For many patients, seeking medical care already comes with a degree of vulnerability. For those living in larger bodies, that vulnerability is often compounded by weight stigma, an experience that can shape interactions with healthcare providers long before a diagnosis or treatment plan is discussed.
At the CU Medicine Weight Management Clinic, addressing weight stigma has become a critical part of how care is delivered. Providers say recognizing and reducing bias isn’t just about improving the patient experience; it’s essential to delivering effective, patient‑centered healthcare.
“Weight stigma in healthcare often shows up through language or practices that make a patient feel ashamed about their weight,” says Adam Gilden, MD, MSCE, a board-certified physician in obesity medicine and Associate Director of the CU Medicine Weight Management Clinic. Even when the intention isn’t harmful, the impact can be.
What is weight stigma?
Weight stigma refers to negative attitudes, stereotypes, or judgments about individuals based on their body size or weight. In healthcare settings, it can influence how patients are perceived, spoken to, and treated, often without providers realizing it.
Weight stigma can appear in obvious ways, such as dismissive comments or blame‑focused language. More often, however, it shows up subtly, like assumptions about a patient’s lifestyle, oversimplified explanations for health concerns, or care plans that prioritize weight loss above all else.
Importantly, weight stigma is not the same as discussing weight for medical reasons. It becomes stigmatizing when weight is treated as a moral failing, a personal shortcoming, or the sole explanation for a patient’s health issues.
What weight stigma looks like in healthcare
According to Dr. Gilden, one of the most common manifestations of weight stigma is the tendency to attribute a wide range of health concerns to weight alone.
“In my experience, weight stigma often shows up when clinicians attribute health conditions to a patient’s weight that are not actually weight‑related,” he says. “Another example is setting unrealistic weight‑loss goals, even when a patient has already achieved a meaningful, health‑improving amount of weight loss.”
These assumptions are often rooted in widespread misconceptions about people living in larger bodies.
“The most common misconception I encounter is the idea that people with obesity aren’t trying,” Gilden says. “In reality, many, if not most, people are already working very hard to manage their weight.”
Cristina Rebellon, RD, a registered dietitian at the clinic, sees similar patterns in nutrition care.
“A common misconception is that body size is simply the result of diet and exercise,” Rebellon says. “In reality, weight is influenced by many factors, including genetics, hormones, environment, stress, medications, and access to resources.”
She also notes that body size is often incorrectly used as a proxy for health.
“People often assume that individuals in larger bodies are automatically unhealthy,” she says. “But health cannot be determined by size alone. Many people in larger bodies are engaging in consistent, health‑promoting behaviors.”
The impact on patients
Patients frequently carry the effects of weight stigma into the exam room.
“Patients commonly report being treated differently at work or in social settings because of their weight,” Gilden says. Those experiences don’t disappear in healthcare settings and can directly influence how and when patients seek care.
“If a patient feels stigmatized, they are less likely to seek preventive care such as cancer screenings,” he says.
Beyond access to care, weight stigma can have significant mental‑health consequences.
“Weight stigma worsens mental health and, in general, lowers a patient’s motivation to make lifestyle changes,” Gilden says. “That’s the opposite of what we want as clinicians.”
Bias is often unintentional, but still harmful
Most healthcare providers don’t intend to stigmatize patients, but bias can still shape care.
“Providers may subconsciously view a patient with a higher weight as lazy, undisciplined, or unmotivated,” Gilden says. “Those assumptions can affect clinical decision‑making and communication, even when providers aren’t aware of it.”
Rebellon notes that traditional healthcare training has long reinforced weight‑centered thinking.
“There’s still a heavy focus on weight‑centered approaches, with less attention given to how bias, conscious or unconscious, shapes how we treat and talk to patients,” she says.
Shifting the clinical conversation
At the CU Medicine Weight Management Clinic, reducing stigma starts with reframing how conversations about weight and health are approached.
“I intentionally use the term ‘weight’ rather than ‘obesity,’” Gilden says. “More importantly, I focus on realistic, health‑based goals rather than a specific number on the scale.”
That philosophy extends to nutritional care as well.
“Weight loss isn’t always the most appropriate or helpful goal,” Rebellon says. “Many patients benefit more from focusing on sustainable behaviors, like improving nutrition quality, movement, sleep, or stress management, rather than pursuing weight loss at all costs.”
By shifting the focus away from weight alone, providers say care becomes more collaborative, individualized, and effective.
Training, education, and systemic change
Formal education plays an important role in reducing stigma. Gilden notes that training on weight stigma is included in board certification for obesity medicine, something he believes should be more broadly integrated into healthcare education.
“It should be part of general medical education, not just in obesity-focused education,” he says.
Rebellon agrees, emphasizing the importance of weight‑inclusive frameworks and practical tools.
“One thing that’s often missing in traditional dietetic training is meaningful education on weight stigma and how it impacts patient care,” she says.
What the public can do
Reducing weight stigma isn’t limited to healthcare systems; it also requires broader cultural change.
“The public should understand that body weight is regulated by powerful biological forces that tend to push us toward higher weights,” Gilden says. “It’s not simply a matter of willpower.”
How people talk about weight matters as well.
“Supportive, non‑stigmatizing conversations focus on health goals, not just weight goals,” he says.
Rebellon echoes that approach. “Using respectful language and avoiding assumptions can go a long way.”
And there’s one common myth Gilden often finds himself correcting: “That obesity is the main cause of low back pain. It’s more complex than that.”
Moving forward
For providers at the CU Medicine Weight Management Clinic, addressing weight stigma isn’t about avoiding difficult conversations; it’s about having better ones.
“When patients feel respected and understood, they’re more likely to engage in care,” Gilden says. “Reducing stigma isn’t separate from good medicine, it’s foundational to it.”
