The medical and social consequences of stigmas towards obesity – a discussion at the Haifa Health Committee

(live here) – The Haifa Municipal Health Committee meeting held today (May 20.5.25, XNUMX) became a fascinating, complex, and sometimes moving forum for discussion on a topic that many prefer not to discuss publicly: the attitude of the health system and society as a whole toward people suffering from obesity, especially women.

The main lecture was given by Prof. Lena Sagi-Dain, a senior gynecologist and geneticist from Carmel Hospital, under the title "Doctor, Who Did You Call Fat?" The focus of the lecture was a sharp critique of the judgmentalism and inherent discrimination against overweight patients, both within and outside the healthcare system.

Israel Savyon – Discussion on the topic of obesity and stigma:

An extraordinary lecture at the ninth meeting of the Municipal Health Committee

The municipal health committee, headed by Deputy Mayor Israel Savyon, convened for the ninth time in the current term. The meeting was attended by representatives from the city's hospitals and health funds, representatives of the National Insurance Institute, academics, and welfare institutions. The lecture, which lasted almost an hour and a half, included not only scientific and research data, but also personal testimonies from the field.

Savyon, who also serves as chairman of the pensioners' faction in the municipality, said at the beginning of the discussion: "Obesity is not only a medical challenge, but a social and cultural challenge of the highest order. We must understand how to treat, not only the body, but also the soul and human dignity."

Obesity: A Sensitive Medical Issue with Profound Implications

Prof. Lena Sagi-Dain, one of the most influential voices in the field of gender medicine in Israel, opened her lecture with a poignant question: "Is it okay to tell a woman in the middle of the night in the emergency room that she needs to lose weight?" In her opinion, focusing on weight causes many doctors to miss important medical diagnoses. She warned against making weight the central focus of medical discourse – sometimes at the expense of the treatment itself.

Discrimination, Stigma, and Medical Errors – The High Price of Judgment

The data presented by Sagi-Dain was disturbing: as a person's BMI increases, their salary decreases, their chances of being hired decrease, and the time for their medical examination shortens.

“Doctors sometimes view overweight people as lazy, sloppy, undisciplined – and that’s a dangerous perception,” she said. She also cited cases where obese patients complained of pain, and doctors immediately classified it as a result of obesity – without investigating further. In extreme cases, diagnoses of cancer or fertility problems were delayed – simply because being overweight was presented as the “answer to everything.”

The impact of obesity on daily life – employment, relationships, and self-image

Beyond the health implications, the lecture dealt with the much broader effects of weight stigma: overweight people tend to experience verbal abuse in childhood, have difficulty finding relationships, are labeled as “unattractive,” and are sometimes considered undisciplined or “not serious.” “On television shows,” said Sagi-Dain, “fat characters are portrayed as stupid, noisy, or ridiculous. We absorb these messages all the time – even without noticing.”

Healthcare system – obese patients receive suboptimal care

According to the lecturer, the negative biases of health professionals towards obese people are also reflected in treatment gaps. “Overweight patients tend to avoid tests such as mammograms or gynecological examinations, due to a sense of shame or previous humiliating reactions from medical teams,” she said. She said that even basic medical equipment – ​​chairs, tables, measuring devices – are not always adapted to the body dimensions of overweight patients, which intensifies the feeling of exclusion and alienation.

Weight gain due to stigma – a dangerous vicious cycle

Paradoxically, one of the effects of stigma itself is further weight gain. Teens who experience humiliation because of their weight tend to engage in less sports and develop unhealthy eating habits. “Stigma does not encourage change – it is debilitating, depressing and leads to avoidance,” stated Sagi-Dain. According to her, the most effective way to help people who are overweight is to have a sensitive, inclusive and personalized approach, rather than a judgmental and accusatory one.

Is obesity a disease? The international debate is heated

In part of the lecture, the lecturer discussed the question of whether obesity is a disease. According to her, Europe has already defined it as such, while in the United States there is a debate about the definition. "If we recognize obesity as a disease, we can train more doctors to specialize in treating it, invest more budgets and encourage holistic treatment approaches," she explained. She pointed out that obesity is the product of many factors - genetic, environmental, hormonal and even behavioral. "It's not just what we eat - but also what our mother ate when she was pregnant, what's in breast milk, how much air conditioning we consume and even the quality of our sleep."

Media and leisure culture – a culture that glorifies thinness

Recent findings from a content analysis of television characters revealed that thin women are perceived as young, attractive, energetic and kind-hearted, while fat women are portrayed as angry, stupid and even dangerous. A clear example of this, she said, is the successful television series "Friends," in which the character Monica is presented as "fat and funny" in the past, but only after losing significant weight does she find love. "Children absorb these messages well - and they affect their self-image from a young age," said Sagi-Dain.

Committee members' responses: Call for a change in approach and infrastructure

Fitness and health indicators

After the lecture, a discussion was opened with the participation of the committee members and guests. Col. (res.) Eitan Matmon, chairman of the IDF Disabled Organization in Haifa and the North, said that the US has a clear policy in the army regarding fitness and health indicators, and suggested adopting a similar system in Israel. "I tried to introduce this at the time - and former Prime Minister and Chief of Staff Ehud Barak opposed it. We thought about the possibility that officers who are overweight would wear civilian clothes and not uniforms," ​​Matmon said.

Yifat Herman, director of the Haifa branch of the National Insurance Institute, said she would reexamine the suitability of medical equipment for overweight people, especially in public institutions. "There is no reason for a patient to feel humiliated because of a chair or sofa that does not fit their body," she said.

Hiriya Aloh Hamra, director of the senior citizens department at the municipality, raised a particularly complex point: "In the case of the elderly, sometimes being overweight actually protects them. There are cases where thinness itself signals functional deterioration."

Constructive words instead of destructive criticism – conclusions from the lecture

Prof. Sagi-Dain concluded her lecture by calling on doctors and the entire system to examine the way they talk about obesity. "When a patient hears from her doctor that she is 'a cow who should only eat lettuce' - she doesn't come back for follow-up. We are harming her health because of words," she warned. According to her, before raising the issue of weight, one must ask permission, and choose one's words carefully. "The goal is not to be right - but to be smart. If the way we present things creates more harm - we have failed in our duty."

Israel Savyon: "The patient's status must be top priority"

At the end of the meeting, Deputy Mayor Israel Savyon thanked Prof. Sagi-Dain for her poignant and thought-provoking lecture. "Just as we demand sensitivity towards the elderly, the disabled or vulnerable populations, we must also apply standards of respect towards people who are overweight. In my opinion, this is not just a question of medicine, but of basic human values," he said. He emphasized his intention to continue to raise the issue on the municipal agenda and to examine systemic changes, including in schools and community institutions.