Addressing Common Stigmas in Weight Loss: David Rometo, MD

Addressing stigma surrounding obesity is important as a physician when consulting patients on their weight loss.

In the discussion concerning stigmas and expanding clinic care for obesity, The American Journal of Managed Care^® spoke with David Rometo, MD, clinical associate professor of medicine at UPMC Division of Endocrinology and Metabolism in Pittsburgh, PA, on how he navigates patient relations. One of the first points Rometo made was addressing the stigma surrounding obesity. Oftentimes, he says, patients meet with him and are confused about their weight, whether that be gaining weight or the inability to lose weight, despite imitating similar behaviors of family members who have not experienced the same weight gain as them since childhood. Whereas many of his patients are persistent that they have a hormonal condition that inhibits their weight loss and induces weight gain more prevalently than some who may not, Rometo said that obesity is more often the result of a genetic predisposition than a hormonal one.

“When you're born and when you reach adolescence and young adulthood, you have the potential to end up with significant obesity based on your genetics,” he said. “And sometimes they'd rather have a hormone problem than a genetic predisposition, but understand that they shouldn’t blame themselves.”

There are anywhere between 200 and 500 specific genes linked to obesity. These genes can influence how a person’s body stores fat, metabolizes nutrients, and signals feelings of satiety.¹ For some, people with obesity caused by a genetic predisposition require additional pharmacotherapy to effectively manage and achieve weight loss.²

Furthermore, Rometo also discussed the quality and avenues of care for patients with obesity who are trying to manage their weight and weight loss. He presented his research on obesity medicine clinics and comprehensive lifestyle programs at the UPMC Pop Health Institute for Value-Based Medicine^® event, which encouraged shared group lifestyle programs and medical appointments led by physicians, exercise physiologists, and behavioral health staff. This method of treatment, he said, allows health care practitioners to treat more patients with obesity, as there are over 650 million impacted adults worldwide.


“Having people in at least groups of 10, meeting with a dietitian or some other health coach-level personnel for the frequency of visits really required to [them to] stay focused and focus on problem-solving and barriers that pop up,” Rometo said. “That's a big part of people getting high-quality care, evidence-based care, and meeting the guidelines.”


Physicians who see multiple patients with obesity in a group setting increase the frequency and quality of care patients receive, which Rometo said allows patients to grow in their weight loss journeys. Discussing health behaviors, weight loss, and the medical benefits of weight loss medication, compounded with frequent visits, increases the intensity of care, which, in turn, has the potential for improved patient outcomes. In addition to improvements in quality of care, group setting visits for patients with obesity can potentially reduce stigmas surrounding the disease.

Rometo also emphasized physician participation in group assessment programs as proper training and exposure for future physicians preparing to enter the field of endocrinology or primary care specialists.

References
1. Obesity and genetics: What is the connection? Obesity Medicine Association. October 30, 2023. Accessed September 29, 2025. https://obesitymedicine.org/blog/obesity-and-genetics/
2. Welling MS, van Rossum EFC, van den Akker ELT. Anti-obesity pharmacotherapy for patients with genetic obesity due to defects in the leptin-melanocortin pathway. Endocr Rev. 2025 May 9;46(3):418-446. doi:10.1210/endrev/bnaf004