It's time for a new approach to obesity care

Reed Tuckson, MD, FACP, and Mara Gordon, MD

Obesity is not a failure of willpower. It’s a complex, chronic disease shaped by genetics, social determinants, cultural expectations — and, increasingly, misinformation. That was the central message delivered at the American College of Physicians (ACP) Internal Medicine Meeting 2025 session, “Confronting Misinformation in Obesity Care: Lessons from the Field,” on Friday afternoon.

Led by moderator Rachel Ramirez, MD, FACP, and featuring Reed Tuckson, MD, FACP, and Mara Gordon, MD, the discussion urged physicians to confront not only public health falsehoods but also the biases and outdated frameworks within their own practices.

“This disease brings up so many issues,” Tuckson said. “Even mentioning it in the clinical arena can cause anger — like, ‘how dare you bring that up in front of me?’”

Tuckson, a former UnitedHealth Group executive and co-convener of the Coalition for Trust in Health & Science, described obesity as a “brain disease,” “genetic disease,” and “chronic illness,” which is often approached with stigma rather than science. He cautioned against framing the issues as a moral failure. “There’s this sense … we often, in the therapeutic arena, will talk about willpower — as if somehow or another you are large because you lack sufficient willpower to do the right thing.”

Gordon, a primary care physician at Cooper University Health Care in Camden, New Jersey, has built her practice around what she calls “size-inclusive medicine.”

“I don’t yell at my patients to lose weight,” she said. “You’d be surprised at how radical that feels for so many patients.”

Gordon shared firsthand stories of patients traveling long distances just to see a physician who wouldn’t judge them for their body size. “They feel like their healthcare provider is sort of taking [a] more holistic approach, rather than just berating them to get to a BMI of 25.”

Body mass index (BMI) itself drew fire from both panelists. Gordon explained that the metric was developed in the 19th century by the Belgian astronomer Adolphe Quetelet, in an attempt to define “the average man” — a standard that was “young,” “white,” and “European.” “Somehow we’ve continued to use this many, many decades after,” she said.

She emphasized a shift toward objective clinical measures, including A1C, liver function, and cardiovascular risk markers. “I find that those feel more objective, and they feel less stigmatizing and less culturally fraught.”

Systemic failures and the role of policy

Ramirez opened the session by outlining barriers to effective obesity care: outdated guidelines, a lack of physician education, insufficient insurance coverage, and pervasive stigma. “What ACP is trying to do is advance equitable obesity care,” she said. “We want to make sure that we are caring for our patients equally and perfectly, as best we can.”

Gordon expressed her frustration over insurers’ shifting policies, saying, “One of our major insurers just made a big announcement that they’re not covering [GLP-1 receptor agonists] specifically for the indication of weight loss anymore.”

She acknowledged better coverage when the diagnosis is diabetes or cardiovascular disease.

The panel also addressed the growing role of telehealth and compounded medications, with Gordon cautioning that “a lot of these companies … you just fill out a checklist online and bam, you have medication.”

Misinformation

The speakers identified social media and even some licensed physicians as leading sources of misinformation. “There are physicians who are really dangerously negligent in terms of [spreading] misleading information that can harm people,” Tuckson said. “There must be some kind of accountability.”

Gordon stressed the importance of self-awareness. “I think our field has a lot of unlearning to do,” she said. “Every time someone comes in [and I push weight loss], I would just feel myself losing my patient’s trust over time.”

The need for trust was a recurring theme, with Tuckson saying, “You may gain trust for a minute, but you lose it down the road … we’re building relationships to sustain over time.”

Three wishes, one goal: Reclaim trust

Asked for her three wishes to improve obesity care, Gordon replied:

• Make joyful movement more accessible.
• Disentangle the “racist and misogynistic” cultural fatphobia from legitimate medical risk.
• Have 30-minute appointments to address complex patient needs.

Tuckson added, “It is not fair for the clinician to be holding the whole bag on these challenges. There are others of us who have to help you.”

Indeed, ACP has backed this message with grants totaling $250,000 across 13 state chapters to support grassroots initiatives in equitable obesity care. The organization is also pushing for better education, interdisciplinary care teams, and updated clinical guidelines that recognize embedded health inequities.

Redefining the clinical conversation

Ultimately, the panelists encouraged physicians to ask patients about their goals and listen more than they speak.

“I try to ground myself in that and be an advocate for them and for all of us,” said Gordon. “It’s such a privilege to be able to take care of my patients every day.”

Tuckson closed with a plea for physicians to see obesity care not as another burden but as an opportunity. “This work is difficult,” he said, “but if we’re well-meaning, [if] we’re well educated, [if] we’re respectful of patients — you do the best you can.”