Weight stigma, including prejudicial attitudes, stereotypes, and discrimination is morally wrong and socially harmful. Victims of it are more likely to report depression, anxiety, disordered eating, and social isolation. Stigma also elevates cortisol, a stress hormone linked to visceral fat accumulation and cardiometabolic risk.

Yet understanding the biological consequences of excess adiposity remains essential for preventing and managing chronic disease.

Defining Excess Adiposity

Body mass index (BMI) is the most common population-level indicator, despite limitations such as failing to distinguish fat from lean mass or account for fat distribution, sex, or ethnicity. It remains widely used because obesity can be defined simply as BMI ≥30 kg/m² with only a scale and height measurement.

Visceral adipose tissue around organs is strongly associated with metabolic dysfunction, while subcutaneous fat beneath the skin is less hazardous. Waist circumference offers a practical proxy: >102 cm (40 inches) in men or >88 cm (34.5 inches) in women indicates elevated cardiometabolic risk.

Why More Fat Matters

One common problem is insulin resistance, the hallmark of type 2 diabetes. As fat cells enlarge, they leak fatty acids into the bloodstream. These fatty acids build up in the liver and muscles, where they interfere with how insulin works and block normal energy use. Over time, blood sugar climbs, inflammation worsens, and the body struggles to maintain balance.

Excess fat also stresses the cardiovascular system. Fat tissue releases inflammatory messengers such as TNF-α and IL-6, while cutting back on adiponectin, a protective hormone that normally keeps vessels flexible. This imbalance damages vessel linings, stiffens arteries, and increases the risk of heart disease and stroke.

Higher insulin and estrogen levels from fat tissue additionally fuel tumor growth, while enlarged organs give more cells the chance to turn malignant, raising overall cancer risk.

Visceral fat also overloads the liver, leading to nonalcoholic fatty liver disease. This begins with simple fat buildup but can progress to inflammation, scarring, and cirrhosis if left untreated.

Finally, studies show that higher BMI, waist size, and weight gain increase the odds of symptomatic gallstone disease, sometimes leading to gallbladder removal.

Weight-Neutral Approaches

In response to stigma, some practitioners adopt weight-neutral models such as Health at Every Size (HAES). These emphasize behaviors like balanced eating, activity, and stress management without focusing on weight reduction. While helpful for reducing stigma, feelings of being stigmatized, and improving care, ignoring the role of adiposity in disease risks underserving patients. The best approach eliminates stigma while acknowledging the biological risks of excess fat.

Beyond Choice: Our Food System Fuels Disease

Weight is deeply tied to food and culture, making discussions emotional and polarizing. Most people with obesity do not want to remain obese, as shown by the rising use of medications and surgeries. Yet the food environment, dominated by ultra-processed, energy-dense products, makes maintaining a lean body impracticable for most Americans. Diets and environments high in calorie-dense, nutrient-poor foods promote both adiposity and metabolic dysfunction, often beyond individual control. Excess fat itself drives inflammation, hormonal imbalance, and impaired metabolism.

Conclusion

Both stigma and excess adiposity harm health. Weight-neutral care helps patients feel respected but must not obscure the evidence that visceral fat contributes to chronic disease. A registered dietitian specializing in weight management can be an essential first-line resource, offering compassionate, evidence-based strategies to improve outcomes while avoiding judgment and unnecessary invasive treatments.

About the Author

Patrick Traynor, PhD, MPH, RD, CSOWM, CPT, is a registered dietitian and founder of MNT Scientific, LLC (MNTScientific.com), an insurance-based nutrition practice serving South Lake Tahoe, CA; Minden, NV; and Ashland, OR. He holds the Interdisciplinary Specialist Certification in Obesity and Weight Management (CSOWM) from the Commission on Dietetic Registration. Virtual appointments are available in-office or via telehealth. For inquiries or appointments, visit MNTScientific.com, dial (530)429-7363, or email securefoodphoto@mntscientific.hush.com.