Addressing Stigma and Bias in Patients with Obesity & Adiposity-Based Chronic Disease

Publication Date: May 4, 2023
Last Updated: May 4, 2023


Key Definitions

  • Weight bias = negative ideologies associated with excess body weight
  • Weight stigma = thoughts and acts of discrimination toward individuals due to their weight and size and a result of weight bias
  • Internalized weight bias = when a person applies negative weight stereotypes (bias) to themselves and engage in self-devaluation
  • Implicit weight bias = unconscious bias toward a person who has obesity, beliefs or attitudes outside of an individual’s awareness and control
  • Explicit weight bias = awareness of bias and intentionally behaving negatively toward a person who has obesity

Synopsis of Affirmed and Emergent Concepts

Affirmed Concepts
  • Obesity is a complex disease caused by multifaceted pathophysiology associated with internalized weight bias and stigma.
  • While obesity is not a lifestyle choice, lifestyle modifications are the critical foundation of treating ABCD and its complications. This requires alterations in diet and physical activity, education, behavioral therapy, and supportive care from health care teams.
  • A BMI-centric diagnosis of obesity is not appropriate, on its own, for individual patient care and should be considered in the context of a clinical examination plus further diagnostic evaluation for complications as necessary for patient-centered care.
  • A complication-centric staging of ABCD can provide personalized interventions that match disease severity and the intensity of therapy.

Emergent Concepts
  • Classification categories of obesity should include improved nomenclature across the spectrum of BMI using ethnic-specific ranges for BMI and WC.
  • Complication-centric staging of ABCD based upon the spectrum of disease severity shifts the conceptualization of this disease away from a weight-centric emphasis and has the potential to reduce stigma and IWB.
  • Weight stigma and IWB are both drivers and complications of obesity/ABCD in a bidirectional manner; therefore, patients with ABCD should be screened for IWB.
  • As complications of ABCD, the presence of weight stigma and IWB should be incorporated into the staging of disease severity.
  • Weight stigma and IWB can lead to or exacerbate psychological disorders such as depression, anxiety, and disordered eating; patients with ABCD should be screened for these psychological disorders.
  • Focusing on a clinical response to obesity therapy that includes both percent weight-loss goals and alleviation of obesity-related complications rather than weight loss per se is consistent with the medical model for treatment of a chronic disease and may help reduce weight stigma and IWB.

5A’s for Obesity/ABCD

  • ASK if you can discuss weight and the health impact of ABCD
  • ASSESS health status and complications
  • ADVISE on treatment options based on the severity of ABCD
  • AGREE on treatment plan and weight-loss goals
  • ASSIST in the continuous process of weight management with reassessment of goals and treatment options

Summary of Recommendations

Weight stigma and IWB impair quality of life for patients with ABCD and constitute complications of this disease. At the same time, stigma and IWB exacerbate the severity of ABCD as a disease and compromise the efficacy of ABCD treatment. To address the impact of weight stigma and IWB, AACE puts forth the following consensus recommendations:
  • Patients with ABCD should be screened for the presence and degree of stigmatization and IWB; the Weight Self-Stigma Questionnaire and the Weight Bias Internalization Scale are validated tools that can be used to assess stigmatization and IWB.21,30,31
  • As complications of ABCD, the presence and degree of weight stigma and IWB should be incorporated into the staging of ABCD severity.
  • IWB and stigmatization can lead to or exacerbate psychological disorders such as depression, anxiety, stress, and disordered eating; patients with ABCD should be screened and treated for these psychological issues. Mental health conditions and social determinants of health should also be incorporated into the staging of ABCD severity.
  • Health care professionals and organizations should implement policies and actions to reduce the impact of weight bias in patient care including, but not limited to, implicit bias training for staff, obesity education of health care professionals to reduce explicit bias, use of person-first policies and language in treatment plans and health records, and adoption of the new proposed ABCD nomenclature for classification and staging of obesity along with clinical goals of therapy.
  • Health care professionals and organizations should advocate for improved access to evidence-based treatment modalities and increased research into practice-based solutions to limit the impact of IWB on management of ABCD.

Recommendation Grading


  • AACE: American Association Of Clinical Endocrinology
  • ABCD: Adiposity-based Chronic Disease
  • BMI: Body Mass Index
  • IWB: Internalized Weight Bias
  • SDoH: Social Determinants Of Health
  • WC: Waist Circumference


The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.



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

Authoring Organization

Publication Month/Year

May 4, 2023

Last Updated Month/Year

July 26, 2023

Supplemental Implementation Tools

Document Type


Country of Publication


Document Objectives

To focus on the intersection of perception, diagnosis, stigma, and weight bias in the management of obesity and obtain consensus on actionable steps to improve care provided for persons with obesity.

Target Patient Population

P:ersons with obesity

Target Provider Population

All healthcare providers

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Hospital

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Diagnosis, Management

Diseases/Conditions (MeSH)

D009765 - Obesity, D015982 - Bias


obesity, adiposity-based chronic disease, weight bias, stigma

Source Citation