Weight Stigma and Fatphobia (Erlanger - 10/11/23)

 A recording of this presentation can be viewed HERE.

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This is one of those Grand Rounds that should be seen and heard (not read), so I am going to keep my notes very short. Please watch the recording at the above link. Prepare to feel challenged.

Dr. Lisa Erlanger, a family physician at University of Washington,  is an advocate for weight-inclusive care and a compelling speaker with plenty of evocative things to say, many of which challenge the way that we were taught to think about obesity.  

Dr. Erlanger encouraged us to reconsider the (generally accepted) notion that obesity is a disease, and encouraged us, rather, to consider how "anti-fat bias" in healthcare providers and "weight stigma" are actually causing tremendous harm to patients -- so much harm, in fact, that they may be responsible for poor outcomes in this population.

Here are a few of Dr. Erlanger's talking points to ponder:

1) There is no evidence that increased adiposity causes increased morbidity and mortality.

2) "A starving fat person does not make a tiny person." In other words, patients at the higher end of the weight spectrum are not going get to "normal" weight or "normal BMI" by dieting, so asking them to do so is inappropriate.

3) Obese patients consistently experience inequities (and often harm) in their interactions with healthcare providers: less warmth and emotional rapport, less time, less eye contact, more patronizing, adn more assumptions made on health based on size.

4) Weight cycling -- restriction of calories or increased use of calories in order to lose weight -- is harmful. It leads to 5-10% decrease in body weight over a short period of time, but ultimately leads to disordered eating and even higher weight and BMI. 

If anyone wants a copy of Dr. Erlanger's slides with references, please contact me (Veronica Jordan) at jordanv@sutterhealth.org.