Emily’s POV

Speaker: Emily

My name is Emily. I work as a registered dietitian in Appalachia. I work in both primary care and medical weight management.

How has obesity and weight bias impacted your life, as well your patients’ lives?

I have lived with obesity for my entire life. I learned very early on that living in a larger body is something to be ashamed of. I spent most of my life experiencing weight stigma, receiving health care was always dreaded, because I knew no matter what I went in to talk about, it was always going to come back to my weight. My experience is not unique. This is the reality that most people face. I lost trust in the healthcare system, as many others do. This is incredibly harmful, because when obese patients stop receiving medical care to avoid the feeling of shame, it leads to worsening chronic diseases that we could manage well, if caught early.

What are some common misconceptions about obesity and obesity care?

Treating obesity is very complex, and it comes with a lot of challenges. It’s not simply eat less move more – if only it was that. I spend a lot of my time explaining different medication options to patients and how they work. There is so much shame surrounding the use of obesity medication, which ultimately harms those who need it most. A question I ask people when they bring these judgments up around using medication as a tool is, would you tell a kidney disease patient that they’re taking the easy way out by taking medication? Would you tell a cancer patient that they’re taking the easy way out by taking medication? Or would you tell someone with diabetes that they are taking the easy way out by taking medication? The answer to is that no, you would not. The stigma surrounding obesity as a personal failure and something within their complete control has to stop.

What obstacles do women face when trying to access obesity care?

The current health care system does not provide proper support for women. When you add obesity into this mix, women are at a very high risk of suffering from chronic diseases or ultimately even dying from an undiagnosed ailment. There is such a stigma around obese women, there are a lot of biases that are in the health care system. Some of them are conscious, absolutely. But a lot of them are not. Learned thoughts throughout life, experiences and education shape our view of the world. When women don’t feel safe coming in for medical care, they are the ones that suffer. The healthcare system needs to learn more about women’s health in general, and especially in the case of obese women and women of color.

How can improved obesity care coverage make a difference in the lives of people living with obesity?

Obesity management coverage absolutely saves lives, be it insurance coverage to see obesity specialists or dietitians or coverage for medications. When treatments are normalized and covered, like with other chronic diseases, patients will have access to services that discuss the etiology and pathophysiology of obesity. When people understand what obesity truly is and how it works, the stigma can melt away. I’ve had many patients tell me that one of the clinics I work for has absolutely changed their lives.

How can policymakers and insurers help improve obesity access coverage?

Insurance companies to know that obesity treatment is crucial to manage the health of insurance recipients. That’s the most important thing. But of course, we have to look at the financials as well. When we effectively treat obesity, overall health care costs decrease with properly managed obesity. You will see decrease in diabetes, complications, kidney disease, heart disease and more. Hospitalizations will decrease as these risks are better managed. Overall, insurance coverage of these medications and services should be a right, not a privilege, and by refusing to provide coverage for specialist visits and medications, direct harm is being done.

What gives you hope?

I have hope, because I’m witnessing a paradigm shift when it comes to obesity care. We now finally recognize that obesity is a chronic disease, not a personal failure, and like every other chronic disease, we treat that with food, movement and medication, if appropriate. With this shift, I hope for expanded access to obesity medications, and that’s on the end of providers prescribing the medications, and in addition insurance covering the medications.