ADA Scientific Sessions: Expanding the Discussion to Include Weight Bias
This past weekend, I had the pleasure of attending the American Diabetes Association’s 85th Scientific Sessions in Chicago. It was a phenomenal gathering of researchers, clinicians, scientists, and experts in the field of cardiometabolic health.
One of the most compelling shifts I observed was the growing emphasis on obesity care and treatment. The Obesity Association, a new division of the American Diabetes Association, recently published the Standards of Care in Overweight and Obesity to guide respectful, evidence-based treatment. These standards highlight weight stigma and bias as critical issues in clinical practice.
To support the launch of the standards, a special panel hosted by Dr. Jonathan Q. Purnell, MD, FTOS, Professor of Medicine in the Division of Cardiovascular Medicine at Oregon Health & Science University, showcased the voices of key opinion leaders in the field. Here are a few key takeaways and concepts I found especially valuable.
Centering the Patient Perspective
Keeping the person truly at the center of person-centered care is essential. The first speaker, Patricia Nece, an esteemed attorney and obesity advocate with the Obesity Action Coalition, shared powerful insights from her lived experience with obesity.
Patricia’s personal journey with obesity was tumultuous. She endured decades of dieting, often turning to extreme and unsustainable methods such as the Atkins diet, the cabbage soup diet, and even relying on Diet Pepsi and cigarettes. Despite her professional achievements, she struggled privately with binge eating disorder, weight concerns, and deep shame.
Repeated messages from the medical community to simply “eat less and exercise more” left her feeling unsupported, misunderstood, and gaslit. This led to isolation, self-criticism, and a shrinking world shaped by guilt and negative self-talk.
Her turning point came when she sought care from an obesity medicine specialist who approached her with compassion and a more comprehensive, person-centered approach. She began to rebuild trust in her body and herself, catching negative thoughts and reconnecting with her internal cues.
Her key message to clinicians: don’t judge patients with obesity. Use person-first language, address mental health, build trusting partnerships, and offer compassion and hope. For many people with obesity, showing up to a medical appointment is an act of courage—meet it with respect and support.
Addressing Stigma in Childhood
Much of what individuals experience regarding weight stigma and bias begins in childhood. Dr. Sarah Barlow, MD, MPH, a pediatric gastroenterologist and researcher at the University of Texas Southwestern, discussed weight-based bullying, bias, and discrimination among children and adolescents in the United States.
Youth with obesity are 50% more likely to experience weight-based bullying. This bullying often comes from peers, classmates, and even parents who may resort to shame in an attempt to change behavior. More than 60% of affected youth report weight-based cyberbullying, which is linked to increased risk of depression, anxiety, sleep disturbances, and academic difficulties. As a parent, this is simply heartbreaking.
Current interventions are largely school-based, focusing on inclusion, respect, and bystander intervention—encouraging students to speak up rather than remain passive observers. Initiatives like StopBullying.gov and Harvard’s Weight Implicit Association Test are also being integrated more proactively into pediatric care settings to promote empathy, awareness, and systemic change.
The Hidden Toll of Internalized Weight Stigma
Decades of research show that internalized weight stigma is associated with poorer mental and physical health, reduced self-care, and worse outcomes in chronic conditions, like diabetes.
Rebecca Pearl, PhD, Associate Professor in the Department of Clinical and Health Psychology at the University of Florida, explains: “Stigma increases stress, which can reduce healthy behaviors like exercise and self-care, reinforcing a harmful cycle.”
Internalized weight stigma occurs when individuals absorb negative societal beliefs about weight and turn them inward, leading to self-criticism and diminished self-worth. While not everyone internalizes stigma in the same way, its effects often extend into nearly all interpersonal relationships.
Dr. Pearl note that addressing weight stigma requires action at multiple levels, including:
- Structural, by enacting anti-discrimination laws and policies;
- Interpersonal, through the promotion of public education and awareness campaigns that confront bullying and bias;
- Individual, by providing peer support, counseling, and cognitive-behavioral strategies to reduce self-stigma and the fear of judgment.
Acknowledging Bias, Rebuilding Trust
Change is hard—especially when it challenges decades of bias deeply embedded in medical training and practice. Dr. Sean Wharton, MD, PharmD, Medical Director of the Wharton Medical Clinic, a government-funded clinic with 27 internal medicine physician, shared the pushback he received from the medical community after leading the development of Canada’s national obesity guidelines, which begin with a chapter on weight bias and stigma in medical care.
Many obesity care providers felt uneasy with the shift in focus from patient weight to provider bias. This discomfort often stemmed from a perceived lack of patient accountability and the challenge of confronting personal assumptions and prejudices. However, Dr. Wharton emphasizes that by acknowledging and accepting that we all carry bias, we can move forward with more productive conversations, and ultimately, more meaningful and compassionate care.
Dr. Wharton’s call to action is clear: acknowledge past harm, rebuild trust, empower patients with agency, and examine our own biases with openness, humility, and support.
Key Takeaways
- Bias in care delivery must be addressed. The ADA’s new Standards of Care in Overweight and Obesity call for confronting weight stigma in clinical practice as a foundation for respectful, person-centered treatment.
- Lived experience reveals the harm of stigma. Stories like Patricia Nece’s underscore how judgment-based care leads to shame, isolation, and delayed treatment, while compassionate, individualized support can be transformative.
- Change starts with clinicians. From childhood bullying to internalized stigma in adults, providers play a crucial role in rebuilding trust, challenging bias, and promoting equitable care across the lifespan.
Want to learn more? Check out the full ADA Scientific Panel on weight bias.
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