Beyond the Scale: Science and Soul

Written by Dr. Stephen Brewer, MD & Dr. Elizabeth Brewer, PsyD

Father and Daughter

August 2025

Introduction

Obesity is one of the most talked-about health concerns of our time, and one of the most misunderstood. Too often, the conversation gets reduced to numbers, diets, or quick fixes. We want to bring both of our voices, medicine and psychotherapy, father and daughter, to widen the lens. Healing requires not only science, but also soul.

Science Perspective (Dr. Stephen Brewer, MD)

From a medical perspective, excess weight is not simply a matter of appearance, it is a driver of chronic disease. In particular, visceral fat, the fat stored deep around organs, is strongly linked to heart disease, stroke, diabetes, dementia, and certain cancers (Cesaro et al., 2023). Unlike fat under the skin, visceral fat is metabolically active, producing inflammatory molecules, clotting factors, and hormones that raise blood pressure and disrupt insulin signaling (Cesaro et al., 2023).

One consequence is non-alcoholic fatty liver disease (NAFLD), which has become a leading cause of cirrhosis. Recent evidence suggests that NAFLD also increases the risk of dementia, especially vascular dementia, highlighting the reach of obesity beyond physical illness into cognitive decline (Shang et al., 2022).

In my practice, I emphasize assessing body composition, not just weight. Tools like DEXA scans provide estimates of visceral fat, which often correlate more directly with risk. While medications such as GLP-1 agonists (e.g., semaglutide) are changing the landscape of treatment and have been shown to produce significant weight loss and improve metabolic health (Schaefer, 2025), lifestyle interventions remain essential. Regular exercise and nutritional care are powerful tools for reducing visceral fat and improving long-term outcomes (Cesaro et al., 2023).

Soul Perspective (Dr. Elizabeth Brewer, PsyD)

When my father speaks about visceral fat, I hear not just physiology but the human stories beneath the weight. Obesity does not emerge in a vacuum. For many, it reflects trauma, chronic stress, poverty, and inequities that shape daily life. Research shows that adverse childhood experiences, including abuse, significantly increase the likelihood of adult obesity, especially among women (Noll et al., 2007). Survivors often describe their weight as protective, a body’s way of buffering against further harm.

Chronic stress also plays a central role. Elevated cortisol, the stress hormone, drives appetite for high-calorie foods and promotes fat storage around the abdomen, creating exactly the conditions my father describes (Puhl & Heuer, 2010).

Layered onto these biological realities is stigma. People living in larger bodies are too often reduced to numbers, blamed for their condition, or dismissed by healthcare providers. This stigma is not benign, it predicts depression, anxiety, disordered eating, and avoidance of care (Puhl & Brownell, 2006). Women are particularly vulnerable, facing discrimination at lower body weights than men, reflecting cultural ideals that equate thinness with worth (Dodgen & Spence-Almaguer, 2017).

Healing must extend beyond diet and exercise to address the relationship individuals have with their bodies, their histories, and the systems they live in. If visceral fat creates physical inflammation, stigma creates social inflammation, corroding dignity, silencing stories, and compounding pain.

The Bridge

Placed side by side, these perspectives reveal a fuller truth. From science, we see how visceral fat drives disease and why reducing it matters. From soul, we see that weight is never just biology, it is woven with trauma, inequity, and cultural meaning.

Healing requires both, medical tools to reduce risk and compassionate, trauma-informed care to restore dignity. Together, science and soul point to an integrated approach that honors physiology and humanity.

Closing Invitation

Obesity is not just a medical issue, nor just a social one, it is both. What would it look like if we stopped reducing people to numbers and began listening to their stories? What if medicine and compassion worked together to restore health and dignity?

We invite you to reflect: What has your body carried, and what would it mean to treat it with both science and soul?

🌿 Practices for Reflection

Story of the body: Take a few moments to ask yourself, what has my body lived through, and how might that history be shaping my health today?.
Cultural lens check: Reflect: how has culture taught me to see my body, and what stories of worth and dignity do I want to carry instead?

References

Cesaro, A., De Michele, M., Fimiani, R., Acerbo, F., Scherillo, M., Signore, N., Rotolo, D., Scialla, C., Raucci, F., Panico, M., Gragnano, F., Moscarella, E., Scudiero, O., Mennitti, C., & Calabrò, P. (2023). Visceral adipose tissue and residual cardiovascular risk: A pathological link and new therapeutic options. Frontiers in Cardiovascular Medicine, 10, 1187735. https://doi.org/10.3389/fcvm.2023.1187735

Dodgen, L., & Spence-Almaguer, E. (2017). Beyond body mass index: Are weight-loss programs the best way to improve the health of African American women? Preventing Chronic Disease, 14(E31). https://doi.org/10.5888/pcd14.160573

Noll, J. G., Zeller, M. H., Trickett, P. K., & Putnam, F. W. (2007). Obesity risk for female victims of childhood sexual abuse: A prospective study. Pediatrics, 120(1), e61–e67. https://doi.org/10.1542/peds.2006-3058

Puhl, R. M., & Brownell, K. D. (2006). Confronting and coping with weight stigma: An investigation of overweight and obese adults. Obesity, 14(10), 1802–1815. https://doi.org/10.1038/oby.2006.208

Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: Important considerations for public health. American Journal of Public Health, 100(6), 1019–1028. https://doi.org/10.2105/AJPH.2009.159491

Schaefer, B. (2025, July 24). Weight management drugs: A new frontier in cardiovascular health. Nuvance Health. https://www.nuvancehealth.org/health-tips-and-news/weight-management-drugs-a-new-frontier-in-cardiovascular-health

Shang, Y., Widman, L., & Hagström, H. (2022). Nonalcoholic fatty liver disease and risk of dementia: A population-based cohort study. Neurology, 99(6), e574–e582. https://doi.org/10.1212/WNL.0000000000200853