Maggie McKay (Host): The stigma of obesity is real and hurtful. But what are the facts? Dr. Erik DeAngelis and Dr. Eleisha Flanagan, both General and Bariatric surgeons at UM Charles Regional Medical Center, will discuss obesity and why there are still misconceptions and prejudice toward people who live with it. Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System.

I'm your host, Maggie McKay. Thank you both for being here today.

Eleisha Flanagan, MD: Thank you for having us.

Erik DeAngelis, MD: Thanks for having us.

Host: Absolutely. Dr. Flanagan, what are the biggest misconceptions about obesity that still persist today?

Eleisha Flanagan, MD: The biggest misconception about obesity is that it's just a personal failure or that all you have to do is eat less, move more, and you'll lose weight. In reality, obesity is a complex disease, just like high blood pressure or diabetes, and losing weight is a process that does require diet and exercise, but oftentimes also needs to be treated with medication or surgery.

Host: And Dr. DeAngelis, how much do genetics, hormones and metabolism influence weight compared to say, diet and exercise?

Erik DeAngelis, MD: Well, diet and exercise are important components of a healthy lifestyle, but weight loss for people with obesity often requires additional treatment. Our bodies are adapted by our genes and our hormones to gain and retain weight because in the past, humans were not always able to have a guaranteed meal. We were hunters, farmers and we didn't have a secure source of food.

So our bodies defend us against weight loss so that we can survive in times of famine. Now, with grocery stores readily available, experiencing a famine is unlikely, but our bodies are still adapted to that kind of environment, and so losing weight becomes more difficult because we are working against biology in a way.

Host: Dr. Flanagan, you mentioned it about how people still view obesity as a personal failure rather than a medical condition. Why do you think that is?

Eleisha Flanagan, MD: I can't speak for other people. But there are messages that we receive by media and other parts of society that value a certain body type and devalue people with extra weight. It's important to recognize that weight loss is a difficult and complicated process. It's not as simple as eating less and moving more.

There are treatment options available to help with weight loss, but ultimately the focus of losing weight should be to improve your health, not to look a certain way or please other people.

Host: Exactly. Dr. DeAngelis, how does weight stigma affect the way people receive healthcare and treatment options?

Erik DeAngelis, MD: Well people with extra weight frequently experience stigma from other people, and sometimes even from medical professionals. And this can result in embarrassment or shame that prevents people from seeking healthcare, not only for weight loss, but any kind. So it is important to find a weight loss provider who is professional and knowledgeable about the disease of obesity and how it can be treated.

Host: Dr. Flanagan, what role do social and economic factors play in obesity rates and access to treatment?

Eleisha Flanagan, MD: Social and and economic factors play a very large role in obesity as well as access to treatment. Eating healthy foods can be more expensive. Fresh foods can be harder to find, especially in neighborhoods with less money, and those places may have less outdoor space for exercise. Insurance barriers can also make access to medications or surgery, quite a challenge.

 These all contribute to making weight loss a challenge for many people. Reaching out to a provider to try to overcome some of these hurdles, is the first step.

Host: Dr. DeAngelis, how do bariatric surgery and medical weight loss options challenge the outdated idea of just eat less and move more, like you mentioned earlier?

Erik DeAngelis, MD: So both medical weight loss and weight loss surgery have been shown in research to alter hormones and signals that control hunger and aid people in their weight loss journey. Lifestyle factors like diet and exercise are still important for success in the long run, but people who combine these treatments with medication or surgery, lose a lot more weight and are more likely to keep it off in the long run.

Host: Dr. Flanagan, this is a tough one, but what do you think can be done to reduce weight bias in healthcare and just everyday life?

Eleisha Flanagan, MD: I think the first thing is that we need to accept people in different shapes and different sizes. There's no one ideal or right way to be. The focus for weight loss should be to improve your health and feel better in your body, not to look a certain way or measure up to some ideal that was created by other people.

 It's also important to recognize that obesity is a complex disease. Over 90% of people diagnosed with diabetes receive treatment for diabetes. But only a few percentage points of people with obesity receive treatment for it. Overcoming the stigma and recognizing obesity as a disease that can be treated, is a key to helping people lose weight and lead healthier lives.

Host: Dr. DeAngelis, what advice do you have for people who feel judged or ashamed about their weight and are hesitant to seek help?

Erik DeAngelis, MD: Well, feelings of shame, embarrassment, or judgment can be very normal, but are often imposed on us by other people that do not have our best interests at heart. There are weight loss professionals out there that want to help you to lose weight and improve your health, and you should never feel ashamed to ask for help, and you should never be embarrassed for wanting to improve your health.

Host: Thank you both so much for sharing your expertise on a topic that affects so many people and it's so important. We really appreciate your time.

Eleisha Flanagan, MD: Thank you for having us.

Erik DeAngelis, MD: Absolutely. Thanks.

Host: Again, that's Dr. Erik DeAngelis and Dr. Eleisha Flanagan. Find more shows like this one at umms.org/podcast and on YouTube. Thank you for listening to Live Greater, a health and wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again, and please share this on your social media.