Diabetes Core Update — Special Edition: Weight Bias & Stigma (Part 2)

Release Date: January 30, 2026
Host: Dr. Neal Skolnick
Guests: Dr. Sean Wharton (Obesity Clinician and Researcher), Patti Nece (Patient Advocate, Lawyer)

Overview

This special episode of Diabetes Core Update centers on the pervasive issue of weight bias and stigma, particularly within healthcare. Dr. Neal Skolnick brings together expert clinician Dr. Sean Wharton and patient advocate Patti Nece for an in-depth, honest conversation about how weight bias affects individuals living with obesity and diabetes. The discussion covers professional, scientific, and deeply personal perspectives to illuminate the real-life consequences of stigma and offers actionable steps healthcare professionals can take to reduce harm and improve care.

Key Discussion Points & Insights

1. Lived Experience of Weight Bias and Internalized Stigma

• Patti Nece’s Journey (03:32)
  • Grew up with obesity, subject to ongoing bullying and discrimination.
  • Internalized negative societal attitudes, becoming her “own worst bully” until she received compassionate, expert care much later in life.
  • "It wasn't until I was in my 50s that I found an obesity medicine specialist who understood exactly what was happening." (04:18, Patti Nece)
  • Began advocacy after sharing personal experience at medical roundtable and testifying before FDA.

2. The Importance of Recognizing Patient Struggles

• Acknowledging the Hidden Burden (06:45)
  • Dr. Skolnick highlights how patients' emotional burnout and feelings of unworthiness can be inadvertently reinforced by healthcare interactions.
  • "We don't often hear as honest a representation of the difficulties that people have throughout their life..." (06:45, Dr. Skolnick)

3. Intersection of Science, Prejudice, and Social Justice

• Dr. Wharton’s Perspective (08:14)
  • Entry into obesity medicine was inspired by understanding the interplay between biology, social bias, and prejudice—especially as it paralleled experiences in racial discrimination.
  • Saw obesity as "biological and scientific and it was social and it was bias, which equals prejudice and it was stigmatizing, which equals stereotype and it was discriminating, which equals racism." (09:07, Dr. Wharton)
  • The passion to address both the science of obesity and the harmful social attitudes it attracts.

4. The “Willpower” Myth and Harmful Narratives

• Challenging Simplistic Solutions (11:15–14:18)
  • Patti uses a home renovation analogy: "If the sledgehammer can't get through the brick wall after a year, you don’t tell yourself you lack willpower. You try a different tool." (12:16, Patti Nece)
  • Emphasizes the frustration and harm in focusing merely on “eat less, move more.”
  • "Shame and blame doesn't ever help. It just hurts. It just makes you feel bad." (21:27, Patti Nece)

5. The Science of Weight Regulation

• Dr. Wharton’s Explanation (16:02–19:29)
  • Outlines the neurobiological mechanisms: hypothalamus (regulatory), mesolimbic system (hedonistic), and executive lobe (control).
  • Genetics and counter-regulatory hormones create uphill struggle for most with obesity; “food noise” is not simply a willpower issue.
  • "Within just six hours of eating less, your body already pushes back with hormones to regain weight." (18:26, Dr. Wharton)

6. Practical Steps for Reducing Clinical Bias

• Environmental and Behavioral Changes (20:31–24:30)
  • Equip clinics with adequately-sized gowns and furniture.
  • Private weigh-ins; staff should avoid comments about weight.
  • "I didn't go back for 15 years after that first mammogram. It was such a horrible experience, and it's so simple to correct." (23:34, Patti Nece)
  • Urges all clinicians to take the Harvard Implicit Association Test for weight bias.

7. Self-awareness and Systems Change in Clinical Practice

• Canadian Obesity Guidelines & Turning the Lens (24:52)
  • Dr. Wharton describes moving bias/stigma to the first chapter of guidelines, essentially telling clinicians: “the camera lens is now on you.”
  • Doctors are often unaware of their learned prejudices, shaped by culture, media, and reinforcement.
  • Tells story of published pushback: “I'm really upset by these guidelines. They told me that I'm a bad doctor. ... The patients are the problem.” (28:41, anecdote from Dr. Wharton)
  • "You can have bias and not do discriminatory stuff. But the only way to do that is to recognize your bias." (27:25, Dr. Wharton)

8. Opening Conversations: How to Talk About Weight

• Patient-first, Permission-based Approach (30:04–34:38)
  • Treat the presenting health issue first; do not default to discussing weight unless appropriate.
  • Always ask permission: “Would you be open to a conversation about weight management?”
  • Present options with nonjudgmental tone: surgery, medication, cognitive behavioral therapy—waiting for the patient’s response and respecting it.
  • "99.99% of your patients have experienced bias and stigma in medical practices. That's a mountain you have to understand is there and need to overcome." (31:39, Patti Nece)
  • Dr. Wharton: “The way we treated obesity in the past was not effective. Would you be open to a conversation about weight management now?” (32:09, Dr. Wharton)

9. Concluding Insights: Building Hope and Compassion

• Final Reflections (35:02–36:29)
  • Patti: "For so long, people with obesity haven't had hope of treatment, but there's every reason to hope now. ... Giving them hope is very important and a good way to build trust..." (35:02, Patti Nece)
  • Dr. Wharton: "Understanding this field of bias, stigma and compassion is also about understanding the word love. ... Letting your patient know that they are loved, that they are cared for..." (35:37, Dr. Wharton)

Notable Quotes & Memorable Moments

• "I became my own worst bully." (04:04, Patti Nece)
• "That analogy—sometimes you just need a different tool. I love that." (12:41, Dr. Skolnick)
• "Eat and reproduce. ... If you've got a genetics that are a little too much on that side, it'll go a little bit higher." (17:18, Dr. Wharton)
• "Shame and blame doesn't ever help. It just hurts." (21:27, Patti Nece)
• "You're biased, and you know that you're biased. ... You've seen The Little Mermaid at least once, and Ariel is this big, and Ursula's this big." (26:14, Dr. Wharton)
• "The only way to do that is to recognize your bias." (27:25, Dr. Wharton)
• "You need to be curious about your patients." (23:11, Patti Nece)
• "Your weight is in a range that qualifies you for weight loss surgery. Is this something you're interested in looking at?" (33:09, Dr. Wharton on clinical phrasing)
• "Give your patients hope." (35:02, Patti Nece)
• "Doctors don't use that word love very often... but letting your patient know that they are loved, that they are cared for..." (35:37, Dr. Wharton)

Highlighted Timestamps

• 03:32 – Patti Nece’s personal story and entry into advocacy
• 08:14 – Dr. Wharton's motivation for specializing in obesity medicine
• 11:15 – Home renovation analogy for failed weight loss attempts
• 16:02 – The science behind weight regulation, brain systems, and counterregulation
• 20:31 – Practical office-based ways to reduce stigma
• 24:52 – Shifting guidelines to confront clinician bias
• 30:04 – How to open sensitive weight discussions in clinic
• 35:02 – Concluding advice: hope, trust, and compassionate care

Actionable Takeaways for Clinicians

• Recognize and own your bias: Every healthcare professional has biases—identifying them is the first step to minimizing their harmful effects.
• Train staff and structure environments: Small changes, like appropriate furniture or gowns and private weigh-ins, make a big difference.
• Ask permission before discussing weight: Never assume; always invite the patient into the conversation.
• Be hopeful and supportive: Patients who feel genuinely cared for and not blamed will be more engaged and trusting.
• Adopt a language of compassion: Use clear, nonjudgmental, and permission-based language.
• Give patients hope: Advancements in treatment mean more is possible now than ever before.

This episode delivers a moving, evidence-based call to action to prioritize empathy, self-awareness, and change—one patient, and one clinic, at a time.