While obesity is a chronic, complex disease that can affect anyone, it affects men and women differently. Although the proportion of men and women who are overweight is about the same, the severity is different – more men are overweight and more women are severely obese. Given the significant health consequences associated with severe obesity, this shift in severity is imperative.
As a healthcare provider, it is important to understand the spectrum of factors involved in treating patients with obesity. There are a number of ways to provide care support to women living with obesity – from starting conversations to collaborating on treatment options.
Women at greater risk of weight stigma than men
Weight stigma is common in both genders. In employment situations, obese men and women are less likely to be hired or promoted than their normal-weight peers. They also experience lower wages and an increased risk of termination. Although both men and women are vulnerable to weight discrimination, Research by Frontiers in Psychology suggests that women, especially middle-aged and/or less educated, seem to be more affected by weight stigma than men, even if they are less overweight. For example, men with a BMI of 35 or greater tend to report significant weight discrimination, while women with a BMI as low as 27 experience a notable increase.
Overweight men are more likely to be perceived as wise or experienced, while overweight women tend to have less credibility. research Research into political candidates found that female candidates who were overweight received lower ratings than female candidates who were not overweight in terms of dependability, dependability, honesty, ability to inspire, and ability to put up with a strenuous job. In contrast, male political candidates affected by obesity received more positive ratings than male candidates not affected by obesity.
Women are more focused on calorie counting and diet restrictions
There are unique challenges and differences in treating women with obesity that need to be understood. Women, especially peri- and postmenopausal women, tend to have less muscle mass than men of the same age. This negatively impacts their body composition, metabolism, and overall energy and well-being. Many women struggle to achieve adequate dietary protein intake, which also has a negative impact on energy, metabolism, and satiety.
Women tend to focus far more on calorie counting and dietary restrictions than men, and are likely to associate weight gain or failure to lose weight with moral or character failures. In addition, women tend to be primarily responsible for planning, shopping for, and preparing food in households, which can contribute to behavioral fatigue related to healthy eating.
Treatment options are rarely evidence-based
Lifestyle factors increase a person’s risk of developing most chronic diseases, such as high blood pressure, high cholesterol, osteoarthritis, and even many types of cancer. When an individual has one or more of these chronic diseases, discussions with healthcare providers typically focus on treatment and how to maintain or improve QOL. However, when it comes to the disease of obesity, most conversations revolve around the perceived cause of the disease (ie, patients’ lack of willpower and/or failure to follow diet and/or exercise recommendations).
To make matters worse, when treatment options are discussed or recommended, they are rarely evidence-based and typically consist of referral to a commercial weight-loss program. When recommended or available, disease management programs administered by health care providers specially trained to treat obesity are often denied by health insurance. Most anti-obesity drugs are not covered by traditional health plans, despite compelling evidence that they are effective in reducing the disease obesity and obesity-related comorbidities. This reinforces the message that obesity is a character issue and does not deserve medical attention and treatment.
People with obesity are aware of their excess weight. Telling a patient that they are overweight as if it were new information is demeaning. It’s even more demeaning to follow that statement with a superficial prescription to “eat less and move more.” Patients don’t always want to talk about their weight when they’re in a doctor’s office—especially if they’re there for some other specific reason. Before raising the issue of a patient’s weight, it is important to ask permission to raise the weight and respect the patient’s response.
As a healthcare provider, we have a responsibility to provide support, not assessment, to our patients suffering from obesity. The language we use when we talk about obesity is critical to changing this notion. Here are some tips to keep in mind:
- Use People First language. words have power. persons to have obesity, just like they have cancer or diabetes. To say “obese people are discriminated against” is demeaning. We’re not saying that “insurance should cover wigs for cancer patients.” We say, “Insurance should cover wigs for people With Cancer.”
- Recognize that patients do not want to be obese. Most people with obesity expend enormous amounts of time, effort, and money trying to treat their condition. While society tends to label people with obesity as lazy or unmotivated, people who persist in seeking treatment despite a lack of progress typically have a great deal of tenacity or determination. 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 directly lead to weight loss. Exercise creates well-being and is probably the most important thing we can do for overall health, longevity, health span and mood – but it doesn’t lead to weight loss.
- Caloric restriction alone rarely results in sustained weight loss. The calorie-in, calorie-out model is simplistic, outdated, and wrong. Food is a combination of calories and information. If the type of food is not changed, the body predictably responds to calorie restriction by lowering its metabolic rate to try to establish homeostasis. Telling someone to just “eat less” is akin to telling someone in poverty to “spend less.”
- The anti-obesity drugs currently on the market are not dangerous. There are a variety of FDA-approved medications used to treat obesity. As with other drugs, there are occasional side effects and some contraindications. Some, but not all, anti-obesity drugs are classified as stimulants, although these are less potent than Ritalin or Adderall, drugs we use liberally in people of all ages. People do not develop tolerance to or withdrawal from anti-obesity drugs. The biggest barrier to these drugs is insurance coverage and stigma, not risk. For optimal effectiveness, these drugs should always be combined with an intensive lifestyle intervention.
- Although many comorbidities are caused or exacerbated by obesity, the treatment for all of them is not necessarily weight loss. Obese people are less likely to receive a referral, an imaging order, or a prescription to treat a condition than people of normal weight. Their symptoms are often wrongly attributed to being overweight and other causes are ignored. Because of this, people with obesity are more likely to seek medical help less often and delay medical treatment, leading to more advanced disease states.
Our knowledge of the disease obesity is constantly evolving. Discover the best resources and tools for treating obesity through the Obesity Medicine Association (OMA). To learn more about treating obesity or to become an OMA member, visit: www.obesitymedicine.org/join.