Treat People With Obesity Like People, Not Their Disease

This month in obesity medicine, two groups of prominent doctors and researchers recommended treating people with obesity like actual people, while a new think piece asked whether extremely effective medications for obesity should be part of its standard of care! 
I’m not knocking any of that but rather pointing them out as examples of the systemic discrimination that has been the standard medical care of these patients, where the suggestions that they be evaluated as people and offered effective medications are novel enough to warrant papers, handbooks, and dedicated websites.
Because how else to explain the recommendations’ absence and the physician knowledge gap prior to now? 
Looking to the American Academy of Family Physicians new obesity practice manual, there are chapters on what obesity is, how to diagnose it, its pharmacotherapy and surgery, how to provide inclusive care, how to build a compassionate physician-patient relationship, how to identify systemic barriers to care, and how to provide collaborative interprofessional care. 
Yes, all very important for physicians to know, but that it’s necessary and laudable to publish this practice manual when the percentage of adult Americans with obesity has exceeded 30% since the 1990s speaks to the abandonment of these patients for decades. If over one third of a doctor’s adult patient population has had the same disease for the past 30 years, how to explain beyond systemic bias that physicians now need a special manual to teach them how to understand, evaluate, and treat it? 
Next up are the new health measures that the International Consortium for Health Outcomes Measurement recommends doctors consider for adult patients with obesity. They encompass quality of life, common comorbidities, cardiometabolic risk, anthropometrics, nutritional status, sarcopenia, surgical risk, and obstetric and gynecologic outcomes. They are recommending these measures and urging “all providers around the world to start measuring these outcomes to better understand how to improve the lives of their patients.” Again, it’s difficult to imagine these as novel suggestions, given obesity’s prevalence for the past 50 years. What have doctors been measuring until now?
Finally we have the think piece published in Current Cardiology Reports asking whether GLP-1 receptor agonists should be the standard of care for obesity. That there even needs to be a think piece about whether a highly effective, extremely safe medication for a condition affecting over 40% of the population — and which improves quality of life and dramatically reduces risk for an ever-growing list of significant medical comorbidities — should be the standard of care for a condition where there is no other available reproducible or durable treatment option… How is that even a question? 
None of this is surprising. Weight bias in medicine is well established and has been shown to have a negative impact on patient care and on healthcare utilization. Would you want to seek medical care from a system that didn’t treat you like a whole person or offer you effective therapeutics?
Taking a broader step backward from obesity and considering the recommendations for care reflecting a patient-centered approach as being novel, perhaps it becomes easier to understand the appeal of nonphysician healthcare providers, as they are far more likely to spend more time listening to and learning about their patients. 
And if you’re reading this and thinking that I’m overstating my case, that it’s not an example of systemic weight bias and that these recommendations for a condition affecting over 40% of adults are necessary, then consider an alternate reality, where physicians have no knowledge of how to manage or even speak with their patients with diabetes, a condition that currently affects roughly 15% of the adult population; would that reality be medically defensible?