The Weight of It All

Click To Subscribe

When I was in residency, I took care of a woman who had obesity.Notice I didn’t say she was obese.

Semantics matter.

A wide open mouth surrounded by speech bubbles featuring random gibberish words, illustrating playful and nonsensical communication.

Obesity is a disease—just like hypertension, diabetes, or cancer. But it is not what defines a person. A person cannot be obese; they can have obesity.

For far too long in this country, we’ve labeled people as “obese,” reducing them to their appearance and a number on the scale.

This woman came to see me for chronic back pain. I told her that her weight was likely contributing to her symptoms. When she asked what she should do, I gave the standard, cookie-cutter advice: eat better and exercise more.

She became angry. She stormed out of the room and slammed the door behind her.

A woman exits the doctor's office, stepping into the hallway after her appointment.

Moments later, I heard desperate shrieking in the hallway. She was sitting outside our office, banging her head against the wall and wailing. I stood there, waiting for emergency medical services to take her to the ER, helplessly watching my patient unravel as other patients walked by—undoubtedly making assumptions, probably that she had “snapped.”

From strictly a medical standpoint, nothing I said was wrong. Her obesity was likely contributing to her back pain. Weight loss could have helped, and at the time, diet and exercise were the only tools I knew to offer.

So how did a medically sound recommendation lead to a middle-aged woman sitting on the floor, screaming and kicking her legs like a toddler?

As I’ve said before, obesity is a disease—but this woman was not the disease. And in that exam room, I failed her. I stepped away from my responsibility as her physician and placed the burden squarely on her. The frustration she must have felt was so overwhelming that her brain shifted into survival mode—fight or flight.

That was the early 2000s. Science has evolved. As a society, we are evolving too—though far more slowly than the research. Obesity is not simply about calorie counting and lifting weights. It is about leptin, insulin, alpha–melanocyte-stimulating hormone, PPAR-gamma genes, and a complex web of hormones and genetics, among other things. It is affected by stress, sleep, food supply chain issues, the environment and sooooo much more.

A vibrant illustration depicting the interaction between chemicals and genes, featuring a dynamic DNA strand intertwined with colorful chemical structures and molecular motifs.

The responsibility for addressing obesity does not lie solely with the patient. It lies with physicians, communities, and society at large, as we challenge outdated beliefs and reshape how we understand this disease.

I think about that woman often. I don’t know what became of her. She was a patient, failed by a flawed young doctor growing up in a world of stereotypes and assumptions. I honor that patient by letting that moment (and others) change me—by remembering not to reduce obesity to a simple directive and by remaining deeply mindful of the complexity and humanity behind obesity.

Silhouette of a person with tousled hair, set against a plain white background.

In the next few essays, I’ll dive into the science behind obesity, my own journey with it, and yes—the infamous GLP-1 medications.

Stay tuned.