Empowered Health Course · Lesson 3 · 8:50
I want to talk about weight bias. There are two areas here. The first is the bias that exists in our society. From childhood on, we live in a culture that has misunderstood obesity and placed judgments on it. If you survey children as young as five, negative attitudes toward peers living with more weight are already developing. This is learned. We live in a society where the message is everywhere — that obesity is the individual's fault, a matter of laziness or eating too much. Just search "obesity" online and you'll find images that are toxic and harmful.
That misunderstanding exists because, as a society and a medical community, we didn't recognize that obesity is seated in the deep, unconscious part of the brain interacting with the environment — and both of those factors are largely outside of personal control. We can separate accountability from responsibility. We can be accountable — say, choosing to eat broccoli for dinner — but we have to recognize that the brain tightly regulates weight. We don't have responsibility or power over what the scale shows.
There's a misunderstanding that body weight is under self-conscious control. This also touches on diet culture, which is everywhere and carries several toxic myths: that we control our body size through food; that body weight is under personal control and individual responsibility; and that physical body size matters more than mental well-being or even physical health.
Many of you have experienced bias. We've all been living in diet culture, and we experience it through negative words from family and friends. Sadly, most patients have experienced bias in healthcare. One example: someone who has made extraordinary efforts and lost a clinically important amount of weight, but still lives with obesity, goes to see a surgeon who says, "Just lose 20 or 30 more pounds and come back." That dismisses everything the person has already achieved — their best weight — which they could only exceed through austere, miserable means. What is that worth?
I hope that understanding the biology of obesity can have a powerful impact in cutting through stigma and bias. There's also internal bias. Those living with weight have internalized society's judgments — we can't avoid it; like tofu or chicken, we absorb the values and beliefs of our culture. So deep down there's often a feeling: I did this to myself, I could have done something different, there's something wrong with me. In hundreds, maybe thousands of encounters, I've heard these stories.
I think people connecting with each other about this — both through understanding the true nature of obesity and through sharing their experiences — can help you feel you're not alone. Obesity is not your fault. That's such a hard thing to truly accept, but it's a seed worth planting and nurturing.
We're very hard on ourselves — that's how we're wired in Western culture. Sometimes, when I'm working with someone and we've maximized every effort — perhaps they've had bariatric surgery and regained weight, or couldn't tolerate medications — the one thing that's there at the beginning and at the end, that we can always work on, is our sense of well-being: how we think about ourselves, recognizing this bias, and freeing up all that mental real estate spent thinking that our weight is our fault, or that hitting a number on the scale will make everything better. It won't. The time is now: we can always work on healing from bias. It won't happen overnight — it's more of an aspiration than a goal — but there's something in it. Thank you.
This transcript has been lightly edited from the video for readability. For the complete experience, please watch the video above.