Weight Bias and Obesity Stigma in Healthcare Nursing CE Course

The AACE reiterates that obesity (also called adiposity-based chronic disease) is a complex, multifactorial chronic disease, emphasizing individualized care using both anthropometric measures (like BMI) alongside clinical context (e.g., metabolic health, functional status; Nadolsky et al., 2023). Recognition of obesity as a medical disease is more than a semantic shift; it reframes how it should be approached clinically. This recognition is foundational to reducing bias and stigma. Rather than attributing obesity solely to personal responsibility or lifestyle “failures,” the disease model encourages understanding of its biologic drivers and supports chronic disease management principles, including long-term treatment, monitoring, and patient support (Rubino et al., 2020). This view is additionally supported by the American Heart Association (AHA) and the American Diabetes Association (ADA), advocating for individualized treatment plans that incorporate behavioral therapy, pharmacotherapy, and bariatric surgery when appropriate. HCPs must be equipped with accurate knowledge of obesity and its classifications to appropriately assess and care for individuals while avoiding stigmatizing language and practices (ElSayed et al., 2023; Nadolsky et al., 2023).

Global Disparities and Risk Patterns

The global burden of obesity is not evenly distributed, with marked disparities observed across countries, regions, and sociodemographic groups. In both high- and low-income nations, obesity prevalence is shaped by systemic factors, including race, ethnicity, gender, income, and geography. In the United States, obesity disproportionately affects non-Hispanic Black and Hispanic populations, particularly patients assigned female at birth. Current data shows that 57% of non-Hispanic Black females and 44.8% of Hispanic females are living with obesity, compared to 39.8% of non-Hispanic White females. These disparities are deeply rooted in structural inequities such as limited access to affordable health care; healthy foods; safe environments for physical activity; and culturally responsive, weight-inclusive care (CDC, 2024a; Global Burden of Diseases [GBD] 2015 Obesity Collaborators, 2017; Pearl et al., 2024).

Low- and middle-income countries (LMICs) globally are experiencing rapid increases in obesity owing to urbanization, changes in food systems, and sedentary lifestyles. Populations in regions such as Latin America, Southeast Asia, and the Middle East are particularly affected, where diets high in ultraprocessed foods have become more accessible, while opportunities for physical activity have declined. This shift in disease burden now coexists with undernutrition in many LMICs, creating a “double burden” of malnutrition and obesity within the same communities (GBD 2015 Obesity Collaborators, 2017; Liu et al., 2024). Even within high-income countries, social determinants of health continue to drive disparities in obesity risk. Factors such as housing instability, transportation barriers, educational inequity, and chronic stress all contribute to increased vulnerability to obesity across marginalized populations. Additionally, childhood obesity is rising at a faster pace than adult obesity in many parts of the world (CDC, 2024a; Liu et al., 2024; WOF, 2023).

Medical and Economic Impact

The health consequences of obesity are vast and well documented. Early-onset obesity is associated with increased risk of more than 230 medical conditions as well as a greater likelihood of experiencing psychological distress, disability, and reduced quality of life throughout adolescence and adulthood (CDC, 2024b, 2024c; National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], 2025). Weight-related comorbid medical conditions include, but are not limited to the following:

• type 2 diabetes mellitus (T2DM)
• cardiovascular disease, including hypertension, coronary artery disease, and lipid disorders
• nonalcoholic fatty liver disease (NAFLD)
• obstructive sleep apnea
• osteoarthritis
• certain cancers (e.g., breast, colorectal, pancreatic, and endometrial)
• fertility disorders (NIDDK, 2025)
• 
  

In addition to its toll on health, obesity carries an enormous economic burden. The 2020 update from the Milken Institute’s Weighing Down America report estimates that the annual cost of chronic diseases linked to obesity in the United States exceeds $1.4 trillion. This price tag includes both direct health care costs and indirect costs such as decreased productivity, work limitations, and absenteeism (Lopez et al., 2020; Obesity Medicine Association [OMA], 2023a). Sweis (2024) evaluated the economic burden of obesity using projections from the GBD database (2020–2024), incorporating deaths, Years of Life Lost (YLLs), and Years Lived with Disability (YLDs), scaled to 2024 population data. Findings revealed that the United States emerged with the highest economic burden, followed by China. Globally, obesity has been identified as a threat to development in low-income countries, where the rising costs of managing obesity-related chronic diseases could overwhelm fragile health systems. Without aggressive public health intervention, obesity is expected to outpace undernutrition as the leading contributor to poor health in LMICs by 2030 (GBD 2015 Obesity Collaborators, 2017; Liu et al., 2024).

Types of Weight Bias

Weight bias and obesity stigma are pervasive in health care settings and negatively influence both the quality of care and patient outcomes. Understanding the different types of bias and their manifestations is essential for HCPs committed to equitable care (Pearl, 2018; Puhl, 2022).

Weight Bias

Weight bias refers to negative attitudes, beliefs, or assumptions about individuals based on their weight, particularly toward those with larger bodies. It can manifest as stereotyping (e.g., assuming laziness, noncompliance, or poor hygiene), derogatory comments, or different standards of care. Weight bias exists across all levels of society, but its presence in health care is especially harmful because it undermines the patient–provider relationship and contributes to disparities in care access and outcomes (Fonoudi et al., 2025; Fruh et al., 2021; Puhl, 2022).

Obesity Stigma

Obesity stigma is the social devaluation of individuals perceived as living with overweight or obesity. It encompasses societal norms, institutional practices, and media portrayals that reinforce negative stereotypes and discrimination (Rubino et al., 2020). While weight bias refers to individual attitudes or behaviors, stigma is a broader social process that results in loss of status, exclusion, and discrimination.

Healthcare professionals may consciously or unconsciously internalize these societal messages, leading to implicit bias in their clinical encounters. For example, research has shown that clinicians spend less time with patients with obesity, offer fewer preventive services, and attribute unrelated health concerns to weight (Alberga et al., 2019).

Sizeism

Sizeism is a form of systemic discrimination based on body size. It reflects cultural norms that prioritize thinness and marginalize individuals living with larger bodies. In health care, sizeism can influence the availability of appropriately sized medical equipment, the design of facilities, and the language used in patient records. Unlike personal bias, sizeism is embedded in institutional policies and practices, often unintentionally but with significant consequences (Pausé et al., 2020; Tomiyama et al., 2018).

Weight Discrimination

Weight discrimination is the unequal or unfair treatment of individuals because of their weight. It may occur in employment, education, or health care settings and includes the denial of opportunities, derogatory remarks, or differential treatment. In a national survey, over half of adults with obesity reported experiencing weight discrimination from healthcare professionals (Westbury et al., 2023). This type of discrimination has been associated with increased psychological distress, avoidance of medical care, and reduced adherence to treatment plans (Pearl, 2018).

Implicit Versus Explicit Bias

Bias can be either implicit or explicit. Explicit bias involves conscious attitudes, beliefs, or behaviors. A clinician who openly believes that individuals with obesity are noncompliant or responsible for their condition exemplifies explicit bias. Implicit bias refers to unconscious associations or assumptions that influence behavior without awareness. Even well-intentioned providers may hold implicit biases that affect their clinical decision-making, communication style, and trust-building with patients. Implicit Association Tests (IATs) are tools designed to assess how strongly individuals associate specific ideas, attitudes, or stereotypes, frequently operating outside of conscious awareness. Studies utilizing IATs have revealed that a significant number of health care professionals, including nurses, harbor moderate to strong implicit bias against individuals with larger body sizes, often without realizing it. Since implicit biases are automatic and subconscious, they are more difficult to detect but equally impactful in clinical settings (Jungnickel et al., 2022; Lawrence et al., 2021).

Language and Communication

The language used by HCPs reinforces weight bias and stigma. Terms such as “morbidly obese” or “fat” can be stigmatizing and emotionally harmful. Person-first language (e.g., “person with obesity” instead of “obese person”) is recommended by the AMA, Obesity Action Coalition (OAC), and TOS. Research consistently indicates that neutral terms such as “weight” or “unhealthy weight” are generally favored during discussions between HCPs and patients about their weight. Respectful, nonjudgmental communication enhances trust and reduces shame, which in turn improves patient engagement and health outcomes (Bannuru, 2025; OAC, n.d.; Puhl, 2020; Schumacher et al., 2023; Shaw, 2025). Motivational interviewing (MI) is a communication strategy that emphasizes empathy, autonomy, and collaboration. It has been shown to reduce resistance, promote behavior change, and reduce weight stigma in clinical conversations. Training nurses and other HCPs in MI techniques may improve not only weight-related discussions but overall quality of care (OMA, 2023b; Moizé et al., 2025; Shaw, 2025).

Intersectionality and Compounded Stigma

Weight stigma does not occur in isolation. Its effects are often magnified by other forms of discrimination, including those based on race, gender identity, sexual orientation, disability, and socioeconomic status—a concept known as intersectionality. Intersectionality describes how overlapping identities compound discrimination and create unique patient experiences within health care systems. For example, Black females face increased scrutiny related to both weight and race in health care settings. Studies show that Black females with obesity are more likely to be considered by providers as “noncompliant” or “unmotivated” compared to White females of the same BMI. This compounded bias may lead to further health care avoidance and unequal treatment. Similarly, individuals in the LGBTQ+ community who live in larger bodies face stigma tied not only to their weight but also to their sexual identity or gender presentation. Transgender patients report significant weight-related distress when seeking hormone therapy or surgical care, particularly when BMI cutoffs are applied rigidly or without context (Pearl et al., 2024; Sikka et al., 2024; University of Connecticut Rudd Center for Food Policy and Health, 2023).

People with disabilities who also live with obesity often encounter a double burden of bias. They may be perceived as “noncompliant,” or assumptions may be made about their mobility or intellectual capacity. Providers must be careful not to ascribe functional limitations solely to weight and instead assess each patient individually. Socioeconomic bias also plays a role. Individuals from lower-income backgrounds may have reduced access to healthy foods, safe environments for physical activity, or obesity treatment services, yet they may still be judged for “unhealthy behaviors.” Understanding intersectionality is crucial for delivering compassionate, equitable care. HCPs must learn to recognize how overlapping identities shape patient experiences and outcomes. Bias mitigation efforts must include all aspects of patient identity—not just weight (Kaeberle, 2025; Pearl et al., 2024; Sikka et al., 2024; University of Connecticut Rudd Center for Food Policy and Health, 2023).

Consequences of Weight Bias in Health Care

Weight bias and obesity stigma have far-reaching consequences in health care, influencing not only how care is delivered but also how patients experience and engage with health services. These consequences can manifest at multiple levels (interpersonal, institutional, psychological, and clinical) and contribute to health disparities, reduced patient satisfaction, and worsened clinical outcomes (Fonoudi et al., 2025; Fruh et al., 2021).

Delayed and Avoided Care

Numerous studies have demonstrated that individuals who experience weight-based stigma are more likely to delay or avoid seeking health care services altogether. Fear of being judged, shamed, or blamed for their weight can deter patients from routine screenings, preventive services, and even urgent care visits (Fonoudi et al., 2025; Fruh et al., 2021). In a national survey, nearly 69% of individuals with obesity reported avoiding medical appointments owing to anticipated weight stigma. These delays can result in late diagnoses of chronic illnesses such as T2DM, hypertension, and cancer. Females with obesity are less likely to undergo recommended Pap smears, mammograms, and other cancer screenings compared to their lower-weight counterparts, increasing the risk of poor outcomes (Fruh et al., 2021; Puhl, 2022).

Diagnostic Overshadowing and Inadequate Treatment

Weight bias can lead to diagnostic overshadowing, a phenomenon in which HCPs attribute symptoms to a patient’s weight without sufficient investigation into other possible causes. This can result in missed or delayed diagnoses for serious conditions, including autoimmune diseases, endocrine disorders, and even infections (Brown et al., 2022). In some cases, HCPs may withhold necessary treatments or interventions owing to assumptions about patient noncompliance or the belief that weight loss should precede treatment. For instance, patients with obesity have reported being denied joint replacement surgery or fertility treatments unless they lost weight, regardless of clinical need or urgency (Tomiyama et al., 2018). Studies have found that providers often spend less time in appointments, offer less patient education, and display less empathy toward patients with higher BMI, potentially compromising care quality (Fonoudi et al., 2025; Fruh et al., 2021).

Psychological and Emotional Harm

Weight stigma in health care settings contributes to significant psychological distress. Patients who experience bias or discrimination report higher levels of stress, anxiety, depression, and disordered eating behaviors. Repeated stigmatizing experiences can erode self-esteem, increase feelings of shame, and lead to internalized weight bias, where patients begin to accept and apply negative stereotypes to themselves. Internalized weight bias is particularly damaging. It has been linked to poorer health outcomes independent of BMI and is associated with maladaptive coping strategies such as avoidance of physical activity, binge eating, and reluctance to follow medical advice (Pearl, 2018; Westbury et al., 2023).

Impact on Patient–Provider Relationship

Weight bias undermines the patient–provider relationship by diminishing trust, communication, and collaboration. Patients who perceive judgment or disrespect are less likely to disclose relevant health information, ask questions, or adhere to recommended treatment plans (Fonoudi et al., 2025; Fruh et al., 2021). They may also switch providers or drop out of care entirely, especially if prior encounters involved humiliation or verbal derogation. Even subtle cues, such as a provider’s body language, tone, or facial expressions, can signal disapproval and reinforce stigma. These nonverbal forms of bias, often driven by implicit attitudes, can be just as harmful as overt discrimination (Alberga et al., 2019). In contrast, positive, respectful HCP communication has been shown to improve patient engagement and satisfaction, even among individuals with prior experiences of stigma. This underscores the importance of training HCPs in bias recognition and communication strategies to foster inclusive care environments (Moizé et al., 2025; OMA, 2023b).

Health Outcomes

The impact of weight bias and obesity stigma leads to detrimental health outcomes. These may include the following:

• increased physiologic stress responses (e.g., elevated cortisol, inflammation) due to chronic exposure to discrimination
• a higher risk of metabolic syndrome and cardiovascular disease independent of body weight
• greater incidence of depression, anxiety, and eating disorders
• lower adherence to medication regimens and lifestyle recommendations
• decreased engagement in physical activity due to embarrassment or avoidance of stigmatizing environments (Pearl, 2018; Westbury et al., 2023)

These outcomes contradict the common misconception that stigmatizing or pressuring patients to lose weight will motivate behavior change. In fact, evidence shows that stigma undermines motivation and contributes to weight gain over time, rather than weight loss (Tomiyama et al., 2018).

Organizational and Economic Consequences

At the system level, weight bias in health care contributes to inefficiencies and increased costs. Missed diagnoses, delayed care, and patient attrition increase the burden on emergency services and contribute to higher long-term costs associated with unmanaged chronic disease. Health care institutions that fail to address weight stigma may also face reputational harm, reduced patient satisfaction scores, and challenges meeting quality metrics tied to patient experience and equity. As a result, incorporating weight-inclusive policies and training is not only ethically imperative but is also a practical strategy for improving care delivery and outcomes (Fruh et al., 2021).

Joint International Consensus Statement for Ending Obesity Stigma

To raise awareness among HCPs, policymakers, and the general public, an international panel of experts from diverse disciplines, including leaders from scientific institutions, examined the current evidence on the origins and impact of weight stigma. Through a structured modified Delphi approach, they created a consensus statement offering actionable recommendations to address and reduce weight-related bias. The group emphasized the need for academic institutions, professional societies, media outlets, public health agencies, and government bodies to support educational efforts that reshape societal views on obesity in alignment with contemporary scientific understanding. A summary of key recommendations is as follows:

• educate the public about the complex biologic and societal factors contributing to obesity
• reframe public narratives grounded in modern scientific understanding, taking into account genetics, metabolism, and environmental context
• make systemic changes to eliminate weight bias and improve care access for individuals with obesity (Rubino et al., 2020)

As outlined in the statement, reducing stigma is both a human rights goal and essential to support evidence-based obesity prevention and care (Rubino et al., 2020).

Evidence-Based Obesity Guidelines and Treatment Strategies

Effectively addressing obesity in clinical settings requires evidence-based, patient-centered care that recognizes obesity as a complex chronic disease on a par with any other type of medical condition. Numerous professional organizations, including the US Preventive Services Task Force (USPSTF), the ADA, and TOS, have published guidelines that emphasize screening, treatment, and the importance of reducing weight bias in the delivery of care (Bannuru, 2025; Nadolsky et al., 2023; Rubino et al., 2020 USPSTF, 2018).

USPSTF Recommendations for Screening and Intervention

The USPSTF recommendation statement on behavioral interventions for weight loss to prevent obesity-related morbidity and mortality was last updated in 2018 and is undergoing revision. The guideline currently recommends, with Grade B evidence, that clinicians screen all adults aged 18 and older for obesity using BMI and offer or refer individuals with a BMI of 30 kg/m² or greater to intensive, multicomponent behavioral interventions (USPSTF, 2018). These interventions should include dietary counseling, increased physical activity, and behavioral strategies such as goal setting and self-monitoring. Structured programs including at least 12 sessions during a year are associated with clinically meaningful weight loss and improvement in metabolic health markers. The USPSTF also recommends, with Grade B evidence, that clinicians provide or refer children and adolescents 6 years or older with a high BMI (95th percentile or greater for age and sex) to comprehensive, intensive behavioral interventions. These early interventions are critical in preventing long-term comorbidities and addressing family-level determinants of health (USPSTF, 2024; Wadden et al., 2020).

Guidelines for Chronic Disease Management

The ADA includes obesity treatment as a cornerstone of T2DM prevention and management. Evidence-based standards of care focused on identifying and addressing weight stigma and bias within clinical settings were included as part of the 2025 guidelines for the management of overweight and obesity. The standards were developed under the leadership of the professional practice committee of the Obesity Association, a division of the ADA. They were designed for HCPs and clinical teams, aiming to raise awareness of weight stigma and reframe obesity as a multifaceted chronic disease, with leaders supporting the adoption of these standards as a foundational step toward ensuring fair and effective care for people living with obesity. The standards encourage HCPs to promote nonjudgmental, evidence-based care free from stigma and blame and avoid language or behaviors that imply that moral failure, lack of willpower, or personal responsibility are the sole causes of obesity. They also encourage the development of institution-wide training and policies that foster inclusive and supportive clinical environments. In the ADA Standards of Care, intentional weight loss of 5% or more is associated with improved glycemic control, blood pressure, and lipid profiles among people with T2DM (Bannuru, 2025; ElSayed et al., 2023).

The ADA recommends pharmacotherapy or bariatric surgery for individuals who meet clinical criteria and have not achieved sufficient benefit from lifestyle interventions alone. Although they were last updated in 2013, they remain the latest joint guidelines from the AHA, the American College of Cardiology (ACC), and TOS. The guideline recognizes obesity as a chronic relapsing condition, emphasizing long-term follow-up, individualized treatment plans, and shared decision-making—especially when introducing antiobesity medications or surgical options (Jensen et al., 2013). The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease focuses on clinically meaningful weight loss, recommending approximately 5–10% of body weight over about 6 months. This level of weight reduction is associated with improvements in cardiovascular risk factors like blood pressure, lipids, and glycemic control in persons living with obesity (Arnett et al., 2019).

Clinical Interventions: A Tiered Approach

Evidence supports a tiered approach to comprehensive obesity care, starting with lifestyle interventions and advancing to pharmacotherapy or bariatric surgery when appropriate. Key components include the following:

• Nutrition Counseling and Dietary Therapy: Registered dietitians or trained providers should guide patients in adopting calorie-reduced, nutrient-dense eating patterns (e.g., Mediterranean diet, dietary approaches to stop hypertension [DASH]). Interventions are more effective when tailored to cultural preferences and individual readiness (Wadden et al., 2020).
• Physical Activity: Guidelines recommend ≥150 minutes/week of moderate-intensity exercise for general health, with greater amounts (≥250 minutes/week) necessary for weight loss maintenance over time. However, physical activity should be promoted in a stigma-free, accessible manner, recognizing physical limitations and barriers (Arnett et al., 2019; Jakicic et al., 2018).
• Behavioral Therapy: Cognitive-behavioral therapy (CBT), MI, and mindfulness-based interventions have demonstrated efficacy in promoting sustainable behavior change. Group-based or telehealth formats can increase accessibility and retention (Moizé et al., 2025; OMA, 2023b).
• Metabolic and Bariatric Surgery: Surgical interventions (e.g., sleeve gastrectomy, Roux-en-Y gastric bypass) are recommended for adults with a BMI of at least 40 kg/m² or 35 kg/m² or greater with comorbidities. Bariatric surgery leads to substantial weight loss and remission of T2DM in many patients. It should be considered within a multidisciplinary framework that includes nutritional, psychological, and long-term follow-up care (De Luca et al., 2024).

Pharmacologic Treatment

Antiobesity medications may be indicated for adults with a BMI of at least 30 kg/m² or 27 kg/m² and above with comorbidities. These medications have gained increasing attention over the last few years. The introduction and rapid uptake of glucagon-like peptide-1 (GLP‑1) receptor agonists such as semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro) have transformed obesity treatment. Trials confirm dramatic weight reductions of ~15% over 68 weeks, substantially improving metabolic outcomes compared to placebo and lifestyle‑only approaches (Wilding et al., 2021; Jastreboff et al., 2022). As GLP‑1 drugs have gained popularity, many users report social stigma for using “medication shortcuts” instead of “earned” weight loss; a phenomenon referred to as “Ozempic shaming.” Individuals often hide their usage, citing fear of judgment and moral criticism. This secrecy contributes to psychological distress even amid significant health improvements (Pazzanese, 2024). A 2025 cross‑sectional study surveyed HCPs and students in Arab countries regarding attitudes toward GLP‑1 drugs and correlated these with obesity bias using novel obesity scales. Familiarity with tirzepatide (Mounjaro) and semaglutide (Ozempic) was high; however, overall attitudes were slightly unfavorable. Interestingly, those with stronger obesity bias tended to view the medications more favorably, likely because they perceived obesity as a serious health risk meriting pharmacologic treatment (Al‑Mahzoum et al., 2025).

In a recent BMJ Ethics article, Ryan and Savulescu (2025) explore the ethical complexities of prescribing GLP‑1 medications, emphasizing that although these drugs offer clear clinical and personal benefits, prevailing societal narratives and moral judgments may inadvertently reinforce stigma by framing pharmacologic treatment as an illegitimate or “easy” solution. Another recent narrative review discusses how these medications may help reframe obesity as a biologic disease rather than a moral failing, which may help potentially reduce stigma; however, the author warns that high costs and uneven access could paradoxically exacerbate bias against those who cannot afford or do not use them (Heitmann, 2025).

Strategies to Reduce Bias and Improve Equity in Obesity Care

Reducing weight bias and obesity stigma in health care requires a multifaceted approach that includes education, institutional change, patient-centered communication, and systemic reform. These efforts are essential not only for promoting equity but also for improving clinical outcomes and patient satisfaction. Nurses are uniquely positioned to lead these efforts by modeling inclusive care practices and advocating for system-level change (Fruh et al., 2021; Kaeberle, 2025; Lawrence et al., 2021; Talumaa et al., 2022).

Training and Institutional Support

Successfully applying evidence-based obesity care requires more than clinical expertise; it demands organizational dedication to health equity. To foster inclusive care environments, health care institutions should:

• offer bias awareness training to all clinical and nonclinical staff
• provide equipment and furniture suitable for patients of all body sizes
• establish treatment protocols aligned with current obesity guidelines
• represent diverse body types in educational resources
• track quality metrics addressing weight-related disparities (Robinson et al., 2024; Talumaa et al., 2022)

Nursing leadership plays a vital role in championing these initiatives and modeling compassionate, evidence-based care for patients with obesity. A foundational step in combating weight stigma is educating clinicians about its prevalence, effects, and underlying mechanisms. Implicit bias training can surface negative unconscious attitudes and offer strategies to mitigate them. Effective programs typically incorporate the following:

• self-assessment of personal biases using tools like the IAT
• instruction on the multifactorial causes of obesity
• patient stories that highlight real-world experiences
• reflection exercises to examine and revise internalized assumptions (Fruh et al., 2021; Lawrence et al., 2021; Talumaa et al., 2022)

A randomized study demonstrated that medical students who underwent antistigma training exhibited sustained reductions in bias and greater empathy toward patients with obesity six months post intervention (Alberga et al., 2019). To create a sustained culture of inclusion, health care systems should integrate weight bias education into nursing onboarding, ongoing education, and annual competency evaluations (Kaeberle, 2025; Talumaa et al., 2022).

Person-Centered and Weight-Inclusive Care

A weight-inclusive approach reframes the clinical goal from weight loss alone to a broader focus on overall health and well-being. This model emphasizes respectful, individualized care that supports healthy behaviors and addresses psychosocial needs (Westbury et al., 2023). Core principles of weight-inclusive care include the following:

• avoiding weight monitoring as the central outcome
• engaging patients in shared decision-making
• using language that is nonstigmatizing and person-first
• considering and addressing social determinants of health

When patients feel respected and understood, they are more likely to participate in care and adopt sustainable behavior changes—especially when stigma and judgment are absent (Westbury et al., 2023).

Patient-Centered Communication

Communication practices, including word choice and tone, play a pivotal role in either fostering trust or perpetuating harm. Stigmatizing terms like “morbidly obese” or language that assigns blame can cause emotional distress, reduce care adherence, and discourage follow-up (Pearl, 2018). Adopting person-first, respectful language should become standard in all care settings. The following examples may be noted:

• saying “person living with obesity” rather than “obese patient”
• describing “unintentional weight gain” instead of “letting yourself go”
• asking, “Would you be open to discussing your weight today?” rather than making assumptions (Pearl, 2018)

Additionally, HCPs should utilize MI to promote behavior change in a supportive, nonjudgmental way. Key elements of MI include the following:

• expressing empathy through active listening
• respecting the patient’s autonomy and readiness
• codeveloping realistic, patient-driven goals
• avoiding confrontation or unsolicited advice (Moizé et al., 2025; OMA, 2023b)

Evidence shows that interventions using MI improve outcomes such as weight loss, glycemic control, and patient satisfaction in individuals with obesity (Moizé et al., 2025; OMA, 2023b).

Creating Size-Inclusive Clinical Environments

The design of health care settings can also unintentionally signal stigma to patients. Ensuring size-inclusive environments communicates respect and enhances comfort. The following changes can significantly improve patient trust and perception of care (Robinson et al., 2024):

• Appropriately sized furniture: Arm-free chairs, high-weight capacity exam tables, wide blood pressure cuffs, and larger gowns
• Welcoming visual cues: Avoid posters or pamphlets that portray only thin individuals as “healthy”
• Accessible scales: Place scales in private areas, ensure scales can accommodate higher weight capacities (e.g., at least up to 500 lbs.)
• Avoiding public weigh-ins: Offer to weigh patients privately and explain the clinical purpose when necessary (Pearl, 2018)

Promoting the Health at Every Size Principles

The Health at Every Size (HAES) framework promotes respectful care by shifting the focus from weight to healthy behaviors and well-being. The core HAES principles include the following (Association for Size Diversity and Health [ASDAH], 2024):

• Body diversity: Accepting natural variations in body size
• Intuitive eating: Encouraging nonrestrictive eating based on hunger and satiety
• Joyful movement: Promoting physical activity for enjoyment and function rather than weight loss
• Critical awareness: Challenging cultural and scientific assumptions about weight and health
• Compassionate self-care: Supporting emotional and mental health (ASDAH, 2024)

Mounting evidence demonstrates that HAES-based interventions improve self-esteem, reduce disordered eating, and enhance quality of life without harming cardiometabolic health. Integrating elements of HAES into patient education and nursing practice promotes a more holistic approach to health that is less stigmatizing and more sustainable (ASDAH, 2024).

Legal and Ethical Considerations in Weight Discrimination

Unlike race, sex, disability, or age, weight is not a federally protected characteristic under US antidiscrimination law. This legal gap leaves individuals vulnerable to weight-based discrimination in employment, education, housing, and health care, including decisions around insurance coverage, access to procedures, and provider attitudes (Puhl, 2022). As of 2025, Michigan is the only US state that has explicit legal protections against weight discrimination under its civil rights law (Tremont, 2023). However, several cities, including San Francisco, Washington D.C., and New York City (2023), have enacted ordinances prohibiting weight-based discrimination in employment and public accommodations, including health care (City of New York, 2023). In contrast, several countries, such as Iceland and parts of Canada, have more comprehensive legal protections against appearance-based discrimination, offering a framework for broader reform in the United States. HCPs should be aware that even in the absence of explicit legal prohibitions, weight-based discrimination may still violate broader ethical and professional standards and may be challenged under disability discrimination protections if obesity is associated with functional limitations (Fonoudi et al., 2025; Fruh et al., 2021; Westbury et al., 2023).

Ethical Implications of Weight Stigma in Health Care

Beyond legal compliance, HCPs must consider their ethical duty to promote justice, equity, and nonmaleficence. Weight stigma violates the following core ethical principles (Westbury et al., 2023; Piwowarczyk et al., 2024; Puhl, 2022):

• Autonomy: Patients should be empowered to make informed decisions about their health. When clinicians frame weight loss as a moral imperative or make assumptions about motivation, they undermine patient autonomy.
• Beneficence: Providers must act in the patient’s best interest. Ignoring non-weight-related causes of illness due to diagnostic overshadowing can delay appropriate treatment and worsen outcomes.
• Nonmaleficence: Providers are obligated to avoid harm. Stigmatizing language, inadequate equipment, and implicit bias can result in psychological and physical harm to patients.
• Justice: All patients deserve equitable treatment. When patients with higher body weight receive shorter visits, fewer preventive screenings, or lower-quality interactions, this constitutes a failure of distributive justice.

Nurses are guided by the ANA Code of Ethics, which emphasizes respect for human dignity, the commitment to equitable care, and the obligation to address social determinants of health. Nurses must advocate against practices that reinforce stigma or exclude individuals from care based on size (ANA, 2019; Fruh et al., 2021; Kaeberle, 2025; Piwowarczyk et al., 2024).

BMI Cutoffs and Procedural Access: An Ethical Gray Area

One of the most ethically complex issues in weight stigma is the use of rigid BMI cutoffs to restrict access to medical procedures, including the following:

• Joint replacement
• Organ transplantation
• Fertility treatment
• Gender-affirming care
• Bariatric surgery itself (Young, 2023)
• 
  

While clinicians may cite safety or evidence-based thresholds, arbitrary BMI limits can be discriminatory when they are applied without consideration of individual health status, functional capacity, or medical necessity. Informed consent should include an individualized risk-benefit discussion rather than automatic denial of care. Ethical practice requires that institutions reexamine policies using BMI as the sole eligibility criterion and instead integrate holistic, individualized assessments into decision-making frameworks (Fonoudi et al., 2025; Fruh et al., 2021; Young, 2023).

In recent years, advocacy organizations such as the OAC and the National Association to Advance Fat Acceptance (NAAFA) have pushed for national legislation to prohibit weight-based discrimination in employment, housing, education, and health care. In 2023, the introduction of federal legislation known as the Body Size Inclusion Act (not yet passed) sparked national conversation about the need to extend civil rights protections to individuals affected by weight bias. The act would amend Title VII of the Civil Rights Act to include weight and height as protected characteristics (NAAFA, 2023; OAC, n.d.). Nurses can use their voice and influence to advance the following causes:

• support inclusive policy development at the institutional level
• advocate for professional guidelines that reject BMI-based exclusions
• educate colleagues and legislators about the harms of weight stigma
• participate in public health coalitions and patient advocacy groups (Piwowarczyk et al., 2024; Talumaa et al., 2022)

Nursing Advocacy, Education, and Policy Leadership

Nurses represent the largest sector of the health care workforce and are consistently ranked among the most trusted professionals. This positions nurses as powerful advocates for systemic change, including the reduction of weight bias in health care settings. Whether at the bedside, in the classroom, or leadership roles, nurses have the authority and influence to advance equity and foster respectful, inclusive care environments. Addressing obesity stigma is not merely a clinical concern; it is a professional obligation aligned with the ANA’s Code of Ethics, which affirms the nurse’s duty to promote dignity, respect, and health equity (ANA, 2019; Fruh et al., 2021; Marler et al., 2025; Piwowarczyk et al., 2024; Talumaa et al., 2022).

Advocacy in Clinical Practice and Policy Development

Nurses working in direct patient care are ideally placed to identify and disrupt bias in real time, such as when encountering others using stigmatizing language or providing inequitable treatment. Nurses can ensure equipment and care environments meet the needs of patients with larger bodies and advocate for inclusive policies, such as alternatives to BMI cutoffs for care eligibility. Further, nurses can encourage team discussions on stigma during unit-based council meetings, grand rounds, or quality improvement huddles, and participate in ethics committees or diversity, equity, inclusion (DEI) initiatives. At the institutional level, nurse leaders can embed weight bias education into orientation, continuing education requirements, and staff evaluations. They can integrate weight equity into Magnet or Pathway to Excellence quality measures, develop dashboards to track utilization and outcomes by BMI or body size, and lead process improvement initiatives targeting disparities in care access. At the policy level, nurses can engage with professional associations, legislators, or boards to shape inclusive health care policy and support antidiscrimination protections (ANA, 2019; Fricke, 2024; Piwowarczyk et al., 2024; Talumaa et al., 2022).

Despite the scope and impact of the obesity epidemic, most nursing programs offer minimal training in obesity management or weight stigma. This gap contributes to misconceptions and missed opportunities to model inclusive care. Nurse educators and academic leaders can lead curriculum reforms in the following areas:

• evidence-based obesity science, focusing on the physiology of obesity, highlighting the chronic disease model, pharmacotherapy treatment, and surgical options
• social determinants of obesity, such as food insecurity, trauma, access to safe spaces, systemic racism
• weight-inclusive care models
• implicit bias training, including tools like the IAT and case-based reflection (Marler et al., 2025; Piwowarczyk et al., 2024)

Nurses involved in research or quality improvement can contribute to closing knowledge gaps by:

• studying patient experiences of stigma in clinical settings
• evaluating interventions to reduce bias (e.g., MI training, curriculum redesign)
• developing and disseminating tools to assess bias and track patient-reported outcomes
• collaborating on grants and initiatives targeting health equity and access to obesity care (Marler et al., 2025; Piwowarczyk et al., 2024)

Nurse-led quality initiatives can examine whether patients with obesity experience longer wait times, receive fewer screenings, or are less likely to be offered guideline-based therapies. Data collection and patient feedback are powerful tools to drive institutional accountability and change (Marler et al., 2025; Piwowarczyk et al., 2024).

Conclusion and Call to Action

Weight bias and obesity stigma in health care represent significant barriers to equitable, compassionate, and effective care. Despite increased recognition of obesity as a complex chronic disease, individuals living in larger bodies continue to experience discrimination, reduced quality of care, and exclusion from meaningful health dialogues. This course has highlighted the multifactorial nature of obesity, the limitations of BMI as a diagnostic tool, and the far-reaching consequences of bias—ranging from delayed care and diagnostic overshadowing to emotional distress and poorer health outcomes. Nurses and other HCPs play a critical role in breaking this cycle through evidence-based, person-centered care that respects all patients regardless of size. Reducing weight bias in nursing begins with self-awareness and education. Implicit bias training, respectful communication, and cultural humility are essential tools for building trust and fostering a safe clinical environment. Institutional changes, such as providing inclusive equipment, adopting antidiscrimination policies, and embedding size-diversity into patient-centered care models, are also critical in creating lasting reform (Fruh et al., 2021; Marler et al., 2025; Piwowarczyk et al., 2024; Talumaa et al., 2022).

Professional guidelines from leading organizations, including the USPSTF, ADA, AHA, and TOS, emphasize the importance of screening, individualized treatment plans, and long-term support. Nurses can apply these guidelines at the front lines, educate patients in nonjudgmental ways, and advocate for inclusive systems and policies. As the prevalence of obesity continues to rise, so does the responsibility of health care professionals to rise above bias and deliver equitable, dignified care. This commitment requires ongoing reflection, education, and institutional support. By shifting from a weight-centric to a health-centric paradigm, the health care system can begin to rebuild trust and improve outcomes for individuals living with obesity. This course can serve as a foundation for change. Whether you are a bedside nurse, an advanced practice provider, or a nurse leader, your actions can influence attitudes, reshape policies, and ensure that every patient, regardless of size, is treated with the respect, empathy, and clinical excellence they deserve (Marler et al., 2025; Piwowarczyk et al., 2024; Rubino et al., 2020; Talumaa et al., 2022).

References

Alberga, A. S., Edache I. Y., Forhan, M., & Russell-Mayhew, S. (2019). Weight bias and healthcare utilization: A scoping review. Primary Health Care Research & Development, 20 (e116). https://doi.org/10.1017/S1463423619000227

Al-Mahzoum, K., Abdelaziz, D., Alenezi, F., Almutairi, J., Alsubaiei, M., Alharbi, A., Al-Rawi, S., Bousheheri, F., Alhajri, A., Alajmi, S., Sallam, M., Mansour, N., Alanzyl, E., & Sallam, M. (2025). Health beliefs and obesity bias as determinants in attitudes toward the rising tides of GLP‑1 medications: Mounjaro and ozempic. Diabetes, Metabolic Syndrome and Obesity, 18, 1389–1409. https://doi.org/10.2147/DMSO.S518994

American Nurses Association. (2019). ANA position statement: The nurse’s role in addressing discrimination: Protecting and promoting inclusive strategies in practice settings, policy, and advocacy. OJIN: The Online Journal of Issues in Nursing, 24(3). https://doi.org/10.3912/OJIN.Vol24No03PoSCol01

Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd‑Jones, D., McEvoy, J. W., Michos, E. D., Miedema, M. D., Muñoz, D., Smith, S. C., Jr., Virani, S. S., Williams, K. A., Yeboah, J., & Ziaeian, B. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation, 140(11), e596–e646. https://doi.org/10.1161/CIR.0000000000000678

Association for Size Diversity and Health. (2024). Health at ever size® principles. https://asdah.org/haes/

Bannuru, R. R. (2025). Weight stigma and bias: Standards of care in overweight and obesity-2025. BMJ Open Diabetes Research & Care, 13, e004962. https://doi.org/10.1136/bmjdrc-2025-004962

Brown, A., Flint, S. W., & Batterham, R. L. (2022). Pervasiveness, impact and implications of weight stigma. eClinicalMedicine, 47(101408). https://doi.org/10.1016/j.eclinm.2022.101408

Callahan, E. A. (2023). The science, strengths, and limitations of body mass index. In Translating knowledge of foundational drivers of obesity into practice: Proceedings of a workshop series (pp. 99–101). National Academies of Sciences, Engineering, and Medicine. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK594362/

Centers for Disease Control and Prevention. (2024a). Adult obesity facts. https://www.cdc.gov/obesity/adult-obesity-facts/index.html

Centers for Disease Control and Prevention. (2024b). Childhood obesity facts. https://www.cdc.gov/obesity/childhood-obesity-facts/childhood-obesity-facts.html

Centers for Disease Control and Prevention. (2024c). How overweight and obesity impacts your health. https://www.cdc.gov/healthy-weight-growth/food-activity/overweight-obesity-impacts-health.html

Centers for Disease Control and Prevention. (2024d). New CDC data show adult obesity prevalence remains high. https://www.cdc.gov/media/releases/2024/p0912-adult-obesity.html

City of New York. (2023). Height and weight protections in the New York City human rights law. https://www.nyc.gov/site/cchr/media/height-and-weight.page

De Lorenzo, A., Romano, L., Di Renzo, L., Di Lorenzo, N., Cenname, G., & Gualtieri, P. (2020). Obesity: A preventable, treatable, but relapsing disease. Nutrition, 71(110615). https://doi.org/10.1016/j.nut.2019.110615

De Luca, M., Shikora, S. A., Eisenberg, D., Angrisani, L., Parmar, C., Alqahtani, A., Aminiam, A., Aarts, E., Brown, W. D., Cohen, R. V., Di Lorenzo, N., Faria, S. L., Goodpaster, K. P., Haddad, A., Herrera, M. F., Rosenthal, R., Himpens, J., Iossa, A., Kermansaravi, M., . . . Kothari, S. N. (2024). Scientific evidence for the updated guidelines on indications for metabolic and bariatric surgery (IFSO/ASMBS). Surgery for Obesity and Related Diseases, 20(11), 991–1025. https://doi.org/10.1016/j.soard.2024.05.009

ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Cusi, K., Das, S. R., Gibbons, C. H., Giurini, J. M., Hilliard, M. E., Isaacs, D., Johnson, E. L., Kahan, S., Khunti, K., Kosiborod, M., Leon, J., Lyons, S. K., . . . Gabbay, R. A. (2023). Introduction and methodology: Standards of care in diabetes—2023. Diabetes Care, 46(Suppl. 1), S1–S4. https://doi.org/10.2337/dc23-Sint

Fonoudi, M., Ewens, B., & Towell-Barnard, A. (2025). Weight stigma amongst nurses and nursing students: A scoping review of direct and comparative evidence. Journal of Advanced Nursing, 0, 1–18. https://doi.org/10.1111/jan.16843

Fricke, J. (2024). Healthcare worker implicit bias training and education. In NCBI Bookshelf. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK600156/

Fruh, S. M., Graves, R. J., Hauff, C., Williams, S. G., & Halls, H. R. (2021). Weight bias and Stigma: Impact on health. Nursing Clinics of North America, 56(4), 479–493. https://doi.org/10.1016/j.cnur.2021.07.001

Global Burden of Disease 2015 Obesity Collaborators. (2017). Health effects of overweight and obesity in 195 countries over 25 years. The New England Journal of Medicine, 377(1), 13–27. https://doi.org/10.1056/NEJMoa1614362

Heitmann, B. L. (2025). The impact of novel medications for obesity on weight stigma and societal attitudes: A narrative review. Current Obesity Reports, 14(18), 1–13. https://doi.org/10.1007/s13679-025-00611-5

Jakicic, J. M., Rogers, R. J., Davis, K. K., & Collins, K. A. (2018). Role of physical activity and exercise in treating patients with overweight and obesity. Clinical Chemistry, 66(1), 99–107. https://doi.org/10.1373/clinchem.2017.272443

Jastreboff, A. M., Aronne, L. J., Ahmad, N. N., Wharton, S., Connery, L., Alves, B., Kiyosue, A., Zhang, S., Liu, B., Bunck, M. C., & Stefanksi, A. (2022). Tirzepatide once weekly for the treatment of obesity. New England Journal of Medicine, 387(3), 205–216. https://doi.org/10.1056/NEJMoa2206038

Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., & Yanovski, S. Z. (2013). 2013 AHA/ACC/TOS guidelines for the management of overweight and obesity in adults. Circulation, 129(5). https://doi.org/10.1161/01.cir.0000437739.71477.ee

Jungnickel, T., von Jan, U., Engeli, S., & Albrecht, U. (2022). Exploring the weight bias of professionals working in the field of obesity with a mobile IAT: A pilot study. Therapeutic Advances in Endocrinology and Metabolism, 13, 1–16. https://doi.org/10.1177/20420188221098881

Kaeberle, J. (2025). Addressing obesity bias: The opportunity for nurses to impact change. https://www.myamericannurse.com/addressing-obesity-bias-the-opportunity-for-nurses-to-impact-change/

Lawrence, B. J., Kerr, D., Pollard, C. M., Theophilus, M., Alexander, E., Haywood, D., & O’Connor, M. (2021). Weight bias among health care professionals: A systematic review and meta-analysis. Obesity, 29(11), 1802–1812. https://doi.org/10.1002/oby.23266

Liu, C., Zhang, Z., Wang, B., Meng, T., Li, C., & Zhang, X. (2024). Global health impacts of high BMI: A 30‑year analysis from the Global Burden of Disease Study. Obesity Research & Clinical Practice, 217(111883). https://doi.org/10.1016/j.diabres.2024.111883

Lopez, C., Bendix, J., & Sagynbekov, K. (2020). Weighing down America: 2020 update. Milken Institute. https://milkeninstitute.org/sites/default/files/reports-pdf/Weighing%20Down%20America%20v12.3.20_0.pdf

Marler, G. S., Turk, M. T., Kalarchian, M., Oermann, M. H., Sabol, V. K., & Phelan, S. M. (2025). Weight bias interventions for healthcare professionals: An integrative review. Journal of Advanced Nursing, 0, 1–15. https://doi.org/10.1111/jan.17065

Moizé, V., Graham, Y., Salas, X. R., & Balcells, M. (2025). Motivational interviewing (MI) in obesity care: Cultivating person-centered and supportive clinical conversations to reduce stigma: A narrative review. Obesity Science & Practice, 11(1), e70057. https://doi.org/10.1002/osp4.70057

Nadolsky, K., Addison, B., Agarwal, M., Almandoz, J. P., Bird, M. D., DeGeeter Chaplin, M., Garvey, W. T., & Kyle, T. K. (2023). American Association of Clinical Endocrinology consensus statement: Addressing stigma and bias in the diagnosis and management of patients with obesity/adiposity‑based chronic disease and assessing bias and stigmatization as determinants of disease severity. Endocrine Practice, 29(6), 417–427. https://doi.org/10.1016/j.eprac.2023.03.272

National Association to Advance Fat Acceptance. (2023). Campaign for size freedom: NAAFA and FLARE project launch first of its kind campaign to end body size discrimination. https://naafa.org/sizefreedompr

National Institute of Diabetes and Digestive and Kidney Diseases. (2025). Health risks of overweight & obesity. U.S. Department of Health and Human Services. https://www.niddk.nih.gov/health-information/weight-management/adult-overweight-obesity/health-risks

Obesity Action Coalition. (n.d.). What we fight for: Weight bias. https://www.obesityaction.org/advocacy/what-we-fight-for/weight-bias

Obesity Medicine Association. (2023a). How much does obesity cost the U.S.? https://obesitymedicine.org/blog/health-economic-impact-of-obesity/

Obesity Medicine Association. (2023b). Motivational interviewing for obesity treatment. https://obesitymedicine.org/blog/motivational-interviewing/

Pausé, C., Lupton, D., Cadigan, T., Hutton, V., & Sisko, S. (2020). Sizeism (Chapter 9). In V. Hutton & S. Sisko (Eds.), Multicultural responsiveness in counselling and psychology: Working with Australian populations (pp. 241–258). Springer. https://doi.org/10.1007/978-3-030-55427-9_9

Pazzanese, C. (2024). How “Ozempic shaming” illuminates complexities of treating weight problems. The Harvard Gazette. https://news.harvard.edu/gazette/story/2024/02/how-ozempic-shaming-illuminates-complexities-of-treating-weight-problems/

Pearl, R. L. (2018). Weight bias and stigma: Public health implications and structural solutions. Social Issues and Policy Review, 12(1), 146–182. https://doi.org/10.1111/sipr.12043

Pearl, R. L., Donze, L. F., Rosas, L. G., Agurs‑Collins, T., Baskin, M. L., Breland, J. Y., Byker Shanks, C., Cooksey Stowers, K., Johnson, S., Lee, B. Y., Martin, M. Y., Mujuru, P., Odoms‑Young, A., Panza, E., Pronk, N. P., Calicutt, K., Nadglowski, J., Nece, P. M., Tedder, M., . . . Stanford, F. C. (2024). Ending weight stigma to advance health equity. American Journal of Preventive Medicine, 67(5), 785–791. https://doi.org/10.1016/j.amepre.2024.06.021

Piwowarczyk, E., MacPhee, M., & Howe, J. (2024). Nurses’ role in obesity management in adults in primary healthcare settings worldwide: A scoping review. Healthcare (Basel), 12(17), 1700. https://doi.org/10.3390/healthcare12171700

Puhl, R. (2020). What words should we use to talk about weight? A systematic review of quantitative and qualitative studies examining preferences for weight-related terminology. Obesity Reviews, 21(6). https://doi.org/10.1111/obr.13008

Puhl, R. (2022). Weight stigma, policy initiatives, and harnessing social media to elevate activism. Body Image, 40, 131–137. https://doi.org/10.1016/j.bodyim.2021.12.008

Purnell, J. Q. (2023). Definitions, Classification, and Epidemiology of Obesity. In K. R. Feingold, S. F. Ahmed, B. Anawalt, et al. (Eds.), Endotext [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK279167/

Robinson, K. M., Robinson, K. A., Scherer, A. M., & Lehan Mackin, M. (2024). Patient perceptions of weight stigma experiences in healthcare: A qualitative analysis. Health Expectations, 27(5), e70013. https://doi.org/10.1111/hex.70013

Rubino, F., Puhl, R. M., Cummings, D. E., Eckel, R. H., Ryan, D. H., Mechanick, J. I., & Apovian, C. M. (2020). Joint international consensus statement for ending stigma of obesity. Nature Medicine, 26(4), 485–497. https://doi.org/10.1038/s41591-020-0803-x

Ryan, N., & Savulescu, J. (2025). The ethics of Ozempic and Wegovy. Journal of Medical Ethics. https://doi.org/10.1136/jme-2024-110374

Schumacher, L. M., Ard, J., & Sarwer, D. B. (2023). Promise and unrealized potential: 10 years of the American Medical Association classifying obesity as a disease. Frontiers in Public Health, 11(1205880). https://doi.org/10.3389/fpubh.2023.1205880

Shaw, L. (2025). Weight stigma and bias: Standards of care in overweight and obesity—2025. The Obesity Society. https://www.obesity.org/wp-content/uploads/2025/05/TOS-Statement-on-Weight-Stigma-and-Bias.pdf

Sikka, T., Almeida-Amir, M., & Alderham, S. (2024). Fatness and its intersections: Stigma, healthism, and visibility in healthcare during the COVID‑19 pandemic. Forum for Social Economics, 1–20. https://doi.org/10.1080/07360932.2024.2430355

Sweis, N. J. (2024). The economic burden of obesity in 2024: A cost analysis using the value of a statistical life. Critical Public Health, 34(1), 1–13. https://doi.org/10.1080/09581596.2024.2333407

Talumaa, B., Brown, A., Batterham, R. L., & Kalea, A. Z. (2022). Effective strategies in ending weight stigma in healthcare: A scoping review. Obesity Reviews, 23(10), e13494. https://doi.org/10.1111/obr.13494

Tomiyama, A. J., Carr, D., Granberg, E. M., Major, B., Robinson, E., Sutin, A. R., & Brewis, A. (2018). How and why weight stigma drives the obesity “epidemic” and harms health. BMC Medicine, 16, 123. https://doi.org/10.1186/s12916-018-1116-5

Tremont, H. (2023). Weighed down by discrimination. Boston University School of Public Health. https://publichealthpost.org/health-equity/weighed-down-by-discrimination/

University of Connecticut Rudd Center for Food Policy and Health. (2023). Intersectional stigma: Weight stigma in minoritized communities. University of Connecticut. https://supportiveobesitycare-rudd-center.media.uconn.edu/wp-content/uploads/sites/3762/2023/11/Intersectional-Stigma-Handout-1.pdf

US Preventive Services Task Force. (2018). Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US Preventive Services Task Force recommendation statement. JAMA, 320(11), 1163–1171. https://doi.org/10.1001/jama.2018.13022

US Preventive Services Task Force. (2024). Final recommendation statement: High body mass index in children and adolescents: Interventions. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/obesity-in-children-and-adolescents-screening

Wadden, T. A., Tronieri, J. S., & Butryn, M. L. (2020). Lifestyle modification approaches for the treatment of obesity in adults. American Psychology, 75(2), 235–251. https://pmc.ncbi.nlm.nih.gov/articles/PMC7027681/

Westbury, S., Oyebode, O., van Rens, T., & Barber, T. M. (2023). Obesity stigma: Causes, consequences, and potential solutions. Current Obesity Reports, 12(1), 10–23. https://doi.org/10.1007/s13679-023-00495-3

Wilding, J. P. H., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., McGowan, B. M., Rosenstock, J., Tran, M. T. D., Wadden, T. A., Wharton, S., Yokote, K., Zeuthen, N., & Kushner, R. F. (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 384(11), 989–1002. https://doi.org/10.1056/NEJMoa2032183

World Health Organization. (2025). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

World Obesity Federation. (2023). World Obesity Atlas 2023. https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2023

Young, J. (2023). AMA Code of Medical Ethics’ opinions related to clinical use of BMI. AMA Journal of Ethics, 25(7), E514–E516. https://doi.org/10.1001/amajethics.2023.514

Powered by Froala Editor