Let's talk about obesity

Obesity is a topic frequently discussed and debated in news, social media, and popular culture. From reports linking obesity to various social factors to endless articles and posts promoting weight loss, stigma around obesity and felt by people with obesity can be extensive. March 4 marks World Obesity Day and a chance to draw attention to the various aspects of the obesity crisis. With projections of 1·4 billion adults living with obesity by 2035 and the global economic impact of overweight and obesity reaching US$4·32 trillion in the same year, the overarching physical health consequences can be pushed to the forefront. However, living with obesity is all encompassing and World Obesity Day this year hopes to help correct the misconceptions and perceptions that can surround obesity and the role it plays in a person's health through frank conversation and stories from people with lived experience. To make meaningful strides, it is first important to identify the main drivers of weight-related stigma. Much of the stigma and misconceptions root from the differing classifications and definitions attributed to obesity. Whether obesity is a disease in its own right or a risk factor for other diseases is an area of much debate, which affects the way it is treated and managed. Additionally, a higher perceived weight stigma can impact an individual's mental health. The Lancet Diabetes & Endocrinology Commission on clinical obesity aims to identify clinical and biological criteria for the diagnosis of clinical obesity. In this issue of the journal, the Commissioners explain the need for a definition of clinical obesity and their hopes that such a definition will lead to meaningful changes in the way in which obesity is conceptualised and treated. Children with overweight and obesity can face weight bias and weight-based discrimination from a very young age, which can cause lifelong damage to self-esteem, confidence, and physical health due to an increase in disordered eating and health-care avoidance. A US study investigating harassment in adolescents found that weight and appearance-based harassment was more prevalent among both girls and boys than any other prejudice-based harassment. The negative effect of the media and popular culture's attitude towards people with obesity on children and adolescents is well recognised, with multiple campaigns and corporations now pushing back on stigmatising advertising and messaging. However, we cannot ignore the more inconspicuous stigmatising behaviours from groups that should be trusted to provide unbiased information, such as health-care services and news articles. Over the past decade, research has consistently shown how people who have reported experiencing weight bias in health care have lower trust in their health-care providers and subsequently poorer treatment outcomes. The new 2023 American Academy of Pediatrics clinical practice guideline highlights the importance of using family-centred and non-stigmatising language that acknowledges the biological, social, and structural drivers of obesity. Empathetic language is often missing in news stories when reporting on obesity and can portray the subject in a negative, stigmatising manner. Even the photographs chosen of people with obesity in news articles are more likely to be dehumanising than photographs of people without obesity by focusing on the abdomen or lower body, cutting off the heads, or by showing people eating or drinking. This year's theme for World Obesity Day emphasises the importance of participation from people with a lived experience of the disease in finding effective solutions. The new American Academy of Pediatrics clinical practice guideline recommend health-care workers use motivational interviewing, leaving people with obesity and family in charge of their treatment goals. The report from WHO entitled Nothing for Us, Without Us shares a series of perspectives from individuals with lived experience of a range of non-communicable diseases, including obesity, and argues how policies and programmes shaped by people living with diseases will improve health outcomes for all by providing a more holistic, bottom-up health-care system. Obesity is complex. The causes are varied and multidimensional so management must be too. Evidence shows that obesity stigma and misconceptions about the condition only worsen health and wellbeing. A person-centred approach is important for tackling the obesity crisis and is needed in all areas, from medical guidelines to media reporting. Important conversations must be had, outdated concepts of obesity need to be revised, and recommendations should be reviewed if we are to truly make an impact in the lives of people with obesity.