactions and some contraindications. Some, but not all, of the anti-obesity medications are classified as stimulants, although these are less potent than Ritalin or Adderall, medications we use liberally in people of all ages. People do not develop tolerance to or withdrawal from anti-obesity medications. The biggest barrier to these medications is insurance coverage and stigma, not risk. For optimal effectiveness, these medications should always be combined with intensive lifestyle intervention.
- Although many comorbidities are caused by or exacerbated by excess weight, the treatment of all of them is not necessarily weight loss. People with obesity are less likely to receive a referral to a specialist, an order for imaging or a prescription to treat a complaint than someone with normal weight. Their complaints are often inappropriately attributed to their excess weight and other causes are ignored. Likely because of this, people with obesity are less likely to seek out medical care and more likely to delay medical care, resulting in more advanced disease presentations.
Our knowledge of the disease of obesity continues to evolve. Explore the best in obesity treatment’s resources and tools through the Obesity Medicine Association (OMA). To learn more about obesity treatment or to become an OMA member, visit: wwww.obesitymedicine.org/join.