Reader Question - What Do You Think Of Obesity Medicine?

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Reader Arlie reached out to ask what I think about the field of “ob*sity* medicine” (OM). This, for many, is a life-or-death question, so I’m going to give my thoughts on this as not just someone who is an expert in the field, but also as a fat patient (albeit one with plenty of privilege.)

First of all, some facts about this certification.

The American Board of Ob*sity Medicine, which doles out the certification (it currently costs $1,500 to take the test) is not an official licensing body and is not recognized by the American Board of Medical Specialties (ABMS).

One of the ways they are working to get accreditation is through creating “fellowship programs.” One of the ways they suggest people fund these programs is through support from businesses that “have an interest in…ob*sity treatment” which sounds to me like code for taking money from the weight loss industry.

One of the paths to recertification is to read journal articles. However, the articles must be approved by their “Journal Article Review Advisory Panel” suggesting that this field is an echo chamber, which may be why they are still peddling weight loss methods that have been shown to be ineffective for about a century.

Their board is a veritable who’s who of people who have pinned their careers to the weight loss paradigm. To be clear, I don’t believe that every doctor who is board certified in OM is out to harm patients. I think many if not most may believe that they are helping people. But as an expert, advocate and patient, my focus has to be on keeping the fat patients safe and not on the doctors’ feelings or intentions. So when a doctor tells me that they are “board certified in OM” I have to assume a worst-case scenario, meaning that there are three assumptions I need to make in order to keep myself safe as a fat patient:

Assumption One:
From the moment I walk into their office as a higher-weight patient, they are trained (and certified!) to see my body as a problem to be solved, often by any means they deem necessary.

The word “ob*sity” was literally made up to pathologize higher-weight people (and is from a Latin root that means “to eat until fat,” so not so much science as stereotype.) With a doctor who has chosen to buy into the idea of “ob*sity medicine,” it’s very possible that they won’t be able to see past their beliefs about higher-weight people (including their tendency to blame nearly anything on my size) to give me care for any health issue I may actually be having. By extension they may, without notifying me, suggest treatment options, not because they have the greatest efficacy in dealing with my actual health issue, but rather because the doctor hopes that they might result in weight loss, or prevent weight gain. Similarly, they might withhold viable treatment options because they have a possible side effect of weight gain. In my experience, as well as individuals I have worked with, I have found these doctors to be the most egregious offenders when it comes to ethical informed consent conversations.

Assumption Two:
They are willing to risk my life and quality of life to make me thin.

They have willingly joined a branch of medicine which centers around the idea that it is completely acceptable (and often recommended) to risk a fat patient’s life and quality of life for the smallest chance that we might get a bit thinner. Again, there is no guarantee that they will feel obligated to be clear about the risks because of the paternalistic nature of their specialty. When I have asked about the risks of diet drugs and surgeries after having them recommended, I (and people I work with) have often been dismissed  with phrases like “every drug has side effects” or “every surgery has risks” which is a far cry from appropriate informed consent.

Assumption Three:
Their relationship to the research is tenuous at best.

They are willing to base their career on shockingly shoddy research. Research that is highly influenced by the diet industry, research that makes basic correlation vs causation errors. They are also perfectly happy to dole out treatments like surgeries that will have lifelong impacts, even though they don’t have long-term outcome data. As their potential patient, this doesn’t bode well for me in terms of their ability to practice ethical, evidence-based medicine.

So when a doctor tells me that they are board-certified in OM I have every reason to believe that I am sitting across from someone who doesn’t have a full grasp of the research and who truly believes that it’s worth risking my life to make me thin, and doesn’t think it matters whether or not I agree. I have to continuously remind myself that everything they say to me is through that filter, which includes the belief that my life is less valuable and more risk-able than a thin person’s life. And that’s given my many privileges including being white, currently able-bodied and neurotypical, and an expert in the field.  These harms are amplified for those without those privileges, especially those at the highest weights and/or with multiple marginalized identities.

Sadly, since OM can also tend toward industry influence, I also have to wonder (and try to research) if this doctor is on the payroll of a company like Novo Nordisk or Allergan and wonder how that might influence their choices.

Depending on where I live and what doctors are available to me, I may still need this doctor’s help. If that’s the case, then I’m going to have to be hypervigilant – researching everything they say and recommend – are they prescribing that medication because it’s actually the best thing for my condition? Or is it because weight loss (however small and temporary) may be a side-effect? Is that medication they suggested going to risk my health and life? Are they going to push me to surgically mutilate my healthy digestive system to put it into a disease state which, if it doesn’t kill me, could leave me with horrific lifelong side effects? Are they going to hold needed care hostage until I comply with their desire for me to look different?

The bottom line is that fat people have to worry about medical fatphobia with almost every healthcare provider (though, happily, the number of weight-neutral practitioners is growing!) but, at least from my perspective, we can never fully trust a doctor who is certified in OM to look out for our actual best interests. For me the only good thing about the certification is that it functions like a big, bright, blinking, red warning sign.  

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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings: Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison: Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.