Obesity stigma: the untold burden of the disease

LIH researcher advocates for a paradigm shift in the definition of obesity

• Department of Precision Health
• NutriHealth

Obesity has long been rooted in a fundamental misunderstanding of its origin, guided by a societal misconception that it is solely a result of unhealthy lifestyle choices. This weight stigma bears significant negative effects in both children and adolescents, increasing obesity and worsening several associated physical and mental health conditions. Child and adolescent obesity is acknowledged as a global health priority. Dr Hanen Samouda (PhD), researcher at the Luxembourg Institute of Health (LIH), fights for the recognition, the right diagnosis and treatment of obesity as a multifactorial disease.

Childhood obesity concerns around 340 million children aged between 5 and 19 years worldwide¹, a prevalence that ranks it as a global health priority. In Luxembourg alone, a study reported that almost 10% of adolescents attending high school during the academic year 2019-2020 were having obesity.² Currently, the Body Mass Index (BMI), which is the ratio of weight (kg)/height (m²), is  mistakenly considered as the reference for the definition of obesity and its different stages. Erroneous treatment approaches, such as the ‘eat less, move more’, are still too often the gold standard.

It is in this context that the European Association for the Study of Obesity (EASO) officially declared its support of the new Canadian guidelines on obesity in adults, which state that obesity should be classed according to its multifactorial roots, and not by weight status. Obesity diagnosis and treatment should thus take into consideration the metabolic, mechanic, mental and social milieu patterns of the person living with obesity. As emphasised by the new guidelines, diet and exercise do not cure obesity, which should instead be addressed using a personalised medical approach that takes into account the specific needs of the patients to treat the underlying causes of the disease . Dr Hanen Samouda, PhD, researcher specialised in obesity and body composition at the LIH, is a major advocate of this paradigm shift. Her work already includes the assessment of the norms and classification systems in obesity, complete with the development of easy-to-use tools to diagnose obesity (visceralfatcalculator.lih.lu), such as a recently developed visceral fat calculator, in collaboration with Dr Jérémie Langlet (PhD), business developer at LIH. However, she believes there is still so many aspects to address in obesity:

We need to act together to have obesity recognised as a chronic multifactorial disease, to treat people living with obesity without stigma and to advance research in these fields.

To this end, Dr Samouda is collaborating with the MOTOR (MOving TOgetheR) group and Dr Chiraz Ghaddhab (MD, PhD), endocrinologist specialising in paediatric obesity at the Childhood Obesity Clinic, Kannerklinik, Centre Hospitalier de Luxembourg, to develop a paediatric obesity registry that will take into account the multifactorial aspect of obesity. The MOving TOgetheR programme is a national multidisciplinary network for the management of children with obesity in partnership with the Childhood Obesity Clinic at the Kannerklinik, the Rehazenter, the National Service of Juvenile Psychiatry (HRS), the LIH and the University of Luxembourg.

Crucial in the institution of the registry will be the development of an approach to prevent weight stigma, as, unfortunately, children and adolescents living with obesity are regularly shamed and blamed for their weight, while obesity is definitely not a personal choice based on laziness and lack of willpower, but a chronic relapsing disease with several roots.

Weight stigma is the attribution of negative beliefs, or bias, based on a person’s weight. It results in actions taken against people living with obesity, like discrimination, stereotyping or social exclusion. Despite the understanding that a person’s internal (biology, genetics, mental issues) and external environment (food exposure, marketing, industrialisation) has a substantial role in the development of obesity, the stereotypical perception that people with obesity are somehow responsible for their weight remains prevalent. Weight stigma is often internalised, and becomes a driver of the disease, causing the person to have increased psychological stress, depression and anxiety, driving issues such as eating disorders and leading to self-dieting which increases weight gain and worsens obesity. Weight stigma induces psychological issues and increases obesity, and vice versa, worsening both mental and physical health, from childhood onwards.

Weight stigma has been reported at all levels of the society starting from school, family and peers, and in the healthcare setting, where patients with obesity receive a poor diagnosis and care, which worsens their health. Combatting weight stigma has become a first-line public health intervention to effectively treat obesity, and a key aspect of the new guidelines.

The registry, which is expected to launch as soon as the funding is in place, will involve both the patient and the family in its development. According to Dr Samouda, “The patient’s experience and knowledge is a unique asset to guide the development of the registry. The patient and their family will help to ensure that their needs are understood and matched with the goals of the physicians, to enable a better disease management.”

1. WHO. Obesity and overweight. https://www.who.int/news-room/factsheets/ detail/obesity-and-overweight. 2021.
2. Gouvernement.lu. Journée mondiale de lutte contre l’obésité. https://gouvernement.lu/fr/actualites/toutes_actualites/communiques/2021/03-mars/03-journee-mondiale-lutte-obesite.html. 03.03.2021.