Obesity Treatment is Complex and Requires Compassion, not Judgment, says Expert


Patients are too often stigmatized, even by healthcare professionals, but there is no one-size-fits-all cause or solution, explains one of Cleveland Clinic’s obesity experts

Dr.W. Scott Butsch, MD MSc FTOS, Director of Obesity Medicine in the Bariatric and Metabolic Institute at Cleveland Clinic

Cleveland: The standard weight loss advice — “Eat less and move more” — is not aging well, and patients with overweight or obesity issues should seek a physician who understands their complex condition and who is aware of available emerging treatment options, says an expert from a top American hospital, Cleveland Clinic.

According to the World Health Organization, obesity has nearly tripled worldwide since 1975 and, in its most recent figures available, more than 1.9 billion adults, 18 years and older, were overweight in 2016. Of these, over 650 million had obesity.

However, W. Scott Butsch, MD MSc FTOS, Director of Obesity Medicine in the Bariatric and Metabolic Institute at Cleveland Clinic, says the good news is that researchers and doctors are continuing to learn more about the disease of obesity, and new pharmacological and endoscopic treatment options are emerging. “We now know many genetic, biological, developmental, behavioral and environmental factors contribute to weight gain and the development of obesity,” he says.

He points out, however, that there is still a widespread belief that obesity is a lifestyle choice — that people develop obesity because they choose to eat too much or exercise too little. As a result, people with obesity are stigmatized and stereotyped in many aspects of their lives — sometimes even at the place they visit to seek help.

Weight bias in healthcare

“Studies find that weight bias is common in healthcare,” Dr Butsch says. While medical professionals strive to provide the best possible care for their patients, studies have shown that some of them also carry negative attitudes toward patients who have obesity, or feel out of their element when it comes to treating it.”

Those attitudes affect patient care, Dr. Butsch says. “As a physician, telling someone to eat less and move more is like telling someone who has depression just to cheer up,” he says. “Doctors wouldn’t dream of saying this to someone with depression, but many have little reservations when making recommendations for weight loss.  For whatever reason, some doctors continue to do this when they discuss obesity.”

Medical professionals as a whole need to be better educated about the biology of obesity, he asserts, as well as the factors that play into it and their own biases — which they may or may not realize they have. The results of a recent study he published showed that among U.S. medical school deans, only 10% reported that their medical students were ‘very prepared’ to manage patients with obesity. He adds that in more than one-quarter of the medical schools, non-judgmental communication and use of respectful language with patients who have obesity was covered to a very little extent or not at all.

Having obesity heightens a person’s risk of developing diabetes, heart disease, hypertension and cancer, so a discussion on weight is an appropriate and important topic for doctors to have with their patients. However, he says, patients with obesity have likely already had many negative, biased encounters with providers, and they deserve the conversation to be thorough and compassionate.

Understanding causes of obesity

Dr Butsch says it is also important for patients themselves to understand the complex nature of obesity. “There is a very tightly controlled physiologic system that regulates body weight, aiming to keep it at a certain set point, and this can hinder weight loss. Therefore, when someone is unable to lose weight, it is not their fault necessarily and they shouldn’t berate themselves, just as the medical establishment shouldn’t blame them.”

He adds that because people do not understand the complex processes involved, they often think there are only two pathways to addressing obesity – exercising and dieting on the one hand, and surgery on the other.

“However, there are many types of obesity, and therefore many types of treatment, and no single treatment will work for everybody,” he says. “Understanding where patient is in their weight loss journey and to what extent their excess weight is not only affecting their health risk, but also their quality of life, can determine what treatment pathway we might choose.”

Dr Butsch stresses the importance of a thorough review of each individual patient’s case. “When a patient comes to see us with a problem with their weight, we want to take a weight history. So, often, what’s not done in the medical establishment is making the effort to understand the chronology of an individual’s weight. Identifying contributing factors to weight gain may not only lead us to more targeted and appropriate treatment options, but may help comfort patients who commonly blame themselves for their excess weight.”

Finding the right pathway

Addressing obesity is an ongoing process, and if one approach is not working after several months, the doctor and patient should consider changing course and trying a different therapy. Working with a physician who has a greater understanding and expertise in obesity is key to this process, says Dr. Butsch.

“If you feel that you’re being judged by your doctor, then you have the opportunity to seek another physician who is more knowledgeable in the field of obesity, and will provide more appropriate, non-judgmental care,” he says.

About Cleveland Clinic:

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 67,554 employees worldwide are more than 4,520 salaried physicians and researchers, and 17,000 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties. Cleveland Clinic is a 6,026-bed health system that includes a 165-acre main campus near downtown Cleveland, 18 hospitals, more than 220 outpatient facilities, and locations in southeast Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2019, there were 9.8 million total outpatient visits, 309,000 hospital admissions and observations, and 255,000 surgical cases throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries.