The 3Ds of Obesity: Discrimination, Disinformation, & Disinterest

Last week I gave a Keynote presentation to dignitaries and attendees at the 5-Year Anniversary of the Helmholtz Institute for Metabolism, Obesity and Vascular Research (HI-MAG) in Leipzig.

Tasked with summarising where we stand in obesity prevention and management for attendees who were not obesity experts, I boiled down the message to three points.

We are where we are in addressing obesity both in terms of prevention and management because of the 3Ds: Discrimination, Disinformation, and Disinterest!

Not much needs to be said about discrimination, as it is well documented that people living with obesity experience discrimination on a daily basis, be it in educational settings, workplaces, or when moving about in public. In my talk I zeroed in on the discrimination people with obesity face in health care settings: doctors spend less time with them, order fewer tests, prescribe fewer treatments, and generally have little advice to offer beyond “Eat Less Move More”. No wonder, people with obesity turn to doctors as a last resort after all their do-it-yourself approaches have failed. 

Much of this weight-bias and discrimination is directly fueled by a barrage of disinformation by a multi-billion weight loss industry that has little to offer beyond useless dietary supplements, fad diets, exercise machines, and loads of other stuff that they can happily unload on desperate victims under a barrage of nonsense or half-truths (all those weight-loss secrets your cardiologist does not want you to know!). Unfortunately, governments and policy makers are complicit in this by announcing successive unachievable population goals, that focus largely on food and activity policies, none of which have yet made a dent in the obesity epidemic but do serve as a fine excuse to not provide treatments to those who already have the problem. 

Finally, it is hard to fathom the amount of disinterest and lack of knowledge that the vast majority of healthcare providers show in the management of obesity. This is particularly true for most of academic medicine, which has bemoaned but otherwise largely ignored the problem. By any metric, be it in the number of academic chairs, PhD theses, research projects, research funding or publications, obesity ranks aeons behind any other major health problem of our time. We are still licensing doctors and other medical personnel that have never managed a single patient for their obesity (not just with obesity). 

Fortunately, we are now finally seeing some movement in all of this.

At least the academic meetings on obesity now prominently feature the issue of weight bias and discrimination and many people living with obesity are no longer willing to put up with being treated as second-class citizens. 

Although social and other media are chock full with information about the new obesity medications (albeit most of the reporting remains unbalanced and sceptical), health zealots, often speaking from a place of privilege, continue to harp on about how obesity could be effectively addressed just by getting people with obesity to embrace healthier lifestyles (a discriminatory message, if there ever was one!). 

And finally, we are also seeing serious but cautious conversations about increasing obesity services and access to treatments in health systems, albeit much of this remains, as they say in German, “merely a drop of water on a hot stone”. 

All of this could be sped up if we could only address the 3Ds – fight discrimination, counter disinformation and show greater interest in better understanding and dealing with the real issues facing people living with obesity. 

Berlin, D

Disclaimer: I have received honoraria as an independent medical, research and/or educational consultant from various companies including Aidhere, Allurion, Boehringer Ingelheim, Currax, Eli-Lilly, Johnson & Johnson, Medscape, MDBriefcase, Novo Nordisk, Oviva and Xenobiosciences.