Joint international consensus statement for ending stigma of obesity

Francesco Rubino^{1

2}, Rebecca M Puhl^#³, David E Cummings^#^{4

5}, Robert H Eckel^{6

7}, Donna H Ryan⁸, Jeffrey I Mechanick^{9

10}, Joe Nadglowski¹¹, Ximena Ramos Salas^{12

13}, Phillip R Schauer⁸, Douglas Twenefour¹⁴, Caroline M Apovian^{15

16}, Louis J Aronne¹⁷, Rachel L Batterham^{18

19

20}, Hans-Rudolph Berthoud²¹, Camilo Boza²², Luca Busetto²³, Dror Dicker^{24

25}, Mary De Groot²⁶, Daniel Eisenberg²⁷, Stuart W Flint^{28

29}, Terry T Huang^{30

31}, Lee M Kaplan³², John P Kirwan³³, Judith Korner³⁴, Ted K Kyle³⁵, Blandine Laferrère³⁶, Carel W le Roux³⁷, LaShawn McIver³⁸, Geltrude Mingrone^{39

40

41}, Patricia Nece¹¹, Tirissa J Reid⁴², Ann M Rogers⁴³, Michael Rosenbaum⁴⁴, Randy J Seeley⁴⁵, Antonio J Torres⁴⁶, John B Dixon⁴⁷

Affiliations

¹ King's College London, Department of Diabetes, School of Life Course Science, London, UK. francesco.rubino@kcl.ac.uk.
² King's College Hospital, Bariatric and Metabolic Surgery, London, UK. francesco.rubino@kcl.ac.uk.
³ Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, USA.
⁴ UW Medicine Diabetes Institute, University of Washington, Seattle, WA, USA.
⁵ Weight Management Program, Virginia Puget Sound Health Care System, University of Washington, Seattle, WA, USA.
⁶ Division of Endocrinology, Metabolism & Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁷ Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁸ Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA.
⁹ The Marie-Josee and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, NY, USA.
¹⁰ Divisions of Cardiology and Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹¹ Obesity Action Coalition, Tampa, FL, USA.
¹² Obesity Canada, Edmonton, Canada.
¹³ European Association for the Study of Obesity, Teddington, UK.
¹⁴ Diabetes UK, London, UK.
¹⁵ Boston University School of Medicine, Boston, MA, USA.
¹⁶ Center for Nutrition and Weight Management, Boston Medical Center, Boston, MA, USA.
¹⁷ Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medicine, New York, NY, USA.
¹⁸ National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK.
¹⁹ University College London Hospital Foundation Trust, London, UK.
²⁰ Centre for Obesity Research, Department of Medicine, University College London, London, UK.
²¹ Neurobiology of Nutrition and Metabolism Department, Pennington Biomedical Research Centre, Louisiana State University System, Baton Rouge, LA, USA.
²² Centro de Innovación Clinica Las Condes Universidad Adolfo Ibañez, Santiago, Chile.
²³ Department of Internal Medicine, University of Padova, Padua, Italy.
²⁴ Hasharon Hospital-Rabin Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
²⁵ Obesity Management Task Force, European Association for the Study of Obesity, Teddington, UK.
²⁶ Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
²⁷ Department of Surgery, Stanford School of Medicine and Palo Alto Virginia Health Care System, Stanford, CA, USA.
²⁸ School of Psychology, University of Leeds, Leeds, UK.
²⁹ Scaled Insights, Nexus, University of Leeds, Leeds, UK.
³⁰ Department of Health Policy & Management, Center for Systems & Community Design, New York, NY, USA.
³¹ NYU-CUNY Prevention Research Center, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA.
³² Obesity, Metabolism and Nutrition Institute, Massachusetts General Hospital, Boston, MA, USA.
³³ Integrated Physiology and Molecular Medicine, Pennington Biomedical Research Center, Baton Rouge, LA, USA.
³⁴ Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
³⁵ ConscienHealth, Pittsburgh, PA, USA.
³⁶ Division of Endocrinology, Columbia University, New York, NY, USA.
³⁷ Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland.
³⁸ Government Affairs & Advocacy, American Diabetes Association, Arlington, VA, USA.
³⁹ King's College London, Department of Diabetes, School of Life Course Science, London, UK.
⁴⁰ Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
⁴¹ Catholic University, Rome, Italy.
⁴² Division of Endocrinology, Diabetes & Metabolism, Columbia University College of Physicians and Surgeons, New York, NY, USA.
⁴³ Pennsylvania State Hershey Medical Center, Hershey, PA, USA.
⁴⁴ Columbia University Irving Medical Center, New York, NY, USA.
⁴⁵ Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
⁴⁶ Hospital Clinico San Carlos. Universidad Complutense de Madrid, Madrid, Spain.
⁴⁷ Baker IDI Heart and Diabetes Institute, Melbourne, Australia.

^# Contributed equally.

PMID: 32127716
PMCID: PMC7154011
DOI: 10.1038/s41591-020-0803-x

Review

Joint international consensus statement for ending stigma of obesity

Francesco Rubino et al. Nat Med. 2020 Apr.

. 2020 Apr;26(4):485-497.

doi: 10.1038/s41591-020-0803-x. Epub 2020 Mar 4.

Authors

Affiliations

¹ King's College London, Department of Diabetes, School of Life Course Science, London, UK. francesco.rubino@kcl.ac.uk.
² King's College Hospital, Bariatric and Metabolic Surgery, London, UK. francesco.rubino@kcl.ac.uk.
³ Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, USA.
⁴ UW Medicine Diabetes Institute, University of Washington, Seattle, WA, USA.
⁵ Weight Management Program, Virginia Puget Sound Health Care System, University of Washington, Seattle, WA, USA.
⁶ Division of Endocrinology, Metabolism & Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁷ Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁸ Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA.
⁹ The Marie-Josee and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, NY, USA.
¹⁰ Divisions of Cardiology and Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹¹ Obesity Action Coalition, Tampa, FL, USA.
¹² Obesity Canada, Edmonton, Canada.
¹³ European Association for the Study of Obesity, Teddington, UK.
¹⁴ Diabetes UK, London, UK.
¹⁵ Boston University School of Medicine, Boston, MA, USA.
¹⁶ Center for Nutrition and Weight Management, Boston Medical Center, Boston, MA, USA.
¹⁷ Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medicine, New York, NY, USA.
¹⁸ National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK.
¹⁹ University College London Hospital Foundation Trust, London, UK.
²⁰ Centre for Obesity Research, Department of Medicine, University College London, London, UK.
²¹ Neurobiology of Nutrition and Metabolism Department, Pennington Biomedical Research Centre, Louisiana State University System, Baton Rouge, LA, USA.
²² Centro de Innovación Clinica Las Condes Universidad Adolfo Ibañez, Santiago, Chile.
²³ Department of Internal Medicine, University of Padova, Padua, Italy.
²⁴ Hasharon Hospital-Rabin Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
²⁵ Obesity Management Task Force, European Association for the Study of Obesity, Teddington, UK.
²⁶ Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
²⁷ Department of Surgery, Stanford School of Medicine and Palo Alto Virginia Health Care System, Stanford, CA, USA.
²⁸ School of Psychology, University of Leeds, Leeds, UK.
²⁹ Scaled Insights, Nexus, University of Leeds, Leeds, UK.
³⁰ Department of Health Policy & Management, Center for Systems & Community Design, New York, NY, USA.
³¹ NYU-CUNY Prevention Research Center, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA.
³² Obesity, Metabolism and Nutrition Institute, Massachusetts General Hospital, Boston, MA, USA.
³³ Integrated Physiology and Molecular Medicine, Pennington Biomedical Research Center, Baton Rouge, LA, USA.
³⁴ Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
³⁵ ConscienHealth, Pittsburgh, PA, USA.
³⁶ Division of Endocrinology, Columbia University, New York, NY, USA.
³⁷ Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland.
³⁸ Government Affairs & Advocacy, American Diabetes Association, Arlington, VA, USA.
³⁹ King's College London, Department of Diabetes, School of Life Course Science, London, UK.
⁴⁰ Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
⁴¹ Catholic University, Rome, Italy.
⁴² Division of Endocrinology, Diabetes & Metabolism, Columbia University College of Physicians and Surgeons, New York, NY, USA.
⁴³ Pennsylvania State Hershey Medical Center, Hershey, PA, USA.
⁴⁴ Columbia University Irving Medical Center, New York, NY, USA.
⁴⁵ Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
⁴⁶ Hospital Clinico San Carlos. Universidad Complutense de Madrid, Madrid, Spain.
⁴⁷ Baker IDI Heart and Diabetes Institute, Melbourne, Australia.

^# Contributed equally.

PMID: 32127716
PMCID: PMC7154011
DOI: 10.1038/s41591-020-0803-x

Abstract

People with obesity commonly face a pervasive, resilient form of social stigma. They are often subject to discrimination in the workplace as well as in educational and healthcare settings. Research indicates that weight stigma can cause physical and psychological harm, and that affected individuals are less likely to receive adequate care. For these reasons, weight stigma damages health, undermines human and social rights, and is unacceptable in modern societies. To inform healthcare professionals, policymakers, and the public about this issue, a multidisciplinary group of international experts, including representatives of scientific organizations, reviewed available evidence on the causes and harms of weight stigma and, using a modified Delphi process, developed a joint consensus statement with recommendations to eliminate weight bias. Academic institutions, professional organizations, media, public-health authorities, and governments should encourage education about weight stigma to facilitate a new public narrative about obesity, coherent with modern scientific knowledge.

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Conflict of interest statement

None of the members of the organizing committee (F.R., D.E.C., D.H.R. and J.B.D.) and none of the voting members of the expert panel received payment for their participation. Travel expenses for the face-to-face meeting of the expert panel were supported by Medtronic, Ethicon, Novo Nordisk, Fractyl Laboratories, GI Dynamics, Cairn Diagnostics, Keyron, and Aventic Group. C.M.A. has participated on advisory boards for Nutrisystem, Zafgen, Sanofi-Aventis, Orexigen, EnteroMedics, GI Dynamics, Gelesis, Novo Nordisk, Bariatrix, Xeno Biosciences, Rhythm Pharmaceuticals, Eisai, and Scientific Intake; has received research funding from Aspire Bariatrics, GI Dynamics, Takeda, the Vela Foundation, Gelesis, Energesis, Coherence Lab, and Novo Nordisk; and owns stock in Science-Smart LLC. L.J.A. has received consulting fees from and serves on advisory boards for Jamieson Laboratories, Pfizer, Novo Nordisk, Eisai, Real Appeal, Janssen, and Gelesis; has also received research funding from Aspire Bariatrics, Allurion, Eisai, AstraZeneca, Gelesis, Janssen, Eli Lily, and Novo Nordisk; serves on the board of directors for Intellihealth/BMIQ, MYOS, and Jamieson Laboratories; and has equity in Intellihealth/BMIQ, ERX, Zafgen, Gelesis, MYOS, and Jamieson Laboratories. R.L.B. is a principle investigator for clinical trials funded by Novo Nordisk and Fractyl (all funds go directly to the institution); and has consultancy agreements with Novo Nordisk, Pfizer, GSK, and International Medical Press. C.B. is a principal investigator on a study of metabolic surgery funded by Prodigies; and has received fees from Ethicon Endosurgery. B.L. is on the Scientific Advisory Board of Novo Nordisk; has received speaker fees from Bruno Farmaceutici; and has a research grant from Enzymmanagemen. D.E.C. is on the Scientific Advisory Boards of G.I. Dynamics, DyaMx, Magnamosis, and Metavention. J.B.D. has consultancies with Bariatric Advantage, iNova, and Reshape; is on advisor boards for Novo Nordisk and Nestlé Health Science; and receives research support from NHMRC. M.deG. has received funds from Lifescan Diabetes Institute, Inc., and the Kenner Family Foundation. R.H.E. has received funds from Amgen, Kowa, Sanofi, and Novo Nordisk. S.W.F. has received from Novo Nordisk for travel; and support for working with media. L.M.K. has received funds from Boehringer Ingelheim, Ethicon, Gelesis, GI Dynamics, Johnson & Johnson, Pfizer, Novo Nordisk, and Rhythm Pharmaceuticals. J.P.K. has received grants and research support from the National Institutes of Health, Ethicon, Covidien, Metagenics, Alliance for Potato Research and Education, CrossFit, Nestlé Research, General Mills, and Robard Corporation; is on advisory panels for Bristol-Myers Squibb, AstraZeneca, Novo Nordisk, and Cereal Partners; and receives speaker fees from Elli Lilly, Pfizer, and ILSI. J.K. is on the scientific advisory board of Digma Medical, GI Dynamics, and Applied Biosciences; and consults for Esquagama. T.K.K. has received consulting fees from Tivity Health, Novo Nordisk, and Gelesis. C.W.leR. is on the advisory boards and speaker bureaus for NovoNordisk, GI Dynamics, Keyron, Herbalife, Sanofi, Johnson & Johnson, Medtronic, and Boehringer Ingelheim; and owns shares in Keyron. J.I.M. has received honoraria for lectures and program development from Abbott Nutrition. G.M. has received fees for consultations from Novo Nordisk, Johnson & Johnson, and Fractyl Inc. J.N. is an employee of the Obesity Action Coalition. R.M.P. has received research grant support from the Rudd Foundation, and WW, Inc. F.R. is on advisory boards for GI Dynamics, Keyron, and NovoNordisk; has received consulting fees from Ethicon Endosurgery and Medtronic; and has received research funding from Ethicon Endosurgery and Medtronic. D.H.R. has an equity interest in start-up companies engaged in various aspects of weight management (Gila Therapeutics, Scientific Intake, Xeno Biosciences, Epitomee, and Calibrate); is on the Speaker’s Bureau of Novo Nordisk and Bausch Health; has served as an advisor or consultant to Alyvent, Amgen, Bausch Health, Boehringer Ingelheim, Epitomee, Gila Therapeutics, IFA Celtic, Janssen, Kensai Therapeutics, Novo Nordisk, Phenomix, Real Appeal (United Health), ReDesign Health (Calibrate), Sanofi, and Scientific Intake; and serves on the steering committee for the SELECT cardiovascular outcome trial for Novo Nordisk’s investigational product semaglutide. P.R.S. is a Board Member and Advisory Panel member for GI Dynamics; has consulted for Ethicon, Medtronic, WL Gore, and BD Surgical; has received research support from Ethicon, NIH, Medtronic, and Pacira; and has equity in SEHQC and LLC. R.J.S. receives research support from Novo Nordisk, Pfizer, Kintai, Ionis, Zafgen, and Astra Zeneca; has received consulting fees from Novo Nordisk, Kintai, Ionis, Sanofi, and Scohia; and has equity in ReDesign Health and Zafgen. T.D. is an employee of Diabetes UK.

Comment in

A Call to Better Understanding: Action Will Follow.
Kaplan LM, Comuzzie AG. Kaplan LM, et al. Obesity (Silver Spring). 2020 Jun;28(6):1002. doi: 10.1002/oby.22792. Epub 2020 Apr 3. Obesity (Silver Spring). 2020. PMID: 32243693 No abstract available.

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Joint international consensus statement for ending stigma of obesity

Affiliations

Joint international consensus statement for ending stigma of obesity

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical