obesity treatment: 'stop talking to patients like they are children'

dr. sean wharton is the medical director of the wharton medical clinic, a community-based internal medicine weight management and diabetes clinic, researcher and advocate for health equity in canada. he also runs wharton medical clinic clinical trials , a program that conducts trials that test new medications and therapies for weight management, type 2 diabetes, and cardiometabolic health. wharton is passionate about changing the dialogue around obesity — that it’s a disease and not a lifestyle choice. healthing spoke with wharton about the importance of compassion in treating obesity, why ethnic diversity needs to matter more in obesity care and the role that politics plays in obesity management.

when did you realize there needed to be some serious change in the ways health-care providers looked at obesity?

dr. wharton: i‘m an internal medicine physician, and as i was doing my residency, i was focusing on high blood pressure, type 2 diabetes and a number of other internal medicine conditions. it occurred to me that for people living with obesity, frequently it was their obesity that was a causative factor when it came to their medical condition. yet there was no physician that was capable of treating it. they were very reticent to have a discussion about it because there were no treatments available that could actually keep the patient’s weight down for a long period of time and treat the medical condition. so what we would do is we would continue to give more medications, more blood pressure agents, more insulin, more diabetes treatments, as opposed to trying to manage the underlying condition. so i’m an enthusiastic resident at this stage, between 2000 and 2004, and i thought we should treat the root cause which is obesity.

when you talk to your patients about quality of life, what kinds of comments do you hear, and how are you using your work to help?

dr. w: speaking to people about quality of life, their primary issue is that many people, particularly the health-care providers, do not treat them with compassion and do not understand their medical condition. they treat them like a child and condescendingly tell them to have a better diet, stick to it and exercise more. it’s not just embarrassing, but frustrating, saddening. and it’s discrimination. since it continues to happen again and again from learned people, it sometimes becomes internalized where people actually believe those paternalistic, condescending messages.

let’s talk about treatments. wegovy was recently made popular by tiktok. what are your thoughts on treating obesity with medication?

dr. w.: the way i feel about treating obesity with medications is the way i feel about treating high blood pressure, cancer or any chronic disease with a medication. medication pharmacotherapy is effective for a disease state. as an internal medicine doctor, or any other physician who understands the biology and the physiology of a chronic disease has in their toolbox pharmacotherapy to treat many of these medical conditions. so obesity is one of those medical conditions. tiktok has not made wegovy famous for treating obesity. tiktok has made wegovy famous for treating elevated weight. they’re two different things.

health-care providers tend to treat people with obesity like a child, telling them to eat better and exercise more — as if they didn’t know the benefits of these actions, says dr. sean wharton. getty

do you have any thoughts on how tiktok is influencing health?

dr. w.: i don’t know that tiktok is influencing health. i have not seen any information or any data that tiktok influences health. it helps people to identify how to identify lumps in their breast for breast cancer or helps with detection of when to check for prostate cancer or for colon cancer. that to me would be an influence on health. and maybe tiktok can be a platform. clearly, it’s influencing people’s use of aesthetic medicine and using it because kim kardashian uses it. but does it address actual health problems? does it make things worse? is it making things better or is it just fluff and everything is neutral? i don’t know the answer to that. it would require a research study.

much of the discussion around obesity is about lifestyle. what makes a person a candidate for medication?

dr. w.: everyone who is admitted to my clinic has a bmi [body mass index] of greater than 27. the qualification for pharmacotherapy is a bmi between 27 to 30 with one comorbidity or a bmi greater than 30. so there’s nobody by definition that comes to my clinic that does not fit the basic criteria to have the medication. then you discuss the next criteria that you would see in any other physician’s office. do they have adverse side effects? if they’ve had medullary thyroid cancer, they can’t take it. if they have had idiopathic pancreatitis, then they can’t take it. there are limited other products that they could take.

are there changes that could be made on a political level to help people with obesity live healthier lives?

dr. w.: yes, endorsement and recognition that the world is biased, which is a negative word. they’re biased or prejudiced against people living with obesity and that the world is full of stereotypes against people living with obesity, which is stigma. if you were to google “obesity man images,” you’ll see guys wearing shirts that are too small for them as if they’re not bright enough to know that that doesn’t look good. sure there’s one guy who will wear that, but the majority of guys that live with obesity don’t do that because they’re bright, competent people — lawyers and doctors and everything else.

what are you hoping obesity management looks like in five years?

dr. w.: more treatment choices for people living with obesity if they have obesity and more recognition that people with elevated weight may not have obesity. african-american women may need a bmi of over 32 before they start to run into blood sugar problems because they carry their weight on their hips and their thighs, not in their stomachs. yet they’re demonized when they should just be called beautiful. they shouldn’t be called a woman with obesity or an obese lady. if they have type 2 diabetes or they have heart disease, then they’re living with obesity and treatment should be available for them. if you’re south asian and your bmi is 26, which would not be defined as obesity and barely defined as overweight. ut if you’re south asian with a bmi of 26 and you have pre-diabetes, your mom has type 2 diabetes, your auntie has it, and they all developed it at age 26 and you’re age 25, you’ve got obesity.