Oxford Dictionary defines stigma as “a mark of disgrace associated with a particular circumstance, quality, or person.” In other words, it’s a state of being in shame. One of the most influential thought leaders in shame is Brene Brown. She describes shame as “the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging. We feel like something we have experienced, done, or failed to make unworthy of connection.”
As a physician, I exclusively work with two populations that deal with stigma and shame on a daily basis: individuals with obesity and women in perimenopause.
Patients with obesity are treated differently. There is no doubt in my mind. I have personally seen and felt it as a person with obesity myself. My patients tell me stories of how they are treated much better by others after they have lost their weight. I think our innate nature to mistreat patients with obesity likely stems from the fact that a lot of people still think that losing weight is a matter of willpower—sewing our mouths shut and getting on the treadmill. It’s ignorance. It’s about not understanding why it is a disease. So the first step in breaking that long-held stigma is education. We have to battle the stigma of science. We educate the medical community, which can perpetuate old beliefs, and we educate society through the power of social media.
Stigma exists both externally (dished out by other people) and internally. Internal stigma is much harder to navigate. The majority of my patients deal with this internal stigma of failure, not being able to “cut it” with diet and exercise. To shatter this long-held belief, I share with them the science of how our brain regulates our metabolism and our food-seeking behaviors, both in a biological as well as a psychological sense. It’s a process we work through. As they learn mindfulness and skills to navigate things and use tools that help treat the biological drivers, they start to believe in their power and develop that self-trust.
Women going through perimenopause/menopause also deal with a different shame. The shame of neglect and being dismissed. Menopausal hormone therapy is safe (for most women), and FDA-approved medications are available, yet we are not offering it. Symptoms related to hormonal fluctuations are based on science, yet we do not think of perimenopause as part of the differential diagnosis when seeing a midlife woman with symptoms. Women’s health is appallingly behind in taking care of our health in the midlife transition. I have heard numerous stories of women who have gone to their providers and were met with dismissive words. Very commonly, they get unhelpful advice like “You just need to suffer through the symptoms you are experiencing as this is a natural event; it will go away.” They would get diagnosed as depressed or anxious and prescribed an antidepressant for their symptoms.
I don’t blame the medical community, as the truth is, we are just not educated about it. The menopausal transition and the quality-of-life-changing symptoms of insomnia, cognitive dysfunction, pain, and so many more are labeled as “part of the change” and something to be suffered through by us midlife women. To be perfectly honest, I also held that same belief before. As they say, lived experience trumps academic experience. It was not until I was going through my own experience with it that I tried to figure myself out and deep-dived into it and saw the science of what menopause specialists call “the zone of chaos.” Perimenopause is literally a rollercoaster of a sharp rise and plummeting of our hormone levels – on repeat. Irregularly irregular (like atrial fib). No wonder the symptoms can be so varied and miserable.
Imagine the double whammy of a woman in midlife also dealing with the medical condition of obesity. It’s time to break the stigma for both situations. It’s time to use science to shatter the misinformation, myths, and incorrect assumptions about both obesity and perimenopause.
I am sorry, but I think it’s time we women in midlife stop suffering.
Caissa Troutman is an obesity medicine and family physician.
