Deconstructing the stigma of people living with obesity
Obesity is a modern pandemic, having tripled its global prevalence in the last 30 years.
Obesity is a chronic disease that requires individualized treatment as lifestyle interventions alone may not be sufficient to achieve medically significant weight loss over time.
Despite the recognition of obesity as a disease, there is still significant social stigma for people living with the disease, affecting, among other things, their healthcare.
Contributing to this is the common belief that the development of obesity is the result of personal choice, failure and/or lack of discipline. More and more studies question that people living with obesity are free to “choose” their body weight, but instead highlight the difficulty of maintaining the lost body weight in the long term.
In fact, the regulation of hunger, satiety, energy balance and body weight is carried out in subcortical areas of the brain. Thus, hunger and satiety signals are generated in areas of the brain that do not seem to be related to conscious experiences. On the soil of a pathological environment, factors that favor the development of obesity such as high-calorie foods, a sedentary lifestyle, constant stress, lack of sleep, the intestinal microbiome, but also genetic and epigenetic factors, etc.
In humans, the lower centers of the brain and more specifically the hypothalamus and the brain stem seem to play the main role in regulating appetite. Peripheral signals that signal energy expenditure, from organs such as adipose tissue, skeletal muscle along with peptides produced by the gastrointestinal tract act on the hypothalamus and brainstem to ensure the body’s energy needs.
Hunger, like thirst, is a response to homeostatic disturbances in the body. The connection of subcortical areas with higher brain centers that produce conscious behaviors is not yet fully clear.
In addition, even after successful attempts at weight loss, multiple, powerful adaptive responses occur that resist losing or even maintaining a lower weight as this would have previously been a threat to survival, leading to weight regain, gradually.
Thus, people in today’s obesogenic environment are vulnerable to weight gain with mechanisms that aim to restore it to its original value. The understanding that appetite is regulated in subcortical areas of the brain beyond conscious behavior challenges the idea that obesity is the fault of individuals according to the common belief, even of many health care providers, that obesity is not a disease.
The stigmatization of people suffering from obesity and the discrimination that often occur in various areas, from the media to their workplace to poor health care, highlights the need for correct information and the adoption of new strategies to improve the way in which the average person understands the mechanisms that govern body weight control.
In this context, simple messages of “eat less and exercise more” reduce the proven complexity of the disease, which leads to prejudices against people suffering from obesity.
Understanding that obesity is not due to a lack of motivation or willpower, the availability and use of a combination of treatments, such as lifestyle changes, medication and metabolic surgery, becomes necessary for a large number of patients.
Decoupling personal responsibility will reduce the stigma of obesity and contribute to enhancing the understanding, prevention and treatment of this extremely complex disease.
