Obese Physicians Tackle Stigma, Promote Compassionate Care

Medscape

5 days ago

Obesity affects a large proportion of US adults, including physicians themselves. And while obesity is increasingly recognized as a chronic disease, bias and stigma remain widespread in healthcare.
Medscape Medical News spoke with three physicians whose personal experiences with weight and health challenges are informing how they practice medicine, counsel patients, and address systemic bias within their profession.
Personal Struggles With Obesity
Margarita Macias, MD, a pediatrician with BCA Medical Associates in Roswell, New Mexico, started with a BMI of 34 while struggling to help her teenage patients with obesity.
'I didn't like the way I looked or felt,' Macias said. 'I was sluggish, tired all the time, was beginning to have sleep apnea, and had poor exercise tolerance.'
Equally evident was her professional dissonance. 'I felt like a fraud or a hypocrite talking to my obese patients about health risks while being obese myself,' she said.
Tro Kalayjian, DO, chief medical officer of Toward Health and a board-certified physician in internal medicine and obesity medicine, faced a more dramatic situation. 'I weighed 350 pounds and was facing the same chronic diseases I was treating in my patients,' he said. 'My role as a physician forced me to confront the failures of conventional advice.'
After losing over 150 pounds, Kalayjian said, '[My journey] fundamentally reshaped how I view nutrition, obesity, and chronic disease.'
Ramón Tallaj, MD, founder and chairman of SOMOS Community Care, describes recognizing his own hypertension while leading a network serving over 1 million underserved patients. 'I was fully consumed by caring for others while quietly ignoring signs in my own body,' he recalled.
Tallaj's leadership role also revealed other underlying issues at play. 'I observed that chronic conditions like hypertension, diabetes, and obesity are shaped not only by personal choices but by systemic factors: limited access to healthy foods, lack of safe spaces for exercise, cultural barriers, language gaps, and financial strain. This is not just a clinical problem; it is a social and economic crisis that repeats itself generation after generation.'
Evidence of Healthcare Bias
Kalayjian described experiencing weight bias 'at every level. Obese physicians are often viewed as less credible, even by peers who fail to recognize the complexity of the disease. Patients sometimes assume you cannot help them if you struggle yourself.'
Tallaj identified a particular form of professional bias. 'In medicine, there's an implicit expectation that knowledge equates to immunity — that we should be exempt from chronic conditions. This bias is prevalent within the system, among colleagues, and even within ourselves,' he said.
Research supports these physicians' experiences with professional stigma. A 2021 systematic review and meta-analysis published in Obesity found that healthcare professionals demonstrate both implicit and explicit weight bias toward people with obesity.
The analysis identified bias among physicians, nurses, dietitians, psychologists, and other allied health professionals based on standardized tools such as the Fat Phobia Scale and Antifat Attitudes Scale.
A 2020 international consensus statement published in Nature Medicine described obesity as a complex, chronic disease driven by genetic, biological, and environmental factors.
The authors reported that weight discrimination affects 19%-42% of adults with obesity, with prevalence being the highest among individuals with higher BMI and among women.
Shifting Clinical Approaches
'I approach it with more compassion because I know the struggle,' Macias said. 'Many parents have been inspired by my progress, having seen me once obese. Many have returned with their kids after starting their own family weight loss journey with significant success.'
Kalayjian's approach transformed completely. 'I now approach obesity as a neurohormonal disease influenced by processed foods, environment, and metabolic dysfunction,' he said. 'I emphasize compassion and education, not willpower.'
Emphasizing metabolic health vs weight loss is also a good approach, according to Tallaj. 'We emphasize building lean muscle mass, optimizing protein intake, stabilizing blood sugar variability, addressing sleep quality, and regulating stress,' he said. 'Muscle serves as the primary site for glucose disposal, improves insulin sensitivity, and supports vascular health.'
Acknowledging the Complexities of Obesity
All three physicians challenged the oversimplified willpower narrative. Macias identified multiple contributing factors. 'Many struggle with depression, anxiety, poor self-image, or it is hereditary,' she said. 'If one parent is obese, 50% of their children could be obese; 75% if both parents are obese.'
Kalayjian argued that the medical profession remains 'stuck in an outdated energy balance model. Medical education is influenced by corporate interests that perpetuate myths about calories in, calories out. Obesity involves disrupted appetite regulation, metabolic damage, and food addiction in many cases.'
Tallaj provided a systems perspective: 'The medical community still reduces obesity to personal failure — eat less, move more. This is dangerous oversimplification. Obesity is influenced by genetics, metabolic adaptation, hormonal drivers, mental health, trauma, cultural norms, and environmental factors including food deserts and socioeconomic barriers that severely limit access to nutritious options.'
Challenging Colleagues
When confronting colleagues who link obesity to patient willpower, these physicians respond with evidence. 'I remind them that no one chooses to be obese,' Kalayjian said. 'Willpower fails when fighting biology. If willpower worked, we would not have an epidemic.'
Tallaj draws clinical parallels: 'No one blames patients with cancer or autoimmune disease for lacking discipline — yet we shame people with obesity in ways that are scientifically wrong and deeply harmful,' he said. 'Obesity involves powerful biological feedback mechanisms. Weight loss triggers metabolic adaptations that resist further weight reduction.'
Recommended Changes in Medical Culture
Tallaj advocates for redefining clinical metrics. 'We need to stop focusing solely on BMI,' he said. 'We need to train doctors to consider muscle strength, metabolic flexibility, inflammation, and blood sugar stability — these factors tell us far more about long-term health than weight alone.'
Macias emphasizes compassionate engagement: 'I would like to see colleagues approach it with compassion over reprimand or scare tactics. Take time to understand their struggle. There almost always is more than just a lack of willpower or discipline. Unlocking that and helping them through the root of the problem is sometimes all it takes to help them succeed.'
Kalayjian calls for systemic change: 'I want to see an end to blame-based language. We need to train providers in the true science of obesity and nutrition. Provider wellness must include addressing food addiction and metabolic health, not just promoting vague notions of self-care.'
Tallaj highlights physician wellness as professional responsibility. 'We need to eliminate the quiet shame that still exists when doctors struggle with mental health, burnout, weight issues, or chronic conditions,' he said. 'We must cultivate a medical culture where physicians prioritize their own health. Healthy physicians lead better, counsel better, and earn greater trust from patients.'
The Path Forward
Macias, whose BMI decreased from 34 to 27, emphasized the therapeutic value of supportive relationships. 'When patients feel that their health provider is their supportive ally in their weight loss journey, it makes a world of difference physically, mentally, and emotionally,' she said.
This practice can be reinforced through organizational leadership, Tallaj said. 'Prevention requires a system of care that meets people where they are, long before disease takes hold,' he said. 'We cannot lead our patients to wellness if we are not living the principles we ask them to follow.'
This evolution represents a shift from traditional approaches that may inadvertently perpetuate stigma toward evidence-based, compassionate care that acknowledges obesity as a complex, chronic disease requiring comprehensive treatment addressing both individual and systemic factors.
Reflecting on how his own experience with obesity transformed his approach to care, Kalayjian said, 'Patients need tools to change their physiology and environment, not lectures about calories.'