A new paper from the University of Georgia finds that current medical education’s emphasis on weight and body mass index exacerbates anti-obesity stigma and increases the risk of eating disorders. (Getty Images)
Nutrition is a key determinant of healthBut a new paper from researchers at the University of Georgia suggests that American doctors aren’t effectively trained to counsel patients on the issue.
Current medical education focuses on weight and body mass index (BMI), exacerbating anti-obesity stigma and increasing the risk of eating disorders, the authors say, and does not adequately educate future doctors on how to promote healthy eating habits.
Carney Gunsaras
“Mainstream medicine is still very much focused on the link between weight and health,” said Carney Gunsalas, lead author of the study and assistant professor at the Augusta University/University of Georgia Healthcare Partnership.
“Because obese and overweight people are more likely to have health problems, it’s easy to jump to the conclusion that weight itself is causing those problems. And if we assume that weight is causing the problems, it seems reasonable to assume that losing weight is the solution.”
The researchers said their study showed that being overweight does not necessarily mean being unhealthy.
The researchers argue that small changes to medical education and the way health professionals interact with patients could have a real impact on some of the biggest health issues facing the world today.
BMI is not an accurate indicator of health, but it is
BMI has long been the standard for classifying individuals into four main categories — underweight, healthy weight, overweight, and obesity — and is taught in medical school as a way to gauge a patient’s overall health.
The problem, say the researchers, is that it’s not accurate: BMI overestimates how many people are unhealthy.
Medical education regarding nutrition should focus on objective measurements of cardiometabolic health.
Cardiometabolic health includes blood pressure, insulin resistance, cholesterol levels, etc. and is a stronger predictor of overall health.
Previous studies have demonstrated that nearly half of Americans who are considered overweight by BMI standards are actually metabolically healthy, and roughly one in three people whose BMI is in the “healthy” range are actually unhealthy when assessed by more comprehensive criteria.
Dr. Ellen House
“If we look at the latest research on bariatric surgery and the use of drugs like Ozempic and Wegobee, it appears that patients can experience health benefits even without losing weight,” said Dr. Ellen House, co-author of the paper and associate professor in the Medical Partnership.
“We love black and white in medicine, but when benefits seem to be leading and unrelated to weight loss, the conversations doctors have with their patients need to change to focus on health, not weight loss.”
Obesity stigma negatively impacts patient care
The researchers said current medical education often fails to address weight stigma beyond focusing solely on weight loss and BMI.
Weight stigma associates obesity with moral failure, laziness, and binge eating without considering the biological and systemic factors that are associated with weight, including the availability of fresh, healthy foods, being able to afford to buy those foods, and access to safe places to exercise.
This stigma can lead doctors to be less empathetic towards overweight patients and provide poorer quality care.
“Overweight patients are less likely to receive appropriate testing and treatment for health concerns,” says House, who is also a board-certified psychiatrist. “Asthma and cancer go unnoticed because doctors attribute symptoms to weight, when weight is not the cause of the patient’s concerns.”
“If I could wave a magic wand and ask doctors to do one thing differently, it would be to start with the premise that every patient wants to be healthy and has the ability to be healthy.” —Carney Gunsalas, Medical Partnerships
Negative interactions that dismiss health concerns as “just lose weight” can demoralize patients and discourage them from discussing their issues in the future. Blaming patients for their weight can increase their negative feelings toward the health care system in general, discouraging them from seeking medical care even when they really need it, the researchers say.
Reframing the conversation between doctors and patients to focus on healthy behaviors, like exercising more and avoiding categorizing foods as inherently “good” or “bad,” can go a long way in encouraging individuals to move toward health.
“Doctors believe they are trying to help people become healthier by recommending weight loss, but they just don’t realize the harm their advice can cause,” says Gunsalas. “If I could wave a magic wand and ask doctors to do one thing differently when working with patients, it would be to start from the premise that every patient wants to be healthy and is capable of being healthy.”
The publication was published by Medical Science Educator and co-authored with Jordan Mixon, a fourth-year medical student from Medical Partnership.
