"Not My BMI": An Ethnoculturally Sensitive Approach to Weight, Body Habitus, and Health

Abstract: Weight, body habitus, and an individual’s perception of their own body aesthetics have been the topics of scientific investigations, pop culture, the media, and –– of greatest importance for this presentation –– challenges for CL psychiatrists who treat people dealing with issues related to body weight, including stigmatization, suicide ideation, and suicide behavior. Indeed, as summarized by Brochu (Int J Obes (2020)), “Subjective perceptions of “overweight” were associated with increased risk of suicidal ideation, plans, and attempt in a large sample of US adolescents, and…Perceived weight-based discrimination is associated with increased suicidal ideation among adult community members living in the US.”

As concerns about the public health effects of obesity have risen in the U.S., so too have negative and stigmatized views of individuals with obesity. Weight stigma has serious negative emotional and physical health consequences including low self-esteem, negative body image, engagement in disordered eating patterns, and reduced physical activity, which may promote further weight gain.

We aim to help attendees better understand and treat those suffering from obesity and comorbid psychiatric conditions by taking an ethnoculturally-informed approach to their treatment. We cannot address every cohort but we hope to stimulate enough interest in attendees that they "pay it forward" by using the knowledge gleaned to treat vulnerable and underserved people distressed by living in a higher-weight body.

Dr. Sockalingam will discuss Body Mass Index (BMI), which was investigated nearly 200 years ago, originally known as the Quetelet Index, and has been the leading measure to determine obesity in clinical care. However, questions about the reliability and its inability to account for differences across race, sex and broader dimensions of health have come under serious question. He will discuss the role of BMI in obesity care, the evolution of our understanding of obesity and why BMI should be downgraded to a screening tool. Using a whole-person approach that considers physical and mental health, alternative obesity classification systems to BMI will be described that support a more patient-centered approach.

Dr. Gentry will discuss the challenges African Americans, who have the highest rates of obesity in the U.S. and are at high risk for suffering from both external and internalized weight stigma, face when challenged by obesity. She will emphasize the importance of increasing awareness, advocacy, and practical strategies to combat the impact of weight bias, particularly its effects on those at risk of other health disparities.

Dr. Eyler asserts weight, and particularly body shape and size, can have particular significance within the LGBTQIA+ communities, expressed in a variety of ways. LGBTQIA+ persons exist within a network of intersecting biases, including stereotypes regarding their physical and sexual selves. How do embodiment experiences affect members of these diverse populations? His presentation will offer a brief introduction to the meaning of weight, fitness, health, and body habitus among gay, trans, and queer-identified persons, with suggested applications for CLP.

Dr. Rabinowitz will moderate and discuss the pros and cons of weight-loss medications, including how they might be misused, inappropriately prescribed, and their side effects.