As a cardiologist who treats patients from diverse backgrounds, I’ve observed how our approach to obesity often lacks nuance. While society has rightly begun confronting weight discrimination, we sometimes avoid frank discussions about obesity’s health consequences, particularly in communities already facing health disparities.
When I see patients who are obese, I see beautiful, dignified human beings first. I’ve watched family members wear stunning outfits with confidence and grace. But as a physician who has sworn to do no harm, I must address how excess weight impacts their health trajectory.
The Medical Consequences of Obesity
The medical consequences of obesity are profound. From my cardiology practice, I regularly witness how obesity serves as the root cause of numerous conditions: hypertension, diabetes, sleep apnea, pulmonary hypertension, arthritis, and more. These conditions often cascade into serious cardiovascular complications, including heart attacks and strokes. For many patients, we can trace their medical challenges directly back to excess weight.
However, simply telling patients to “lose weight” without providing practical guidance is ineffective and potentially harmful. This approach lacks compassion and fails to acknowledge the complex barriers many patients face.
Individualized Strategies for Weight Management
I’ve learned that successful weight management requires individualized strategies. When I discuss weight with patients, I start by understanding their specific circumstances. What foods do they enjoy? What cultural considerations influence their diet? What physical limitations or neighborhood safety concerns might impact exercise options?
A patient of mine eliminated soda from his diet—reducing from 3-4 daily to zero—and lost over 30 pounds in a year without any other changes. This illustrates how identifying specific modifications can create positive feedback loops: one successful change motivates further healthy decisions.
For some patients, particularly those from Chicago’s West Side where I practice, outdoor exercise isn’t feasible due to safety concerns. Rather than dismissing their circumstances, I recommend alternatives: peddlers that do not occupy space and can be used while watching television, YouTube exercise videos, or other home-based activities that don’t require special equipment or outdoor access.
Similarly, dietary recommendations must respect cultural preferences and economic realities. The most effective nutrition professionals tailor advice to patients’ ethnic foods and taste preferences rather than prescribing generic diets that may be culturally disconnected.
Addressing Systemic Inequities and Health Disparities
This individualized approach becomes particularly important when considering the 20-year life expectancy gap
between Chicago’s predominantly Black South Side and predominantly white North Side. While health interventions like weight management are essential, they represent just one component of addressing profound structural inequities. The root causes of these disparities trace back to structural racism and socioeconomic factors that shape health outcomes.
As healthcare providers, we must simultaneously address immediate health concerns while acknowledging the broader social determinants that create and perpetuate disparities. Our approach to obesity must reflect this complexity.
Compassion and Clinical Precision
We can affirm that all body types deserve dignity and respect while still having frank, compassionate conversations about health risks. We can acknowledge systemic barriers while providing practical, individualized strategies for healthier living. We can recognize beauty in all forms while still working to reduce cardiovascular risk.
My most successful patients understand they’re not being judged—they’re being supported. When one patient loses enough weight to eliminate multiple medications, it reinforces that weight management isn’t about conforming to arbitrary standards but about improving quality of life.
By approaching obesity with both clinical precision and deep compassion, we can help patients achieve meaningful health improvements while preserving their dignity. This balanced approach represents the true spirit of the Hippocratic oath: to heal while doing no harm.
Dr. Tochukwu Okwuosa is a Professor and Director of the Cardio-Oncology Program at Rush University Medical Center in Chicago, IL. She earned her medical degree from the Philadelphia College of Osteopathic Medicine and completed her Internal Medicine and Cardiology training at the University of Chicago. Dr. Okwuosa’s primary research interests lie in the areas of Cardio-Oncology and Cardiovascular Disease Prevention. She actively participates in multiple locoregional and national Cardiology/Cardio-Oncology committees and boards, serves as an Associate Editor for the Journal of the American Heart Association, and is the Immediate Past Chair of the American Heart Association’s Cardio-Oncology sub-committee.
