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Cited by 26Obesity and Health PracticesObesity, Physical Activity, DietEating Disorders and Behaviors

Are Current Guidelines Perpetuating Weight Stigma? A Weight-Skeptical Approach to the Care of Patients with Obesity

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Hagan, Scott, Nelson, Karin·2023·Journal of General Internal Medicine
DOI 10.1007/s11606-022-07821-wPMC PMC9971382
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Abstract

Significant controversy exists regarding the evidence to support the clinical benefits and risks of weight loss interventions for individuals with obesity. United States Preventative Task Force (USPSTF) guidelines recommend weight loss for all individuals with obesity while weight-neutral models such as Health at Every Size promote weight inclusivity, focusing on body acceptance rather than weight loss. We discuss how lifestyle-based weight-centric paradigms, such as the USPSTF Guidelines, may increase weight stigma and weight cycling, and many of their purported clinical benefits are not supported by existing evidence. However, we also acknowledge the clear benefits of metabolic surgery in high-risk individuals, and the potential benefits for pharmacotherapy for obesity in selected patients. Herein we describe a weight-skeptical approach to the care of patients with obesity that aims to use available evidence to support patient-centered care.

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  • A strong focus on body shape and weight may reduce program effectiveness by creating weight stigma.

    “Overly focusing on body shape and weight itself might undermine program effectiveness because it risks creating weight stigma (Hagan & Nelson, 2023, see the online supplemental materials for related analysis).”

    From A Randomized Controlled Trial of an Acceptance and Commitment Therapy-Informed Diabetes Prevention Program Reduces Body Shame and Distress. (2025) · cites this paper as Hagan & Nelson, 2023

    In “Why Recommending Weight Loss Dieting May Be Harmful” (page unavailable), the paper says weight-centric health care may increase weight stigma and that avoiding weight bias is important to improving care. It does not say that stigma reduces program effectiveness, and its discussion concerns clinical care rather than programs focused on body shape. (LLM, conf=0.84)

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Authors
Hagan, S., & Nelson, K.
Affiliations
University of Washington (US)
Corresponding author
Hagan, Scott
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
2022-09-22
Volume
38
Issue
3
Pages
793-798
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1007/s11606-022-07821-w
PMC
PMC9971382
OpenAlex
W4296793703
Cited by
26
References
77
Citations by year
2026: 3 · 2025: 10 · 2024: 9 · 2023: 4
FWCI
8.60
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
Keywords
obesity, weight stigma, weight loss interventions, Health at Every Size, weight cycling, metabolic surgery, obesity pharmacotherapy, patient-centered care
MeSH terms
Weight Prejudice, Humans, Life Style, Obesity, United States, Weight Loss, Anti-Obesity Agents

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