I think of “Tim” often. He was a coworker, dedicated to his job as a staff member and doing his best on behalf of our medical students, staff, and faculty. He was smart, funny, insightful, and always helpful. Having no local family, he retired early and was happily settling into retirement in the community. We did not hear from him for a while. Then the bad news arrived. He had died at home of natural causes, alone. You see, ironically, Tim hated going to the doctor. “All they ever tell me is to lose weight.” Tim’s death was tragic, and possibly preventable. It is likely that we have all had patients like Tim. You see, Tim’s BMI was over 50, and he suffered from the stigma and shame associated with his size.
His death certainly made me reflect: How could we have done better by him, and do better on behalf of others like him?
Tim’s story came to mind again because of the new American College of Physicians (ACP) position paper, “Public Policy Approaches to Adult Obesity,” from the college’s Health and Public Policy Committee. As much as we collaborate with and care for our patients one-on-one, substantive and broader-scale impact will happen by shining bright spotlights on the issues, changing practices, and adopting paradigm-changing policies.
So, what does the paper say? First, obesity is a complex, multifactorial condition with significant societal and personal costs for those afflicted. Up to 40 percent of U.S. adults have obesity. Rates are higher in the Midwest and South, and in rural areas as compared to urban centers. We have more treatments than ever before; however, high costs and coverage restrictions remain barriers for many. The complexity of the condition requires a multi-pronged response.
Real physician voices, twice a week
Free, and one click to unsubscribe.
The paper’s recommendations include things such as comprehensive payer coverage of evidence-based interventions, sufficient reimbursement, and the expansion of access to nutritious foods. All health care settings should provide accommodations for people with obesity, such as appropriately sized chairs and blood pressure cuffs, and discrete, private care areas. Medical educators should incorporate evidence-based obesity care and nutrition content into their curricula. And we must support initiatives to reduce bias and stigma, including using person-first language (e.g., “The man with obesity is young” rather than “The obese man is young”).
Federal dietary guidelines must be based on sound scientific evidence, and we must educate the public about healthy eating. Community planning and environmental policies that encourage safe, active transportation and safe physical activity are recommended. A robust research agenda, which includes ways to achieve equitable care for adults with obesity, must be free of industry and political interference.
Tragically, Tim suffered the worst possible outcome. What can we do to help a patient like Tim establish a trusting relationship with health care professionals?
Undoubtedly, these recommendations could have helped Tim, or patients like him, especially early on. And then we circle back to the necessity of decreasing bias, stigma, and shame. How do we do that? Like the overall multisector approach to obesity, a multisector approach to decreasing stigma is also required. Educational campaigns for health care professionals to increase understanding of obesity causes and reminders to first assess our own biases are recommended. Use shared decision-making to develop care plans and even plans for what to discuss. A thoughtful 2020 international consensus statement for ending obesity-related stigma describes its societal widespread presence and contains a pledge to eliminate it.
In addition, the ACP hosts the Obesity Management Learning Hub, which contains numerous resources addressing treatments, prevention, management, conversations, and more. And Annals of Internal Medicine hosts a rich repository of content pertaining to overweight and obesity.
In many ways, together with using the ACP position paper’s recommendations, Tim’s story reminds us to return to fundamentals. Meet patients where they are. Listen. Demonstrate respect and dignity. Avoid judgment and derision. And we must get out of our own heads: Focus on the patient. What are they thinking? How do they feel? Is this the first time they have been to a clinic in months? Years? Find and show empathy and compassion. Demonstrate these principles and be a role model for our teams.
Undoubtedly, and sadly, there will be more deaths like Tim’s. We can work together to erase stigma and shame and to promote health among our patients with obesity. Tim, if he could, would thank us. Let’s do this together, for him.
Janet A. Jokela, MD, MPH, completed her term as ACP Treasurer at IM 2025. She serves as professor and senior associate dean of engagement at the Carle Illinois College of Medicine, Urbana, IL. She may be reached on BlueSky @drjanetj.bsky.social.
The American College of Physicians is the largest medical specialty organization in the United States, boasting members in over 145 countries worldwide. ACP’s membership encompasses 163,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who utilize scientific knowledge and clinical expertise for diagnosing, treating, and providing compassionate care to adults, spanning from those in good health to individuals with complex illnesses. Stay connected with ACP on X @ACPIMPhysicians, Facebook, LinkedIn, and Instagram @acpimphysicians.
