NARRATION: Melissa Krechmer is a social worker in Philadelphia. A big part of her job is listening to people, so she began to wonder why doctors had such a hard time listening to her.
MELISSA KRECHMER (SOCIAL WORKER, PHILADELPHIA, PA): I was coming in with issues, and nothing was getting resolved. Every time I went to the doctor, it was like, “You need to lose weight”— like, “You need to eat healthier.” And I’m like, “I do eat well. You know, I eat well; I move my body. This is still happening.” But I feel like you’re not really believed when you say that.
NARRATION: Melissa felt that, no matter her medical problem, doctors always focused on her weight and that society did, too. She felt this fixation was making her less healthy, not more.
MELISSA KRECHMER: Usually going to the doctor meant feeling like a lot of shame about my body. For me that, and for a lot of people, that just leads to, like, this pathway to disordered eating and hating yourself—and, you know, just feeling like you’re not worth care and love and everything, you know.
NARRATION: Melissa’s story isn’t uncommon, says Fatima Cody Stanford, an obesity specialist at Massachusetts General Hospital.
FATIMA CODY STANFORD (OBESITY MEDICINE PHYSICIAN, MASSACHUSETTS GENERAL HOSPITAL): I think it goes back to a lack of understanding. And that lack of understanding regarding obesity is on the part of all individuals—physicians, other health care providers, the general population. They think it’s a lifestyle choice. Unfortunately, this is completely false.
There are over probably 100 factors that contribute to body size. The bacteria in one’s gut, medications that lead to weight gain. And the biggest factor is genetics. If we have parents that have obesity, the likelihood that we ourselves will have obesity is on the order somewhere of between 55 to 85 percent. That is even with optimal behaviors.
Many of the patients I see, by the time they finally make it to me, have diets that are better than most people, exercising more than most people, but still have excess weight.
NARRATION: These misconceptions about weight can lead to stigma and discrimination, which have been associated with harmful impacts on patient health.
FATIMA CODY STANFORD: Weight bias needs to be picked up as a major threat to the health of our public.
It actually leads to increase in stress, increase in blood pressure. It can raise their average blood sugar, which predisposes them to getting diabetes. It leads to depression, it leads to anxiety, and unfortunately can lead to higher rates of suicide.
NARRATION: It also leads to lower-quality medical care for heavier patients, Stanford says. She sees the damage of weight stigma in nearly every person who walks through her door, recalling that one middle-aged patient even brought his mother to their first visit.
FATIMA CODY STANFORD: He needed his mom to convince me, the doctor —because that’s what he had had to do his whole life—that what he was saying about his activity and things were indeed true.
NARRATION: Stanford ultimately helped this patient reach a weight that worked better for him. But, she says, if he walked into another doctor’s office, he’d likely be told that he needs to lose all of the weight.
FATIMA CODY STANFORD: If you knew nothing about him, and he walked in your office at 300 pounds, the first thing that would probably come out of the mouth of the doctor or other health care providers: “You need to lose weight”—not recognizing he’s lost 250 pounds; he’s been able to maintain it; he has no other health risk factors now. He’s able to do everything he wants to do. So are we listening to our patients? Are we recognizing that we’re not one-size-fits-all? I don’t need to get him to a certain number on the scale. Like I tell my patients, whatever is the happiest, healthiest weight for you.
NARRATION: When Vicky Borgia co-founded her own primary care practice in Philadelphia, she found that many of her higher-weight patients shared similar negative experiences with the medical community.
VICKY BORGIA: They have all been on multiple diets; they have all lost significant amounts of weight and then gained back more. They have all been shamed in the medical system at some point and so don’t go back. They actually have physical trauma from our medical system.
NARRATION: Borgia chose to create a weight-inclusive practice, from exam tables and blood pressure cuffs made for larger bodies to the way that she talks with patients about weight.
VICKY BORGIA: Weight should be a factor, of course. But it should not be the only factor.
The only time really I talk about weight weight with people is when we talk about weight stigma and their experiences and how that shapes things because what I talk about is health.
NARRATION: Borgia works in-depth with each of her patients to determine their health needs. She may focus on measures such as blood pressure or hormone levels, or she may help a patient with their sleep, strength, eating habits or stress management.
VICKY BORGIA: I’m talking to people, figuring out what their goals are and then trying to make that happen in whatever way we can.
NARRATION: After years of feeling unheard by her doctors, Melissa decided to find a physician who took a different approach.
MELISSA KRECHMER: I wanted someone who would listen to what I actually need and actually look at me as a human being, which I know sounds wild to say. But I’ve had a lot of experience where that wasn’t the case.
NARRATION: Things changed when Melissa joined Borgia’s practice.
MELISSA KRECHMER: I feel a lot healthier. I have my blood sugar managed in a much better way. I’m not doing any sort of disordered eating behaviors.
So I think it’s been a huge change in terms of just feeling better about myself and wanting to take care of myself.
VICKY BORGIA: Patients are gonna live in this body the rest of their lives. And so we want to make it as healthy as possible and give people lives that they find meaning in. It’s, you know, about sustainable lifestyle that will bring you joy in life, not just make you skinny.