The Nurse Keith Show · Keith Carlson, RN, BSN, NC-BC

Confronting Obesity as a Chronic Disease of Pandemic Proportions

August 23, 2024·57 min·5 clips

A doctor told Dr. Thomas George to lose weight, not knowing he'd already lost over 100 pounds.

This episode of The Nurse Keith Show features host Keith interviewing Dr. Thomas George, a family nurse practitioner and obesity specialist. They explore the recognition of obesity as a chronic disease and the challenges in its treatment. The American Medical Association formally recognized obesity as a disease around 2014. Dr. George cites statistics showing 43% of American adults have obesity, a condition linked to over 236 other health issues. He references a 2014 Milken Institute study calculating the economic cost at $1.14 trillion. A key focus is the pervasive weight bias in healthcare, with nurses often holding negative perceptions. Dr. George shares his personal experience gaining over 100 pounds after a traumatic brain injury and facing bias from providers. He describes working with patients in underserved urban and rural food deserts, like a single mother in Baltimore. Consensus statements from groups like the Obesity Medicine Association emphasize addressing stigma to improve care access. The American Association of Clinical Endocrinology proposes the term "adiposity-based chronic disease" to focus on pathophysiology. Dr. George explains how excess fat acts as an endocrine organ, hijacking hunger and reward pathways in the brain. He notes there are 11 FDA-approved medications for obesity, including semaglutide and liraglutide. Research into obesity phenotypes by scientists like Andres Acosta aims to match patients with more precise treatments. A surprising insight is that Dr. George himself once tested positive for implicit bias against people with obesity. He argues that shaming patients leads them to avoid preventative healthcare, especially women. The concept that obesity might cause overeating, rather than the reverse, represents a paradigm shift. He recounts emotional moments where patients cried with relief upon learning their condition was a disease, not a personal failing. The episode highlights systemic barriers, like clinics lacking appropriate blood pressure cuffs or furniture for larger patients. Dr. George advocates "loving" biased providers into education rather than shaming them. The tone is educational and conversational, blending personal narrative with clinical data. The style is passionate and advocacy-focused, stemming from Dr. George's professional and lived experience. This episode would deeply interest nurses, nurse practitioners, and any healthcare provider treating patients with obesity. Listeners concerned with health equity and systemic bias in medicine would find it compelling. Those seeking a purely clinical discussion of pharmacology without the social justice lens might find it less aligned with their interests.

As heard by us

A compassionate case for naming obesity clearly and reshaping care around it.

The discussion treats obesity as a chronic disease and stays focused on what that framing does for patients. It makes the case that people often need language that helps them move out of shame and toward agency, especially after being dismissed elsewhere.

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Why you'd press play

You want a plainspoken case for treating obesity as a chronic disease.

Read the full recommendation in PlayNext →

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