Medical gaslighting due to weight stigma and bias: a viral TikTok study [PODCAST]

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“Disrupting weight stigma and bias in health care starts with calling it out. The power of stories and shared experiences highlights the collective voice. I’m coaching TikTok Followers to own their health power and start speaking up during clinic visits to make sure they get their questions answered. Future directions and next steps are to disrupt weight stigma and bias by speaking up, calling it out, and calling on doctors, nurses, and all of health care to do better. Back to TikTok!”

Karla Lester is a pediatrician.

She shares her story and discusses the KevinMD article, “Medical gaslighting due to weight stigma and bias is harmful: a viral TikTok study.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today we welcome back on the show Karla Lester. She is a pediatrician, obesity medicine, and life coach, and she co-wrote the KevinMD article “Medical gaslighting due to weight stigma and bias is harmful: a viral TikTok study.” Karla, welcome back to the show.

Karla Lester: Thank you for having me, and just a shout-out to you, Kevin, for all of the incredible work that you do for physicians, especially during this time. All your amplification of our voices is so appreciated.

Kevin Pho: Well, thank you so much. My job, like I said, is very, very easy. I just sit back and listen to all you guys, and I’ve just learned so much from doing these podcasts. Now, for those who didn’t get a chance to listen to our first episode, can you just briefly share your story and journey to where you are today?

Karla Lester: Yeah, sure. So like you said, I’m a community pediatrician. I’ve been one for a long time, and I’ve been working on the childhood obesity epidemic since 2004. So I started a clinic in my practice, and I was like, “Well, that was great.” But then in 2007 the expert committee recommendations came out, and those were a guideline for how a community pediatrician can assess, prevent, and treat childhood obesity. And so I was reviewing those, and I was like, “Well, this clinic is great, but it’s not enough to support what the children and families need when they walk out of the clinic doors.” And so this is a public health issue. This is a community issue. This is a policy advocacy issue.

So I looked at those expert committee recommendations and started looking at other communities and what was happening in their communities and what the infrastructure was. And so I decided to actually leave my full practice, which was a really tough decision, in 2008, and launched Teach a Kid to Fish, a nonprofit that I started from scratch in the Lincoln community, and it was amazing. So my vision was creating community solutions for children’s health, and Teach a Kid to Fish was about empowering the youth voice.

And it was like, one doctor’s voice is great, but it’s not going to be enough to really turn the tide on this. And if we wait for food companies to change and stop marketing to kids, and we wait for the farm bill to include health, and we wait for school lunches to change, and PE to be, and changes, and build community and healthy food access, we need to work on all those things. But if we wait for all that to happen, it’s not going to happen, as we know now when we look at the data.

So that was an amazing adventure, and very challenging, but an incredible community collaborative that I created with local, state, and national partners. And then I worked with Children’s here in Nebraska and also the YMCA and the University of Nebraska-Lincoln psychology department to create a pediatric weight management clinic. And I was the medical director for that, because I was getting so many calls from school nurses: “You need a clinic. We need to send this kid who weighs 150 pounds, who’s a first grader, who can’t walk down two steps without turning blue.” And I kept getting calls like that, and so I thought, “OK, great, I will go ahead and create a full.” What the expert committee recommended was a staged approach to treatment. So I’d had things for early childhood and prevention and in schools, and had created To Foster Healthy Weight in Youth, Nebraska’s clinical childhood obesity model, physician toolkits with DHHS and the Nebraska Medical Association. So I’m like, “I’ve done all this, and then we do need a clinic,” so I started that in 2015.

And that was great, but then population health, the Affordable Care Act, addressing the Triple Aim came out, and then Dr. Nadine Burke Harris started talking about, and she was the whistleblower on, pediatric ACEs and chronic stress in children and the effects on their health. And that’s like, well, that’s what I’m seeing in my clinic. And so I thought, the weight’s one thing, but we need to figure out a way to address this. So I actually moved my nonprofit and created the Center for the Child and Community at Children’s here in Nebraska and led that, and we created a systems approach and a population health approach.

And in the meantime, I developed my own weight problem, and I wonder if I have my picture. Oh, I do. I had never had a weight issue. Here’s me with my family in 2017 in Hawaii, an awesome trip. And so I really never thought I would have a weight issue. I’d always been a thin person, but I became clinically obese actually while I was doing this work. So I’m like, “I’m not going to go on a diet.” But I discovered Dr. Katrina Ubell’s podcast and started learning about life coaching, and then signed up for her Weight Loss for Busy Physicians group in September. And then we read The Obesity Code by Dr. Jason Fung, and then the life coaching, and it was six months, and it took me 11 months, but I lost 57 pounds, actually.

And I was like, “This is what we need to be doing with the kids, is coaching, and we need to be focusing on metabolic health, reversing insulin resistance.” Obesity is not caloric. We’ve been getting it wrong. [Remark removed by the editor.]

I started speaking up, so I was unfortunately caught in the web of a lot of political issues as I was speaking up for children, and my attorneys instructed me to resign from that position two years ago. And that was really tough, because that was, like, what I created. And then I left, and I was like, “Well, what am I going to do?” Well, I decided I’m going to get back to my original vision of teaching to fish, which was creating community solutions for children’s health.

And my husband, it was so funny, because he’s a physician too, so basically it’s been a family thing, all of this work and a lot of investment. And he’s like, “Karla, we are not going to invest in you creating another thing unless you fully cut out the middleman. You’re not going to create all this value for children so you’re not going to create all this value for funders in the community. It’s going to be you connecting again.” So I feel like a pediatrician. So I had the vision to create IME Community for teens, so it’s a life and weight coaching platform for teens.

Kevin Pho: Wonderful. So let’s transition now into the KevinMD article that you co-wrote, and it’s titled “Medical gaslighting due to weight stigma and bias is harmful: a viral TikTok study.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to co-write it?

Karla Lester: Yes, and by the way, big shout-out to my daughter, Katherine Lester, who’s a junior at TCU. She’s majoring in biology and also journalism, so it’s incredible to get to work with her. She’s worked with me a lot with IME Community and co-wrote my articles, so shout-out to Katherine.

Anyway, of course, launching a platform for teens, everyone’s like, “You’ve got to get on TikTok, and the social media is just going to be so important.” So I was like, “Great.” I mean, I love music and I love to dance and whatever, but my kids are, like, freaking out. They’re 18 and 15, and it’s just the worst cringey thing to have their boomer mom on. But anyway, I’m like, “OK, I’m going to start showing up.” And I think I had five followers for such a long time, and I had not even a hundred views and maybe five likes on my videos for quite a while, and I was just kind of showing up and talking about IME Community.

But I spent a lot of time on TikTok, because I was like, “Wow, I really love this.” I love Chowder the bulldog, who’s a skateboarding bulldog, and all these cute little kids on there who say funny stuff. And anyway, I really fell in love with TikTok. And I was in the middle of a TikTok trance one day, and I follow this comedian, Big Tray 1000, who does these little spiels. He’s like, “Why are neighbors always like,” and then he does this really funny head turn and has this dramatic music.

Well, I scrolled onto his video, and he said, “Why are doctors always like, ‘Everything looks good, just watch the weight’? Your mama, I didn’t come here today for you to crack jokes, doc. I have a mild-grade fever and I got the chills. I’m a little scared, and you’re talking about weight. I ain’t got time for jokes.” And this was literally in the throes of COVID. He’s obese, he’s also Black, and he was making a joke, and yeah, it was funny, but this was pre-vaccine, too, and all the data was coming out about disparities and all the risks, and it was just like, “Whoa.”

And so I kind of stopped. I laughed, and then I scrolled on, but I kept going back to it, trying to think through why this was bothering me so much. And the reason is all those reasons: health disparities. Saying “just watch the weight” is not offering evidence support. It’s not going to decrease his risk for severe disease or death. But to say “just watch the weight,” what’s he going to do? And the doctor wasn’t addressing the chief complaint.

So I did a duet of the video. That was my first time. On TikTok, that’s where you’re side by side. It’s kind of like that. So they played his video, and then at the top you can put text, so I put, “This is medical gaslighting and is dangerous during COVID.” And again, I’m getting like five views on my videos, so I’m thinking, “Great.” And I was like, “Wow,” I had like 6,000 views of that video before I went to bed. I posted in the afternoon, and people were starting to comment: “Oh, this happens to me all the time.” “This is why I don’t go to the doctor.” “I haven’t been to the doctor for 20 years.” “Doctors never listen. They just blame weight for everything.” “I don’t even go in for the weight. I could go in with my arm cut off, and the doctor would say, ‘Just watch the weight.'”

And so I went to bed. I opened my phone, got on TikTok, and saw it said 44K views, so I was like, “Wow, holy crap.” But then I opened up the comments, and there were floods of comments of the same experiences, which is what’s really cool about these social media apps: There’s a way to connect and have that sharing of the collective voice. Of course, there’s a lot of hate, too, people who have weight stigma and bias too.

So anyway, I couldn’t believe some of the comments. “I don’t even want to go to the doctor for anything anymore. My doctor is trying to shove surgery on me. I barely eat, but he thinks surgery will fix it.” “Started losing weight by starving myself, and the first thing my doctor said was, ‘Whatever you’re doing to lose weight, keep doing it. It’s working great.'” “I passed out because I was eating very little, and I went to the doctor, and she told me to watch my weight after I had lost 70-plus pounds, was bones.” “Same here. I wasn’t eating because I couldn’t afford groceries, shaking my head.” “I thought I was the only person to deal with this.” “My eating disorder wasn’t taken seriously until I entered a normal weight category and had extremely low vitamin levels. It had been years.” “Medical gaslighting caused me to go for years being improperly treated for type 2 diabetes when I actually have type 1. I now have complications.” Those are just a few, and there were over 800 comments.

And so I was starting to notice the trend. My daughter and I, as I was sharing the comments with her, and of course she was like, “Mom, you’re getting viral.” It posted, I don’t know, 450K views, which isn’t viral to some people, but it was to me at that time. And so Katherine and I started really mining the comments and going through what the trends are. And she was the first one to say it. She’s like, “Why are these people going to medical school? This is medical negligence. I mean, if they’re just going to say ‘just watch the weight’ and not really help their patients who are at risk, it sounds like medical negligence.” And I was like, “Yeah, it is.”

And then we decided to create kind of our own qualitative TikTok study and really mine the comments. Of course, we had to throw a lot of them out, and then she did all the lit research to look at different articles. There was a study from the UConn Center for Food Policy and Obesity that came out at the same time, across six countries, and they had almost 14,000 participants, and they showed weight stigma was really common from family members, classmates, and doctors, 58 to 73 percent.

And so weight stigma is defined as when there’s physical traits, character traits, labeling the bearers as having lower social value, and then weight bias takes it further, where the victims become targets of prejudice and unfavorable treatment. And then I define this as medical gaslighting, which you can’t find much on, weight and medical gaslighting, but this was seen in many of the commenters’ patient experiences. It occurs when medical professionals downplay or silence marginalized patients’ self-reported experiences with illness. And I’ve been gaslit before, and my job is like, “This is gaslighting, and it’s due to the weight stigma and bias.”

Kevin Pho: Now that you have a little bit of a bigger, more influential TikTok platform, how are you using that to combat the false and disinformation that’s out there on TikTok?

Karla Lester: Oh, thanks for asking me that. I wasn’t planning on being the doctor who’s known for disrupting weight stigma and bias in health care on TikTok, but my expert identity is Dr. Karla Activist MD. So one of the things I’m really committed to is having my free voice. So I definitely have done several videos about this. I follow the TikTok trends to try to make it funny, too, and it’s a place where people can share. I have people who actually tag me and ask me to do videos on different topics that maybe their doctor hadn’t addressed. Of course, I’m not giving out any medical advice, and I tell everybody it’s obviously my opinion. There are some amazing doctors out there.

And one of the main things that I did was try to help the patients own their health power, because you’re not stuck. It’s a consumer-driven industry. I know we feel like it, so don’t play the victim. I mean, I’m a big part of that. There are amazing doctors. Also, recognize weight is obviously, I mean, I’m an obesity medicine doctor, I’ve been taking care of patients for a long time. We have to face the reality that weight has health-related consequences that are very severe. So we also can recognize that, and I call this out: We’ve gotten it wrong in medicine and health care in talking about obesity as caloric and not hormonal.

And I’ve done a lot. I did a 12-week Reverse Your Insulin Resistance challenge on TikTok, and I finished that recently, and I’m going to create an ebook and write a book about it. And it’s 12 weeks of, I showed up every day. I did over 175 videos on TikTok. I did YouTube videos and podcasts every week, and created amazing content that incorporated self-love superpower, which is my whole platform, and also life coaching tools, and then the low-carb lifestyle, addressing your metabolic health. So I’m willing to call out that we’ve gotten it wrong.

And also, I direct people to doctors, to the ABOM.org website, doctors like me who are board-certified in obesity medicine, to find someone near you, and to read The Obesity Code by Dr. Fung. And so, I mean, it comes with its disadvantages too, like when you’re willing to say, “Hey, we’ve gotten this wrong,” and, as an expert in childhood obesity, “I focus too much on BMI,” and then people will pile on you in the comments. But it’s OK.

Kevin Pho: Can you share a story, case study, or an example where your TikTok presence has made a positive difference in one of the commenters’ or content creators’ lives?

Karla Lester: Oh, yeah. Well, before this post, I first started following the body-positive creators, and I just decided that what I was going to do is be completely curious and learn. So I have really great connections and relationships with the body-positive creators, because the cyberbullying that happens is just profound. So there’s one in Canada who I follow closely. Her account gets banned for showing up and doing the same thing that a thin content creator would post. And so I’m an advocate for body-positive creators on the app, and they know me.

A couple of stories from this week. So one is, she actually had Cushing’s disease, and she wasn’t diagnosed for years, and her doctor just said, “Oh, you need to eat less, move more,” basically the bullet-point recommendations. And so she and I have created a common connection, and I’ll duet her videos, or she loves my videos and shares mine, and we talk about how doctors need to really focus on what’s the etiology: Look for the causes, look for the pathology, work this up.

And there’s another woman who’s starting a weight loss journey. She’s called Reducing Red Hat, and she does beautiful work, and she shares her story. And she posted a video of her eating at Burger King, and she was eating a more mindful choice there, and the hate and trolls that came out, it was unbelievable. So she created a response video talking about how this other very famous content creator has millions of followers, and she can do these things, and she eats an In-N-Out burger. And it wasn’t anything against the content creator, but it’s thin privilege. And I posted, “Yeah, it’s totally ridiculous,” and then I posted a response video, and the hate that I get too for defending her. And so I do a lot with really supporting people who are going on this journey, who are brave enough, with the courage to show up to share their journey, because it is hard.

Kevin Pho: We’re talking to Karla Lester. She’s a pediatrician, obesity medicine specialist, and life coach, and she co-wrote the KevinMD article “Medical gaslighting due to weight stigma and bias is harmful: a viral TikTok study.” Karla, you mentioned the word “hate” a couple of times in terms of the response to your increasing platform and influence on TikTok. How do you deal with that?

Karla Lester: Well, I’ve had a lot of coaching. That’s the most powerful thing for me. So one of the things that I really want to tell doctors, too, is that we can’t fix and solve all of this issue, but what we can do is recognize what we cause and control, and that’s not much. But we can show up to create community through compassionate connection, which is my vision now. So whenever I’m doing that, and I’m inspired to do that, then I’m fine. It doesn’t matter, any of the comments that I get or the trolls. But one of the things is, we can decide how we want to show up and then where we put our attentional focus. So you have to have intentionality if you’re going to show up on these apps, like TikTok or Instagram or wherever you’re going to put your time into.

I also have a strategy. I got a death threat when I did a COVID post advocating for people to get vaccines if you can. It was just a simple post, and I got a death threat, and then I did a response video to that. Of course, on TikTok you can report, you can delete the comments, and then you block. And so I really do spend time doing that. I actually got coached by my teens in my IME Community on how to handle it, because they were like, “Whoa, whoa, whoa.” They were going through my TikTok, and we were spending time on that, and they tell me what kind of videos to make. And they said, “If it’s misinformation, if it’s truly wrong, you should do a response video to clarify, and then always lead with that you’re the physician,” because we all know that experts don’t get credit now. So yeah, I have a strategy. I’ve just been through so much in my career that it doesn’t really bother me. I think I’m just going to keep going.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Karla Lester: Well, I think the most important thing is for physicians, like, I’m not a perfect doctor. I haven’t been, even though I’ve done this work. I just keep learning, and it’s OK to challenge the status quo of what we’ve been taught. Please recognize your weight stigma and bias, and you can go into each patient room with a clean mind. Your patient’s weight has no reflection on, you know, your audience. They may not be at a stage of change to consider any changes in their life at that point.

So the main thing, too, is that it’s OK to know that there’s nothing wrong with having thoughts or beliefs, because everybody does, and we don’t like all of them. Those are just like rainbows that come and go in our brain. But when we don’t challenge them, and we stay attached to those beliefs, fixed and limited beliefs that aren’t helping our patients and cause us to show up as the kind of physician that we didn’t intend to show up as when we went into medicine, you can let go of those fixed and limited beliefs that cause you to have weight stigma and bias toward your patients, and have a compassionate approach. Also, we are not there to fix and solve. You are there to show up and connect with compassion, and that’s what’s going to transform your patient’s self, when you’re a compassionate, listening doctor.

Kevin Pho: Karla, thank you so much for coming back on the show and sharing your time and insight.

Karla Lester: Thank you.

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