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Two documents sit side by side, and at first glance they contradict each other.

One is Project Report No. 160 from AIHTA, Austria’s health technology assessment agency, published in Vienna in November 2024. Its conclusion: the strongest evidence is for multi-day and multi-week training courses.

The other is the meta-analysis by Jayawickrama and colleagues, which we covered in August. Its finding: anti-bias training changes what students say about fat patients, not what shows up when you measure below the level of self-report.

Put those two sentences next to each other and you get the familiar shrug: studies disagree, pick the one you like. That is not what is happening here. The two do not measure the same thing, they do not count in the same way, and they were not even written at the same time. Sort that out and no contradiction is left. Something less comfortable is.

What the Vienna report is

AIHTA is neither an advocacy organisation nor a treatment provider. It is Austria’s HTA agency, the body that prepares evidence for decisions inside the health system. For the German-speaking world that matters. Most of the sources this magazine relies on come either from the movement itself or from organisations with a commercial interest in treatment. This is the first state-backed evidence report on the subject in German.

The authors are Sarah Wolf and Julia Kern. The systematic search ran from 21 to 23 May 2024 across five databases. For the first research question, which strategies are recommended, they included 13 guideline papers and 13 reviews. For the second, what actually works, 30 primary studies.

The report is unusually clear about its own limits, and those belong in any citation of it. The effectiveness analysis explicitly claims no completeness: only studies published from 2014 onward, and only from Europe, North America, Australia or New Zealand. The trustworthiness of the guidelines used was not systematically assessed. Nine of the 13 reviews are non-systematic, and most of those give no information about their methods, their literature search, or what they included.

Above all, the evidence base is overwhelmingly American. Nine of 13 guideline papers, six of 13 reviews and 19 of 30 effectiveness studies come from the United States. AIHTA writes in its own critical reflection that transferability to Austria is therefore questionable, and it does not blame culture alone. In the US there is an established debate and correspondingly many tested measures; in Austria the focus has so far been on the medical perspective. The same caveat applies to Germany.

What it says, and what it does not

In the summary, one word about health professionals should not be skimmed past. For multi-day seminars or courses, the effectiveness analysis reports “controversial” results, based on three studies. Beliefs about fat patients improved. There were no significant changes in external weight bias, in attitudes toward patients, in communication with them, in their quality of life, or in their health status.

For students the picture is somewhat better. Long-term seminars showed significant improvements; one-day courses were inconsistent. Training improved students’ ability to recognise discrimination and strengthened empathy.

From this the discussion section concludes that multi-day training has the most evidence with the strongest indications of positive effects, and the conclusion states that the strongest evidence currently exists for multi-day to multi-week training. Both are relative statements. “Most evidence” here means three studies for staff, a few more for students, and effects that the conclusion itself describes as “mostly only short-term.”

One phrasing that circulates in coverage of the report is not in it: AIHTA nowhere calls multi-day training “most promising.” It says that is where the most evidence sits. Those are different claims.

Why this is not a contradiction

Three reasons, in ascending order of importance.

First, chronology. The AIHTA search closed on 23 May 2024. The Jayawickrama meta-analysis went online on 8 October 2024. The Vienna report could not have included it. These are not two camps. They are two points in time.

Second, method. AIHTA ran no meta-analysis. It summarises narratively and counts how many studies showed a significant change. Jayawickrama pools effect sizes across 35 studies and reports confidence intervals. A counted “three of three studies improved” and a pooled g are not competing answers to one question. They are two different questions.

Third, and this is the actual point, the endpoint. The AIHTA report lists the measurement instruments used across its included studies: twelve for explicit weight bias, six for internalised bias, four for empathy, and exactly two for implicit weight bias, both of them versions of the Implicit Association Test. The evidence Vienna draws its statement from is therefore almost entirely self-report. And self-report is precisely where Jayawickrama also finds an effect: explicit g = -0.31, confidence interval -0.43 to -0.19. What does not move is measured implicit attitude: g = -0.12, confidence interval -0.26 to +0.02, not significant.

So both reports say the same thing. What people say about fat patients can be shifted by training. What sits underneath was barely measured in Vienna, and was measured in the meta-analysis and did not shift.

Two further details point the same way. AIHTA notes that follow-up periods in most included studies were too short to show long-term effects. And it warns explicitly that training which is not sensitive and well structured can unintentionally reinforce existing bias. That is the same content as Jayawickrama’s prediction interval, which runs from -0.93 to +0.31: the next training can also go the wrong way.

Anyone citing either source as “training works” or “training does nothing” is citing it wrong. Neither sentence appears in either document.

The part they share that nobody quotes

The AIHTA report is not only an effectiveness analysis. Its first half collects recommendations, and there sits a checklist more concrete than anything in the training debate. Sixteen sources, eight guideline papers and eight reviews, recommend structural measures:

• step-free, accessible entrances
• wide seating without armrests in waiting rooms
• accessible toilets with grab rails
• a private place to be weighed, and the option of being weighed without having to see the number
• blood pressure cuffs, tape measures, examination instruments and gowns in appropriate sizes
• scales with a measuring range of 150 to 300 kilograms
• examination tables, chairs and hospital beds of adequate width and load capacity
• no stigmatising imagery on walls, in magazines, on the website or on social media, meaning no isolated body parts, no headless bodies, no stereotype scenes

Alongside those come the policy recommendations from ten guideline papers and seven reviews. One of them is new for the German-speaking record: discrimination on the basis of body weight should be formally recognised as a legitimate social concern and written into anti-discrimination law, which already prohibits discrimination on other personal characteristics.

We know that demand. We described it in our piece on Germany’s federal anti-discrimination survey, where it comes from an advocacy association and from the researchers commissioned by the government agency. What is new is who else is making it now: a state-backed HTA agency, in an evidence report, addressed to decision-makers inside the health system.

The point

And here is the sentence the whole debate hangs on. The report’s conclusion states that interventions for children and adolescents, and structural measures, were not examined in any of the identified studies. The discussion says it again at greater length: the effectiveness of recommended strategies such as communication-based interventions, changes to the environment, and patient empowerment strategies has not yet been studied.

There is not one effectiveness study on whether a waiting room with chairs that fit and a scale with an adequate range changes anything about care. Not because it was tested and failed. Because nobody tested it.

The training debate is loud because training is the only thing that gets evaluated regularly. It is cheap to demand, easy to measure, it produces certificates of attendance, and it leaves nobody with an invoice for new examination tables. The measures you could verify in an afternoon, by walking into a waiting room and looking at a scale, have no evidence base because they were never made a research subject.

That is not a defence of training and not proof for equipment. It is a statement about what has been considered worth measuring for the past decade.

Placing the source

AIHTA is part of the health system and argues from inside its frame. The report treats overweight and obesity as medical categories, lists treatment recommendations, and draws in part on guidelines from professional societies with an interest in treatment. Readers should know that.

What it recommends is nonetheless notable. The Health at Every Size model is named repeatedly as a central approach, on the grounds that it places the focus on health and wellbeing rather than weight reduction. Re-evaluating interventions and guidelines built on a weight-centred approach, meaning BMI as an indicator of health, also appears as a recommendation. That is not a position one expects from an HTA agency.

External review was carried out by Friedrich Schorb of the University of Bremen and Martina Hermann-Thurner of Austria. The report states explicitly that the external reviewers are not co-authors and do not necessarily agree with its content. The authors declare no conflicts of interest.

One small internal inconsistency, for completeness: the results section lists twelve instruments for explicit and two for implicit weight bias, the discussion section says ten and one. It does not change the order of magnitude.

What follows

Anyone in Germany or Austria who wants to do something about weight stigma in healthcare has, after these two documents, two options. The first is well studied and works in a limited, short-term way on what people say. The second has not been studied at all, but can be checked without a study.

We will keep citing both sources. Neither one as evidence that training works or does not.

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Sources

• Wolf, S. and Kern, J.: Strategien zur Reduktion von Gewichtsstigmatisierung bei Personen mit Übergewicht oder Adipositas im Gesundheitswesen. AIHTA Project Report No. 160, Vienna, November 2024. Full text: https://eprints.aihta.at/1547/
• Jayawickrama, R. S. et al.: Interventions to reduce weight stigma in healthcare students. Obesity Reviews 26(2):e13847, online 8 October 2024. DOI 10.1111/obr.13847

Image: original editorial graphic.

Germany runs a tidy little argumentative loop, and it has been spinning for almost twenty years.

The General Equal Treatment Act, the AGG, names six protected characteristics: sex, ethnic origin, religion or belief, disability, age, sexual identity. Body weight is not one of them. Because it is not in the law, the large government-commissioned surveys do not ask about it. Because they do not ask, there is no solid data. And because there is no solid data, the argument for adding the characteristic to the law is missing.

The loop stalled once. In the largest discrimination survey ever conducted in Germany, weight showed up even though nobody had asked about it. The researchers ended up recommending that the law be widened. Nothing has happened since.

What the study is

The Federal Anti-Discrimination Agency commissioned the study “Diskriminierungserfahrungen in Deutschland” from the Berlin Institute for Empirical Integration and Migration Research (BIM) at Humboldt University. The authors are Steffen Beigang, Karolina Fetz, Dorina Kalkum and Magdalena Otto. Fieldwork ran in autumn 2015; the 340-page results report appeared in 2017.

The study has two parts, and the distinction matters:

• a telephone representative survey with 1,007 participants,
• a survey of affected people in mixed-mode design with 18,162 participants (16,798 online, 1,364 on paper), open to anyone living in Germany aged 14 and over.

The second is the largest of its kind in Germany, with 14,765 usable first-hand accounts of discrimination. It is not representative, and it was never meant to be. People opted in themselves. Respondents could describe up to two experiences from the previous 24 months that mattered most to them.

The preset characteristics were the six AGG categories plus social position. Anyone whose experience fit none of those boxes had to write it into a free-text field and name it themselves.

How weight got into the study anyway

That free-text field is where advocacy groups went to work. In autumn 2015 the Gesellschaft gegen Gewichtsdiskriminierung (Society Against Weight Discrimination) called on people to take part under the slogan “Deine Stimme hat Gewicht” and pointed explicitly at the free-text field. It was not the only organisation doing this.

That belongs on the table, because it shapes the numbers that came out. And it is not an outside accusation: the research team says so in the report itself. The varying frequencies of characteristics may “also reflect how strongly particular associations promoted the survey”. The absolute figures, the report says, serve “expressly only to present the data basis” and must not be read as a statement about which kind of discrimination happens most often.

Christine Lüders, then head of the Anti-Discrimination Agency, framed it the same way in an interview: the number of accounts is “first of all not an indication of how frequently these things occur, only that these experiences exist”.

That is the honest version. It makes a worse headline than “this many cases”, and it is the only one that holds.

The number, and the two other numbers

Table 9 of the report, page 128, lists appearance with 935 reported cases. Indented underneath it, as a sub-category: weight, 634. That is the figure that has circulated since 2017, and it is correct.

Two variants float around next to it.

643 appears in a single secondary account; two sentences later the same text says 634 again. A transposition error.

534 appears in a specialist article by the research team itself. In 2017, Beigang, Otto, Fetz and Kalkum re-analysed the data for exactly this question in the series “Wissen schafft Demokratie” published by the Institute for Democracy and Civil Society (DOI 10.19222/201702/6). There the count is 534 cases of weight discrimination and 558 cases of discrimination based on a physical impairment, 1,092 cases in the analysis.

The gap between 634 and 534 is not a contradiction but a different base population. The online appendix states the selection rule: cases naming both weight and a physical impairment were excluded, as were cases where neither characteristic was clearly identified. How many cases fall under which exclusion is not published. So the difference of a hundred cases can be explained, but not recalculated.

Where these cases come from: the doctor’s office

The raw count is the least interesting part of the finding. What matters is where the cases cluster, and for that the research team built its own measure: the transfer factor. It compares how many reports for a characteristic actually come from a given area of life with how many would be expected if all characteristics were spread evenly across all areas. A value of 1 means as expected. A value of 2 means twice as often as expected.

For weight in the health and care sector, Table 29 on page 230 reports:

• Doctor’s practice, psychotherapy and similar: 5.95 (114 cases)
• Hospital: 2.27 (25 cases)
• Health, long-term care or pension insurance: 2.11 (17 cases)
• Social services: 0.93 (2 cases), other: 0.26 (1 case)

In medical practices, in other words, weight discrimination is reported almost six times as often as the distribution would lead you to expect. That is higher than the value for appearance overall (4.32) and higher than every other characteristic in that column. For comparison: disability, impairment and chronic illness come in at 1.65 there, being trans at 2.45.

This holds inside a non-representative sample. It does not tell you how many fat people in Germany are discriminated against at the doctor’s. It tells you where the experiences of those who did report concentrate, and that is unambiguous: not at work, not at the public authority, but at the doctor’s. What to do in that situation is something we have written up separately.

A second finding from the same report fits. Where discrimination is co-caused by the physical setting, meaning a lack of accessibility, 31.1 per cent of all such cases in the health and care sector are linked to weight. Examination tables, chairs and equipment are frequently not built for people at higher weights.

What else holds up in this data

The second solid piece is a comparison inside the same dataset. The research team set weight discrimination against discrimination based on a physical impairment. The choice is deliberate: both attach to the body, both accuse the person of deviating from bodily norms, both are experienced particularly often in the health system, and in both a lack of accessibility plays a large role. The decisive difference is legal. Disability is named in the constitution and in the AGG. Weight is named nowhere.

The results:

• Took no action at all against the person or condition causing it: 37.8 per cent of those affected in the impairment group, but 65.7 per cent in the weight group. Two out of three.
• Sought counselling afterwards: 17.0 per cent in the impairment group, 4.9 per cent in the weight group.

The obvious objection is that this might be down to different circumstances, different areas of life, different age groups, different forms of discrimination. The team tested that objection in multivariate regressions, N = 1,092. For four of the reasons given for doing nothing, the difference survives controls for situation and person: the expectation that reacting would achieve nothing, the burden of having to deal with it further, not seeing a need to react, and not knowing what could be done.

For two other reasons, fear of negative consequences and fear of not being believed, the difference disappears once situation and person are controlled for. That belongs in the picture too. The team limited its own finding here rather than pushing it through.

The models explicitly explain only a small share of the variance; the team puts the adjusted R² at 0.04 to 0.15 and writes that important explanatory variables are missing. So the finding is not: we know why fat people do not fight back. It is: the fact that they do it less often is not because different things happen to them.

The loop, said out loud

The four reasons that survive describe precisely what a missing law does.

“It wouldn’t achieve anything” is not resignation when there is no legal protection; it is an accurate reading of the situation. “I didn’t know what to do” is not an information deficit on the part of those affected; it describes a counselling system built along the AGG characteristics, which has little to offer for a characteristic that does not appear there. And “I saw no need to act” is the most uncomfortable point: when a society treats high body weight as self-inflicted, people affected partly adopt that attribution and consider the disadvantage understandable. Citing qualitative interviews, the research team calls this “solidarity with those doing the discriminating”.

The recommendation that followed was in the report back in 2017, on page 97, and it came from the researchers, not from an advocacy group:

The many experiences of discrimination that people have had on the basis of external characteristics, and in particular on the basis of weight, demonstrate the urgent need to create a way for these people to defend themselves against their experiences of discrimination. In order to offer these people protection against discrimination as well, the characteristics protected in the AGG should be extended to include external characteristics.

The team also proposed turning the AGG’s list of characteristics from a closed list into an open one, so that courts could recognise comparable characteristics that are not explicitly named.

Nothing has happened since. The AGG still does not know body weight. Legal protection exists only by detour: someone whose obesity requires medical treatment because of accompanying or consequent illness may under some circumstances be protected via the characteristic of disability. That construction goes back to a 2014 ruling of the European Court of Justice (FOA v Kommunernes Landsforening). It means protection exists if you are ill enough. Being fat alone does not get you there. The same pattern shows up in coverage decisions for weight-loss drugs, where France pays and Germany does not.

What this means for readers

First: if you experienced disadvantage because of your weight and had the impression that no office was responsible, you did not imagine it. That is the documented state of affairs, not a personal failure. And you are not alone in it; we have described where fat people in Germany meet offline.

Second: the organisation working on exactly this legal question in Germany is the Gesellschaft gegen Gewichtsdiskriminierung. It demands that “body weight” be added to § 1 AGG, that the membership threshold for anti-discrimination associations under § 23 AGG be lowered, and that the advisory board of the Anti-Discrimination Agency be expanded by a 17th seat. Two things belong disclosed alongside that. In the Bundestag lobby register (R007584), the organisation has been listed as a former interest representative since 24 October 2025, so its active registration has ended. And for financial year 2023 it reports project funding from the Anti-Discrimination Agency of 70,001 to 80,000 euros, for developing training that qualifies anti-discrimination counselling centres on weight discrimination. The same agency whose study never asked about the characteristic is funding the training on it.

Third, and this is the unsatisfying part: as long as the characteristic is missing, the route via existing characteristics remains the only legally solid one, and it fits only in exceptional cases. We will expand on that in a separate piece once the legal position has been worked through properly.

Transparency about this research

Every figure from the results report used here comes from the report itself (340 pages, checked 19 August 2026): the 634 from Table 9 on page 128, the transfer factors from Table 29 on page 230, the recommendation from page 97, the method behind the transfer factor from page 129. The response data (65.7 versus 37.8 per cent, 4.9 versus 17.0 per cent) and the regressions come from the research team’s specialist article and its online appendix, not from the results report.

One trap belongs on the record: the official summary of the study contains a different five-fold figure, namely that women report sex-based discrimination almost five times as often as men. That has nothing to do with weight. Pulling the two together produces a false statement.

Sources

• Federal Anti-Discrimination Agency: Diskriminierungserfahrungen in Deutschland. Ergebnisse der Repräsentativ- und der Betroffenenbefragung. Beigang/Fetz/Kalkum/Otto, 2017. https://www.antidiskriminierungsstelle.de/SharedDocs/downloads/DE/publikationen/Expertisen/expertise_diskriminierungserfahrungen_in_deutschland.html
• Beigang/Otto/Fetz/Kalkum: Eine Frage von Gewicht. Wissen schafft Demokratie 2/2017, IDZ Jena, DOI 10.19222/201702/6. https://www.idz-jena.de/wsddet/wsd2-6
• Online appendix to Beigang et al. 2017 (case selection, operationalisation, regression tables). https://www.idz-jena.de/fileadmin/user_upload/Anhang_Beigang_et_al_5.pdf
• Bundestag lobby register, entry R007584 (Gesellschaft gegen Gewichtsdiskriminierung e. V.). https://www.lobbyregister.bundestag.de/suche/R007584
• Gesellschaft gegen Gewichtsdiskriminierung e. V., collected posts on the Anti-Discrimination Agency. https://gewichtsdiskriminierung.de/tag/ads/
• Gesellschaft gegen Gewichtsdiskriminierung e. V., interview with Christine Lüders. https://gewichtsdiskriminierung.de/gewichtsdiskriminierung-eine-alltaegliche-erfahrung-in-deutschland/

There is a comforting story about weight stigma in medicine, and it goes like this: doctors were never taught better, so teach them better. Add a module. Bring in a fat patient to speak. Show the students the evidence on why bodies differ. The next generation will be different.

Someone has now added up thirty years of attempts to do exactly that. The answer is not that it fails. The answer is more uncomfortable than failure: it works on the part that is easy to measure and easy to fake, and it does not detectably move anything else.

What was actually counted

Ravisha S. Jayawickrama and colleagues at Curtin University in Perth, with co-authors at Monash University, the University of Leeds and the Swedish School of Sport and Health Sciences, screened 3,463 journal articles and dissertations and found 67 studies that tested an intervention meant to reduce weight bias in healthcare students. Thirty-five of them reported enough data to be pooled statistically; the rest were described narratively. Together the studies cover 7,528 participants, mostly women (62 percent), average age 22.75 years, from studies published between 1991 and August 2023.

This is not news, and we are not presenting it as news. The paper went online on 8 October 2024 and appeared in the February 2025 issue of Obesity Reviews (26(2):e13847). It is simply the most complete answer currently available to a question that gets asked every time a hospital announces a training day.

Two numbers carry the paper.

Explicit bias — what students report on a questionnaire — improved a little. The pooled effect was g = −0.31, with a 95 percent confidence interval of −0.43 to −0.19. In plain terms: a small but statistically reliable shift in the intended direction.

Implicit bias — the automatic association measured by a reaction-time test — did not move. g = −0.12, confidence interval −0.26 to +0.02, p = 0.105, pooled from ten studies. The interval crosses zero, which means the data are compatible with a small improvement, with nothing at all, and with a slight worsening.

The authors grade the certainty of both results, using the standard GRADE system, as “very low”. They also record that the risk of bias in most of the individual studies was high. That is their assessment of their own evidence base, not our gloss on it.

The sentence that should be quoted more than the effect size

Buried in the results is a prediction interval for the explicit-bias finding: −0.93 to +0.31.

A confidence interval tells you how precisely the average across these studies was estimated. A prediction interval tells you what to expect from the next one. Here it says that if you run a weight-bias intervention with a new group of healthcare students, the true effect could plausibly be a large reduction, or nothing, or a modest increase in weight bias. That is what heterogeneity of 74 percent looks like when it is written out honestly.

So the pooled figure is real, and it is also nearly useless as a prediction for any specific course. Which brings us to the finding that should worry course designers most.

Nothing about the course design explained the difference

The team ran eight subgroup comparisons on the explicit-bias data: healthcare discipline, one-off versus multi-session, in person versus online, active versus passive learning, single-strategy versus multifaceted, underlying theory, which outcome measure was used, and whether students had contact with an actual fat person during the intervention — active contact, passive contact, or none.

Not one comparison came out significant. A meta-regression on the proportion of male participants found nothing either.

The honest reading of that is not “these things don’t matter”. With this few studies per cell, the analysis could not have detected moderate differences even if they existed, and the authors say as much: eyeballing the estimates, multi-session, multifaceted and active-learning formats look better, but the comparison groups are too small to trust. The reading that does hold is narrower and still awkward: after thirty years of varied designs, there is no evidence base telling anyone which design to buy. A hospital choosing between a two-hour e-learning module and a semester-long curriculum with patient speakers is choosing on intuition.

And it does not stay

Only 10 of the 67 studies followed students beyond the end of the intervention at all.

The example the authors highlight is a study by Kushner and colleagues with 127 medical students. Empathy and confidence in clinical interaction were still improved a year later. The negative stereotypes about fat patients had returned to baseline.

That is a pattern worth naming precisely, because it is easy to get backwards: the part that felt good to the clinician persisted. The part that describes the patient did not.

What the questionnaire is actually measuring

Explicit weight bias, in these studies, means a score on instruments like the Beliefs About Obese Persons Scale, the Antifat Attitudes Test, or the Fat Phobia Scale — a student ticking boxes about whether fat people are lazy, or whether obesity is within a person’s control.

Only four of the 35 pooled studies checked whether students were simply giving the answer they knew was wanted. The findings from those four were mixed, and in one of them, controlling for socially desirable responding erased the difference between the intervention group and the control group entirely. The authors are careful not to over-read four studies, and so are we. But it means the most obvious alternative explanation for a small post-course improvement in questionnaire scores — that students learned which box to tick — has barely been tested.

The implicit measure has its own problem, and the paper does not hide it. Twelve of the thirteen implicit studies used the Implicit Association Test, and the authors cite the standing criticism of it, including Ulrich Schimmack’s argument that the construct validity evidence does not support the claim that the IAT measures implicit bias at all.

Put those two limitations together and you get the real state of knowledge. The first instrument measures what a student is willing to say. The second measures a reaction time whose meaning is contested. Almost nothing measures what a student later does to a patient. The authors call for exactly that: studies that assess stigmatising behaviour, not just attitudes.

Who is speaking, and why that is worth knowing

Obesity Reviews is the journal of the World Obesity Federation, and the paper is written from inside that frame. It opens with the Federation’s projection that around 51 percent of people aged five and over will be living with overweight or obesity by 2035, uses “people living with overweight or obesity” throughout, and argues for reducing weight bias partly on the grounds that stigma worsens the conditions it is attached to.

We link it anyway, because the analysis is careful and the numbers are the numbers. But readers should know the frame, and they should know the declared interests: co-author Stuart W. Flint reports research grants and meeting support from, among others, Novo Nordisk, the Novo Nordisk Foundation and Johnson & Johnson, all declared as unrelated to this manuscript, and co-author Erik Hemmingsson reports royalties from a book on weight stigma. The first author and five others declare no competing interests.

None of that invalidates a meta-analysis. It does mean that when a paper written from the disease frame reports that anti-bias training barely works, that finding is not the one its institutional context would have preferred.

Germany just made this a “should”

In October 2024, the German Adipositas Society and its partner societies published version 5.0 of the S3 guideline on the prevention and treatment of obesity (AWMF register 050/001). For the first time it contains a dedicated chapter on stigma, and inside that chapter, recommendation 2.4:

Training curricula for the health professions involved in prevention and treatment should not only inform about the aetiology, mechanisms, prevention and treatment of obesity, but should also educate about weight-related stigmatisation and self-stigmatisation and their clinical implications, and should teach practical skills for non-stigmatising interaction with people with obesity.

It carries recommendation grade A — the strongest “should” the system has — and was adopted with 94 percent consensus. The evidence quality printed directly underneath it is “very low”, based on indirect evidence.

The guideline is not hiding this. Its own implications section states that promising results exist for at least small, short-term improvements in weight stigma among health professions, and that all meta-analyses on weight-related stigmatisation showed low methodological quality.

So Germany has now committed its health professions curricula, at the highest recommendation grade, to an intervention its own guideline describes as producing small, short-lived, poorly evidenced change. That is not a scandal. Given what stigma costs patients, acting on weak evidence is defensible, and the alternative — teaching nothing — has been tested for a century and produced the situation the guideline is responding to.

It does mean something specific for patients, though: the training is a promise made about your doctor, upstream of you, and nobody checks whether it took.

What is actually checkable

The same chapter of the same guideline contains something a patient can verify from the waiting room. Recommendation 2.2, adopted with 88 percent consensus, says facilities should provide adequate equipment — it names heavy-duty chairs and scales with a sufficient weighing range — or maintain a referral network for onward care.

That is the difference between the two kinds of measure. Whether a practice bought a chair that holds you is visible in ten seconds. Whether the doctor sitting in it completed an anti-bias module in 2019 is not visible at all, and on this evidence would not tell you much if it were.

Which is why the practical advice on this site does not run through hoping your doctor was trained well:

• When your symptom is being answered with your weight, the documentation and escalation steps are in What to Do When a Doctor Blames Everything on Your Weight.
• When you are looking for a different practice, the search criteria that actually predict weight-neutral care are in How to Find a Weight-Neutral (HAES-Aligned) Doctor.
• When the problem is discrimination rather than bad care, the legal picture is in Weight Discrimination: What It Is and What You Can Do.

The point that survives all the caveats

Thirty years of teaching produced a small, real improvement in what healthcare students are willing to say about fat patients, no measurable change in their automatic associations, no durable change in stereotypes a year out, and almost no data on behaviour.

Read carelessly, that is an argument for giving up on training. It is not. A small genuine reduction in explicit bias, spread across everyone who will treat patients for the next forty years, is worth having, and the alternative has no evidence behind it either.

Read carefully, it is an argument about where to put the weight of expectation. A course is not a safeguard. It produces an effect that cannot be predicted for any individual cohort, cannot be attributed to any particular design, and fades on the measure that matters most for how you get spoken to. If the goal is that fat patients are treated properly, the mechanisms that do that job are the ones that stay in place when everyone has forgotten the workshop: equipment that fits, referral paths, complaint routes, documentation, and rules about what may be said and done in a treatment room.

Prejudice, it turns out, is not primarily an information deficit. You cannot explain it away, and the people who study it hardest say so in their own conclusion: a real shift in implicit bias may only come from a large societal change in beliefs and attitudes towards people in larger bodies. That is a longer job than a module, and it is the one this magazine exists for.

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Sources: Jayawickrama RS, Hill B, O’Connor M, Flint SW, Hemmingsson E, Ellis LR, Du Y, Lawrence BJ. “Efficacy of interventions aimed at reducing explicit and implicit weight bias in healthcare students: A systematic review and meta-analysis.” Obesity Reviews 26(2):e13847, published online 8 October 2024, DOI 10.1111/obr.13847, open access: https://pmc.ncbi.nlm.nih.gov/articles/PMC11711078/ · PROSPERO registration CRD42020209407 · Deutsche Adipositas-Gesellschaft et al., “Interdisziplinäre Leitlinie der Qualität S3 zur Prävention und Therapie der Adipositas”, AWMF register 050/001, version 5.0, October 2024, chapter 2 “Stigmatisierung”, recommendations 2.1 to 2.4 and section 2.4 “Implikationen”: https://register.awmf.org/assets/guidelines/050-001l_S3_Praevention-Therapie-Adipositas_2024-10.pdf

A year ago, on 1 August 2025, Minneapolis added height and weight to the protected classes of its Civil Rights Ordinance. The City Council had approved the amendments unanimously on 1 May, Mayor Jacob Frey approved them on 5 May (Ordinance No. 2025-022), and on the day they took effect the city announced that anyone “living, working or visiting Minneapolis” now had new protections in employment, housing, education, business, professional organisations, public accommodations and public services.

That is worth reporting a year later rather than on the day, because two details only become visible once you read the text next to the city’s own explanation of it. One of them is better than almost anything else on the books. The other is the reason this article exists.

The good part: it protects the impression, not the number

Most legal protection for fat people runs through a diagnosis. You get a claim to the extent that you can be described as impaired, disordered or ill. We have written about that trade in Weight Discrimination: What You Can Actually Do, and it is the central weakness of the disability route.

Minneapolis does not do that. The city’s own protected class page defines the ground plainly: height means how tall you are, weight means how much you weigh, and this “includes actual numbers and how people see you, such as tall or short, heavy or light.”

That second half is the important one, and it is in the ordinance text itself. The definition, as quoted by the law firm Ogletree Deakins from the signed amendment, reads: “A numerical measurement of body height, body weight, or body size. Height encompasses, but is not limited to, an impression of a person as tall or short, regardless of numerical measurement. Weight encompasses, but is not limited to, an impression of a person’s weight (fat, thin, etc.), regardless of numerical measurement.” Employment lawyers reading it point out what follows: future claims may mirror the “regarded as” analysis familiar from the Americans with Disabilities Act and the Minnesota Human Rights Act, which lets someone bring a claim on perceived rather than actual status.

This matters because discrimination does not consult a scale. Nobody is turned down for a job at a BMI cut-off. They are turned down because someone in the room decided they looked lazy, unhealthy, unrepresentative, or “not a fit”. The harm attaches to the attribution, and Minneapolis attached the protection to the attribution as well. Michigan, which has protected weight since 1977, and New York City, which added it in 2023, protect the characteristic. Minneapolis protects being seen as having it.

The part that cancels a good deal of it

The same amendments contain a carve-out. According to employment-law analyses of the signed ordinance, the protections relating to height and weight do not override actions an employer takes to comply with other federal, state or local law, and the ordinance further clarifies that it does not prohibit covered entities from offering voluntary wellness program incentives that promote healthy weight management.

Read those two sentences together. An employer in Minneapolis may not treat you worse because they think you are fat. The same employer may attach money to you becoming less so, as a benefit, on a voluntary basis, with the city’s explicit blessing.

We were not able to open the signed ordinance PDF at the city’s legislative document server; it is behind a bot check that blocks direct retrieval. So this clause is reported here on the authority of two independent law-firm analyses of that document, published three weeks apart and each linking to it: Stinson LLP writes that the ordinance “further clarifies that it does not prohibit covered entities from offering voluntary wellness program incentives that promote healthy weight management”, and Saul Ewing writes that “the ordinance makes clear that employers are permitted to offer incentives supporting weight management as part of a voluntary program without violating the law.” What we can verify directly is the other half of the point: the city’s public-facing protected class page, the page an ordinary resident would read to find out what the law now does for them, lists the exceptions for essential job duties, undue hardship and direct threat. It does not mention the wellness carve-out at all.

Why this is not a technicality

An anti-discrimination ground says something specific: this characteristic is not a legitimate basis for treating people differently, and it is not something people can or should be asked to change. That is the definition Minneapolis itself uses. A workplace incentive for “healthy weight management” says the opposite, in the same building, from the same employer, with money attached.

The two messages do not cancel out neatly. The employer who runs the incentive scheme is the employer who later decides whether you are “a fit”. Voluntary is doing a lot of work in that sentence, and it is doing it in a room where one party sets the salary.

There is a defensible reason for the exception, and it is not hidden: employers in the United States operate wellness programmes under a thicket of federal rules, and a city ordinance that made them unlawful would put employers in conflict with law they cannot opt out of. The ordinance says as much in its own compliance clause. That explains the carve-out. It does not make the contradiction go away. It relocates it: the city has protected the ground as far as city law reaches, and the incentive structure sits in the part it does not reach.

What Minneapolis actually gets you, and where it stops

Height and weight can still be considered where a person cannot be accommodated without changing the main purpose of a programme or service, or where health or safety would be at risk. Employers additionally have a defence where height or weight prevents someone from performing essential job duties, where accommodation would be an undue hardship, or where there is a direct threat to health or safety. Those are conventional limits and they are the same ones disability law uses.

The reach is the notable part. Minneapolis covers employment, housing, education, business, professional organisations, public accommodations and public service, and applies to any employer with an employee performing services in the city, wherever the employer sits. With this, Minneapolis joins Michigan, New York City, Washington DC, San Francisco, Santa Cruz, Madison, Urbana and Binghamton on a short list.

The German question this raises early

Germany has no weight ground at all. The General Equal Treatment Act (AGG) does not list body weight, and fat people in Germany argue through disability, general civil law, or nothing. A parliamentary motion to add body weight, among other characteristics, had its first reading in the Bundestag in June 2026 (Drucksache 21/4538, tabled by the opposition group Die Linke). It is a proposal, not law, and we covered it when it was introduced.

Here is what Minneapolis makes worth asking now rather than later. Germany does not have to invent an employer weight-incentive structure; it already has one, in statute. Under Section 20b of the Fifth Book of the Social Code, the statutory health insurers fund workplace health promotion, specifically the building of health-promoting structures inside firms. Section 65a governs bonuses for health-conscious behaviour, and its second paragraph reads: the health insurer “should also provide in its bylaws that, for workplace health promotion measures run by employers, both the employer and the participating insured persons receive a bonus.”

Whether any given programme targets weight is a matter of programme design, not of the statute, and we are not claiming the statute mandates it. The point is structural. If body weight became a protected characteristic in the AGG, it would land on top of a subsidised, legally anchored system of employer-side health incentives that nobody has yet had to test against a weight ground, because there is no weight ground to test it against. Minneapolis had to answer that question and answered it with an exception. Germany would have to answer it too, and the time to ask is while the text is still being drafted.

If you are dealing with this now

• Know which door you are using. In most places the weight ground does not exist and the argument runs through disability. What that costs you is set out in our cornerstone on weight discrimination.
• Separate the offer from the assessment. A wellness incentive is not evidence of discrimination. Being passed over afterwards, by the people who ran it, may be. Keep the two records separately and keep them dated.
• Medical settings are a different fight. See What to Do When a Doctor Blames Everything on Your Weight and How to Find a Weight-Neutral Doctor.

A law that bans discrimination on the basis of being seen as fat, and in the next clause protects the programme that pays you to stop being fat, is not a failure. It is a good law with the shape of the problem still visible in it. That shape is worth naming before the next jurisdiction copies the text.

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Sources: City of Minneapolis, “Minneapolis expands anti-discrimination protections in Civil Rights Ordinance”, 1 August 2025, https://www.minneapolismn.gov/news/2025/august/new-civil-rights-protections · City of Minneapolis Department of Civil Rights, “Protected classes”, retrieved 15 August 2026, https://www.minneapolismn.gov/government/departments/civil-rights/complaint-investigations/protected-class · Stinson LLP, “Minneapolis Amends Its Civil Rights Ordinance to Expand Protections in Employment Decisions”, 16 June 2025, https://www.stinson.com/newsroom-publications-minneapolis-amends-its-civil-rights-ordinance-to-expand-protections-in-employment-decisions · Saul Ewing LLP, “Minneapolis Expands Anti-discrimination Ordinance”, 12 June 2025, https://www.saul.com/insights/blog/minneapolis-expands-anti-discrimination-ordinance · Ogletree Deakins, “Local Politics Makes a Big Splash”, 17 June 2025 (quoting the ordinance definitions), https://ogletree.com/insights-resources/blog-posts/local-politics-makes-a-big-splash-amendments-to-minneapolis-civil-rights-ordinance-provide-further-protection/ · Jackson Lewis P.C., “Minneapolis Anti-Discrimination Law Revised”, 22 May 2025 · Signed ordinance No. 2025-022, City of Minneapolis legislative information system, document 39068 (linked by all four firms; not directly retrievable, the server returns a bot challenge) · Elliott-Larsen Civil Rights Act, Act 453 of 1976 · NYC Local Law 61 of 2023 · Deutscher Bundestag, Drucksache 21/4538, first reading June 2026 · SGB V § 20b and § 65a, https://dejure.org/gesetze/SGB_V/65a.html

A randomized experiment with 1,313 participants tested how people judge someone who lost weight on a GLP-1, someone who lost it by dieting, and someone who didn’t lose any. The drug user came out worst. Here is what the study shows, and where its numbers are thinner than the headlines.

There is a promise buried inside every weight-loss conversation: do this, and people will stop treating you that way. A study published in the International Journal of Obesity on 3 April 2026 put that promise into an experiment, and the promise did not survive.

Erin Standen (Rice University), Sean Phelan (Mayo Clinic) and Janet Tomiyama (UCLA) ran two randomized, between-subjects experiments. Participants read a short description of a fictional person and then rated them. The only thing that changed between groups was how that person’s weight history was described.

What the participants actually read

In both studies the fictional target was the same person: 38 years old, college-educated, gender deliberately left unspecified, described as having had obesity since puberty, currently around 220 pounds (roughly 100 kg). The authors say they built these details around an average-aged, average-weight U.S. adult with the most common age of onset.

Study 1 (N = 607, recruited on Prolific in October 2024) split participants into three groups. The target had either lost 35 pounds (about 16 kg) over the past year using a GLP-1 medication, lost the same 35 pounds through diet and exercise, or had not lost weight at all. In both weight-loss conditions the description added that the person was no longer in the “obese” BMI category.

Study 2 (N = 706, February 2025, no overlap with Study 1) had four groups: regained the weight after stopping a GLP-1, regained it after stopping a diet-and-exercise plan, never lost weight, or lost weight and kept it off with the method unspecified.

Participants then rated the person on ten positive traits (honest, generous, sociable, productive, organized, friendly, outgoing, intelligent, warm, humorous) and eight negative ones (lazy, undisciplined, self-indulgent, unclean, weak-willed, sloppy, insecure, sluggish) on a 1-to-7 scale, rated them separately on “unhealthy”, and answered six questions about whether they would want anything to do with them, adapted from the Interpersonal Attraction Questionnaire. The study materials and the de-identified data are public on OSF.

What they found

Against the diet-and-exercise version of the same person, the GLP-1 version lost on every measure: fewer positive traits, more negative traits, rated more unhealthy, and less socially wanted (all Tukey HSD p < 0.001).

Then came the finding that made the press releases. The authors had predicted that the person who did not lose weight would be judged most harshly of all. That is not what happened. Compared to the GLP-1 user, the person who never lost weight was rated higher in positive traits (p = 0.003), and people were more willing to spend time with them. On willingness to affiliate, all three groups differed from each other: diet and exercise 5.51, no weight loss 5.25, GLP-1 4.99, on a seven-point scale (F(2, 603) = 12.54, p < 0.001).

In plain terms: in this experiment, taking the drug cost more social standing than staying fat.

Where the numbers are thinner than the headline

Two things get lost when this study is summarized in a sentence, and both matter.

First, the “worse than not losing weight at all” result is narrower than it sounds. It holds for positive traits and for willingness to affiliate. It does not hold for the negative traits, and it does not hold for “unhealthy”: on both of those, the GLP-1 user and the person who never lost weight were rated the same (p = 0.26 for each). So people did not call the drug user lazier or unhealthier than a fat person who did nothing. They just liked them less and granted them fewer good qualities.

Second, the effects are small. The gap in willingness to affiliate between the GLP-1 user and the person who never lost weight was 0.26 points on a 1-to-7 scale, with a confidence interval running from 0.02 to 0.51 — that is, just barely clear of zero. The effect size for the whole model was ηp² = 0.04 in Study 1 and 0.01 in Study 2. These are real, statistically significant differences, and they are not large ones.

Third, and this is a limitation the authors state themselves: participants were rating a paragraph about a person who does not exist. That design buys clean causal inference and pays for it with artificiality. All participants were U.S. adults recruited on an online survey platform. Nothing here has been shown for Germany, and nothing here has been measured on actual behaviour towards actual people.

The part nobody quoted

Study 2 is the more interesting half, and it got almost no coverage.

When the weight came back, the difference between the drug and the diet disappeared entirely. Participants rated the person who regained after a GLP-1 and the person who regained after dieting the same way — no difference in positive traits, negative traits or unhealthiness (p > 0.55). What did produce a large difference was regain itself: both regain groups were rated significantly higher in negative traits and more unhealthy than the person who lost weight and kept it off (p < 0.001).

So the “easy way out” penalty is attached to the ongoing state of having taken a shortcut. Once you are fat again, nobody cares how you briefly stopped being fat. You are simply back to being blamed for the weight.

Two words we are not going to use

The Rice press release calls this “the GLP-1 paradox”. The paper does not use the word “paradox” once. It is a framing added afterwards, and it is the wrong frame, because it implies something contradictory happened. Nothing contradictory happened.

Look at what the trait list is actually measuring: lazy, undisciplined, self-indulgent, weak-willed. That is not a list of things people believe about fat bodies. It is a list of things people believe about fat character. The judgement was never really about the number on the scale. It was about whether you are the kind of person who takes the hard road. A drug removes the weight without removing that suspicion — it confirms it. Which is exactly why the diet-and-exercise version of the same person, with the same body, scored best of all three.

There is no paradox in a moral system that rewards suffering. There is only consistency.

What follows from it

We have written before about how the injection moves the shame rather than dissolving it, and about how access to these drugs splits along class lines. This study adds the piece that was missing: a direct comparison with the option of not losing weight at all. And on the measures where it holds, that option came out ahead.

This is not an argument for or against anyone’s medication. It is nobody’s business what you put in your body, and the authors’ own conclusion is that stigma reduction, not behaviour change, is the thing that needs work. It is an argument against the promise. If you are being told that the judgement stops once the weight does, the best available experimental evidence says otherwise. It does not stop. It re-attaches.

Which means the thing worth working on was never the body. It is the standard being applied to it.

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Sources

• Standen EC, Phelan SM, Tomiyama AJ. An experimental investigation of the stigmatization of weight loss and regain from GLP-1 receptor agonist use and cessation. International Journal of Obesity 50, 1478–1485 (2026), published 3 April 2026, open access. https://www.nature.com/articles/s41366-026-02061-y
• Study materials and de-identified data: https://doi.org/10.17605/OSF.IO/7FM2R
• Rice University press release, 4 May 2026: https://news.rice.edu/news/2026/glp-1-paradox-rice-study-finds-weight-loss-drugs-may-carry-unexpected-stigma

A note on language: the paper uses “higher-weight” and BMI categories throughout, and treats weight loss as a health goal. We quote its findings, not its framing.

In eight days, the largest documented gathering of fat people in Germany takes place in Frankfurt am Main. It runs for a weekend, offers around 30 sessions, and the concession ticket costs 15 euros. It is called the Adipositas.Camp, the Obesity Camp.

That is good news first. The place exists, it is cheap, it is national, and it treats stigma and weight discrimination as subjects in their own right rather than a footnote. It is also news about the state of the country. If you want to meet other fat people offline in Germany, you have essentially two doors. One is labelled illness. The other is labelled dating. A third one, where fat people are simply a social group, does not exist on a national scale.

What happens in Frankfurt on 22 and 23 August

Adipositas.Camp 2026 runs from Saturday 22 August, 10:00, to Sunday 23 August, 16:00, at Saalbau Titus-Forum, Walter-Möller-Platz 2, 60439 Frankfurt am Main. The organiser is Adipositaschirurgie Selbsthilfe Deutschland e. V., AcSD, which translates as Bariatric Surgery Self-Help Germany.

The announcement describes it as a meeting point for people living with obesity and for leaders of self-help groups from across Germany. Thirty sessions are planned, partly in parallel, organised by the self-help community itself with expert support where it helps. The organiser names three strands: the medical perspective including the practical business of implementing therapies, nutrition and movement; deeper workshops on causes and mechanisms; and, in its own words, for those “interested in society”, the topics of stigmatisation, discrimination and health policy.

Prices as of today:

• full weekend: 29 euros
• weekend for first-time attendees (“Neucamper”): 19 euros
• full Saturday or full Sunday: 19 euros each
• concession weekend ticket: 15 euros, for students and people receiving social benefits, proof required at the door

Registration runs through a form on the event page, it is binding, and places are confirmed in order of payment received while places last.

For scale: a weekend with 30 sessions for 15 to 29 euros is not a normal German conference price. This is volunteer work, not a commercial product.

The name is not an accident, and it is the actual point

AcSD grew out of self-help after bariatric surgery, and the website’s information portal is built accordingly: gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass, gastric balloon, risks, aftercare, social court rulings, clinical guidelines.

That is entirely consistent with this association’s mandate. It also shapes the frame the camp sits in. The camp announcement speaks of “living with the disease”. The first content bullet of the accompanying workshop series on weight discrimination reads “obesity as a disease”, followed by “bringing order to the terminological chaos”.

None of this is a criticism of the association. AcSD does work nobody else does at this scale, and it does more against weight discrimination than most better-funded bodies: there is a dedicated workshop series with role play, communication exercises and concrete options for action, and there are concession tickets so that money is not the barrier.

The question is not what AcSD does. The question is why nothing exists beside it.

Because the frame has consequences. Anyone unwilling or unable to say “I am ill” enters this room carrying a precondition others do not have to carry. For some people that is irrelevant or even useful, because in Germany recognition as a disease triggers concrete things, from reimbursement to being taken seriously in a consulting room. For others it is precisely the label they have spent half their life arguing against. Those people meet nobody offline.

What else exists

We checked rather than asserted. Three things exist. None of them closes the gap.

The Stammtische. On rubensfan.de, a dating site for fat and plus-size people, sits the liveliest fat offline network we could find in Germany. Its forum section for meetups carries a continuous stream of real events with high sequential numbers: the 30th Duisburg meetup on 5 September 2026, the 121st and 123rd in Cologne, the 27th in Mannheim, the 4th in Hamburg, the 10th in the Oberallgäu, the 113th in Lindau, plus a board game meetup in Oberhausen with dates in September, November and December 2026. This is infrastructure grown over years, and it is open to anyone. It is also the by-product of a dating platform whose forum includes a section on losing weight. It is not a place where fat people organise politically, and it does not claim to be.

The queer spaces in Berlin. They exist, and they came first. On 22 January 2019, the Berlin queer magazine SIEGESSÄULE described a whole scene: the Fat Queer Hang Out at the H48 project space in Neukölln, every second Tuesday of the month; the series “Reframe Fat, Reclaim Movement” at xart splitta e. V.; the “Fat Live, Die Yum” dinners; the Fat Cabaret at Ballhaus Berlin. Important caveat: that report is seven years old. We have not verified which of these formats still run in 2026, so we do not claim they do. What is clear is that they were local Berlin offerings, some very small, some tied to individual organisers. If you live in Bremen or Chemnitz, they were never available to you.

The advocacy association. Gesellschaft gegen Gewichtsdiskriminierung e. V. in Berlin, the Society Against Weight Discrimination, is the only German body that treats fat people explicitly as a human rights subject rather than a diagnosis. It campaigns for body weight to be added to section 1 of the General Equal Treatment Act, for lower thresholds allowing small organisations to be recognised as anti-discrimination bodies under section 23, and for one extra seat on the advisory board of the Federal Anti-Discrimination Agency.

The German Bundestag’s lobby register also shows the scale of that counter-voice. For financial year 2023 the entry lists 39 members, all of them natural persons, lobbying expenditure between 1 and 10,000 euros, and 0.00 full-time equivalents assigned to it. The one substantial public grant, 70,001 to 80,000 euros from the Federal Anti-Discrimination Agency’s respekt*land programme, was earmarked for developing a training course that qualifies anti-discrimination counselling centres on weight discrimination. Since 24 October 2025 the register lists the association as a former interest representative. We do not know what that means internally and make no claim about it; in the register it no longer appears as an active interest representative.

One of this association’s offerings is the closest thing currently available to readers of this piece: a free monthly online talk that serves as a preview of the training course. One documented instance is 23 January 2025, 18:00 to 20:00, “Well treated? Weight discrimination in medicine”, free of charge, registration by email to fortbildung@gewichtsdiskriminierung.de. The remarkable part is the last line of the announcement: after the talk, the room stays open for another half hour, explicitly for fat people who want to network. That half hour is, in Germany, what in the United States is an organisation with committees and an annual programme. We could not verify today whether and when the series currently runs, because the website would not load for us. The training address above is how to ask.

The gap, in numbers

Based on this research, Germany has no national, weight-neutral gathering of fat people that is neither medically framed nor built around dating. What it has is a volunteer association from bariatric surgery with 30 sessions and concession tickets, a dating forum with a hundred and fifty pages of meetup history, a Berlin scene of unclear current status, and an advocacy body with 39 members and zero staff.

That explains a good deal about why German debate on fat bodies runs so reliably along medical lines. No rooms means no spokespeople. No spokespeople means professional societies speak for you. And professional societies talk about patients.

If you want to go

The camp is eight days away. What we saw at the source today, 14 August 2026:

• Adipositas.Camp 2026, 22 August 10:00 to 23 August 16:00, Saalbau Titus-Forum, Walter-Möller-Platz 2, 60439 Frankfurt am Main. 15 to 29 euros, registration form on the event page.
• 26th Adipositastag, 31 October 2026, 10:00 to 18:00, Frankfurt and online. Programme still listed as to be announced. On-site tickets between 7.50 euros for first-time attendees and 24 euros for the VIP category, online between 7.50 and 24 euros.
• “Weight discrimination, no thanks! … on Tour”, the workshop series. Regional small-group workshops are announced for Berlin, Bremen, Cologne, Leipzig, Nuremberg and Saarbrücken, from September according to the website, Saturdays 10:00 to 16:00, 29 euros per date, 15 euros concession, 39 euros for a combined ticket with the masterclass.

And now the awkward part, which we are not going to hide: the dates for that series are not internally consistent on the website. The booking form names specific days for two cities, 13 September for Bremen and 27 September for Saarbrücken, both without a year. In 2026 both dates fall on a Sunday, while the text explicitly announces Saturdays. In 2025 both were Saturdays, and the campaign graphic on the same page is stored as a 2025 file. Likewise, the body text puts the masterclass on “Sunday 10 May”, while the same association’s own event calendar puts it on 1 November 2026.

Our conclusion, stated openly: reliably datable for 2026 are the camp on 22 and 23 August, the Adipositastag on 31 October and the masterclass on 1 November. We would confirm the regional workshop dates by phone or email before booking any travel. This is not negligence anyone should hold against the association. It is the ordinary result of a volunteer structure maintaining a website that other organisations staff with employees.

Finally

Nothing in this piece is about whether anyone should weigh less. It is about the fact that a country of 83 million people has exactly one national weekend where fat people can meet each other, and that the ticket in runs through the language of illness. Those who can accept that language will find a cheap, sincere, volunteer-built offering. Those who cannot currently find nothing comparable in Germany. If you are looking for a weight-neutral doctor in the meantime, we have a guide for that.

This article is not medical advice and not a recommendation for or against any treatment. It describes events and the frame around them.

Sources

All dates and prices verified at the source on 14 August 2026.

• AcSD e. V., events calendar: acsdev.de/calendar
• AcSD e. V., Adipositas Camp 2026: acsdev.de/Veranstaltung/ac2026
• rubensfan.de, meetups forum: rubensfan.de
• SIEGESSÄULE, “Fett-Aktivismus in Berlin”, 22 January 2019: siegessaeule.de
• Lobby register of the German Bundestag, entry R007584: lobbyregister.bundestag.de
• Antidiskriminierungsbüro Sachsen e. V., event listing, 23 January 2025: adb-sachsen.de

Before we start: this article is not about whether retatrutide works, and it is not a recommendation for or against any drug. It is about a question that comes before that one. Who decides who is allowed to stand at the front of a line that does not officially exist yet?

What happened

On 3 August 2026, Eli Lilly confirmed that a defined group of patients can apply for early access to retatrutide, an obesity drug that has not been approved by the US Food and Drug Administration. A company spokesperson told Reuters that for “a limited number of patients who meet specific medical criteria and cannot enroll in a clinical trial,” Lilly considers it “medically appropriate to make authentic retatrutide available before FDA approval, consistent with FDA’s guidance.” The company said it had built an expanded access programme and was “actively reviewing requests from health care providers.”

The announcement did not arrive on its own. It arrived after four months of pressure, and the pressure started with one patient.

In April, Lilly granted a single 79-year-old patient compassionate-use access to retatrutide, months before any broader framework existed. STAT News first reported the case in June. According to that reporting, the application was filed by a senior clinician at the National Institutes of Health and cited refractory obesity, obstructive sleep apnoea and pulmonary hypertension.

Then it turned political. STAT asked the White House whether the recipient was President Donald Trump, who turned 80 in June. A spokesperson said the application was not for the president. Democratic lawmakers have since pressed the administration for more detail about who the recipient was. As of the reporting we could verify, the identity has not been disclosed.

Meanwhile, doctors who had asked the same company for the same thing on behalf of their own patients described weeks of silence. Spencer Nadolsky and Mike Albert, both of the online obesity clinic Vineyard, told STAT they had applied for several patients who had not responded adequately to Lilly’s approved drug Zepbound. Nadolsky said one of his patients received only a preliminary qualification, and only after STAT contacted Lilly for comment. Angela Fitch, chief medical officer of the obesity clinic knownwell, said clinicians “are owed an explanation of some sort” about whether a formal programme existed at all.

So the sequence reads: one person gets in, a news organisation asks about it, lawmakers ask about it, and then a programme appears.

The criteria, and the fact that they come in two versions

Here is what a patient now has to satisfy. Be 18 or older. Have refractory obesity. Have two or more serious or life-threatening obesity-related complications for which they are currently receiving standard care. Be unable to enrol in a trial of retatrutide or a comparable investigational medicine. Have discussed all standard treatment options, including bariatric surgery.

That is already a narrow door. But there is a detail worth sitting with, because it is the kind of thing that decides individual cases and almost never makes headlines: the criteria exist in two slightly different published versions.

A source familiar with the programme told STAT that patients must be 18 or older, unable to join a trial, have refractory obesity with two or more serious complications, and have discussed all standard options. Reuters, quoting a company spokesperson, reported something stricter: refractory obesity despite tolerating the highest approved dose of an obesity therapy. The American Journal of Managed Care, which laid the two accounts side by side on 5 August, put it plainly: depending on the account, the requirement is either maximum-dose treatment failure or documented discussion of standard options. The discrepancy had not been reconciled at the time of publication.

Two versions of a rule is not a footnote. It is the difference between a patient who qualifies and a patient who does not, and neither the patient nor their doctor gets to see the version that will be applied to them. Fitch said she had not submitted an application yet and was still trying to find out from Lilly whether patients would even need to travel to a clinical trial site to receive treatment.

Not every specialist wants in. Fatima Cody Stanford of Harvard Medical School and Gitanjali Srivastava of Vanderbilt University Medical Center told STAT they are not pursuing compassionate use for their patients and want more safety data before offering the drug outside a monitored trial. Stanford, herself a clinical investigator on Lilly’s retatrutide trials, said she does not believe the company intended to extend access beyond the original patient, and now has to manage a programme it may not have planned to build.

Who actually holds the key

The instinct is to blame the regulator. That instinct is wrong here, and the correction matters, because it points at where the power actually sits.

The FDA’s own guidance for physicians describes expanded access as a pathway with three roles. The patient consults a physician. The physician agrees to oversee treatment, files the paperwork with the FDA and an institutional review board, and takes responsibility for care and reporting. And the company has to be “willing to provide the investigational medical product.” The FDA states that it authorises the vast majority of expanded access requests it receives. What it cannot do is order a manufacturer to hand over a drug it does not want to hand over.

So the bottleneck is not a government office. It is a corporate decision, and there is no external standard the decision has to meet, no published queue, and no appeal.

That is the part worth carrying out of this story. For a drug that has not been approved, there is no right of access anywhere in this system. There is only a company’s willingness, and willingness is distributed by whoever happens to have reach: a senior clinician at a federal research institution, a reporter with a phone number, a member of Congress with a letterhead.

Would Germany handle this differently? Partly

German law has a version of the same pathway, and it is stricter in ways that are easy to miss.

Under § 21 (2) no. 3 of the Arzneimittelgesetz, a medicine needs no marketing authorisation if it is supplied free of charge, under the conditions of Article 83 of Regulation (EC) 726/2004, to patients with a seriously debilitating or life-threatening illness who cannot be satisfactorily treated with an authorised medicine. (Older guidance documents, including the page the federal regulator BfArM still publishes, cite this as no. 6, from the earlier numbering. The current statute reads no. 3.)

The procedure sits in a separate ordinance, the Arzneimittel-Härtefall-Verordnung, in force since 22 July 2010. Under § 3, whoever initiates, organises and finances such a programme has to notify the competent federal authority and file a defined set of documents. Under § 4, the authority confirms receipt within two weeks, the programme may only begin once that confirmation has arrived and the authority has not objected, and the authority may object if the conditions are not met.

Compare that with what happened in the US case. In Germany, a group programme cannot quietly exist or quietly not exist. It has to be declared to a public authority, it cannot be sold, and a public body can stop it.

But here is the limit, and it is stated on BfArM’s own page: the ordinance applies only to programmes intended for groups of patients. Treatment of an individual single case is explicitly not covered by the ordinance or its notification procedure.

Which means the exact thing that started this story, one named-nowhere person receiving an unapproved drug ahead of everyone else, would fall outside the visible procedure in Germany too. The German system makes programmes accountable. It does not make individual favours visible. And in both countries, the company still decides whether to run a programme at all.

Why this belongs in a magazine about fat people

Because it is the same shape as everything else we have documented this year, and the shape is starting to be the story.

In France, weight-loss drugs are reimbursed; in Germany the law files them under lifestyle. In the US, access to GLP-1 drugs already splits along income lines, and the split punishes twice. Germany’s own reimbursement debate, as we described when the G-BA leadership questioned the exclusion, offers coverage at the price of being classified as ill. And in law, body weight is not a protected characteristic in the US, the UK or Germany; protection runs through disability law, which means through a diagnosis.

Every one of those is the same trade. Access is available, but only in exchange for a category: sick enough, poor enough, diagnosed enough, connected enough. What the retatrutide case adds is the crudest version: access in exchange for proximity to power.

There is a second reason. When the evidence about these drugs arrives, it mostly arrives from the people selling them. Three Cochrane reviews of tirzepatide, semaglutide and liraglutide, reported by Deutsches Ärzteblatt on 7 November 2025, found clinically meaningful weight reduction for as long as treatment continues, and all three research teams pointed out emphatically that most of the underlying randomised trials were manufacturer-funded. We wrote about who pays for the studies that shape this debate earlier this month. It applies here too.

For the record, the numbers Lilly is building its approval case on come from the company’s own announcement of 23 July 2026: in TRIUMPH-2, adults with type 2 diabetes and obesity or overweight lost up to an average of 20.8 per cent of body weight at 80 weeks on the highest dose; in TRIUMPH-3, adults with severe obesity and established cardiovascular disease lost up to an average of 22.6 per cent. Lilly plans to file for approval with the FDA in the first quarter of 2027. We report those figures as what they are: topline results announced by the manufacturer, not an independent verdict, and not a reason for anyone to want or not want a drug.

The thing to take away

A 79-year-old man got a medicine that officially does not exist yet. We do not know who he is. His doctors at a federal research institute knew how to ask. Other doctors asked and waited weeks. Then journalists asked, and lawmakers asked, and a programme appeared with rules that come in two versions.

Nothing about that is an argument about bodies. It is an argument about queues, and about who is allowed to write the rules for standing in them. For fat people, who spend a great deal of time being told that their health outcomes are a matter of personal effort, it is worth naming out loud how much of the actual access in this system is decided by proximity, paperwork and press attention.

Sources

• Sneha S K, Deena Beasley: Eli Lilly to offer early access to next-gen obesity drug to some patients. Reuters, 3 August 2026. https://www.reuters.com/legal/litigation/eli-lilly-offer-early-access-next-gen-obesity-drug-some-patients-2026-08-03/
• Lizzy Lawrence, Elaine Chen: Eli Lilly to allow more patients to apply for special access to unapproved obesity drug. STAT, 3 August 2026 (STAT Plus, full text behind paywall; details used here are as reproduced by AJMC and Reuters). https://www.statnews.com/2026/08/03/eli-lilly-retatrutide-mystery-patient-doctors-seek-same-access-their-patients/
• Giuliana Grossi: Lilly Expands Retatrutide Access Amid Doctor Pushback. The American Journal of Managed Care, 5 August 2026. https://www.ajmc.com/view/lilly-expands-retatrutide-access-amid-doctor-pushback
• Eli Lilly and Company: Lilly’s triple agonist, retatrutide, successful in two additional Phase 3 obesity trials. News release, 23 July 2026. https://investor.lilly.com/news-releases/news-release-details/lillys-triple-agonist-retatrutide-successful-two-additional
• US Food and Drug Administration: Expanded Access, Information for Physicians. https://www.fda.gov/news-events/expanded-access/expanded-access-information-physicians
• § 21 Abs. 2 Nr. 3 Arzneimittelgesetz. https://www.gesetze-im-internet.de/amg_1976/__21.html
• §§ 1, 3, 4 Arzneimittel-Härtefall-Verordnung. https://www.gesetze-im-internet.de/amhv/
• BfArM: Arzneimittel-Härtefallprogramme / Compassionate Use. https://www.bfarm.de/DE/Arzneimittel/Klinische-Pruefung/Compassionate-Use/_artikel.html
• Fast alle Studien zu Abnehmspritzen von Herstellern finanziert. Deutsches Ärzteblatt, 7 November 2025 (Cochrane Database of Systematic Reviews 2025, DOI 10.1002/14651858.CD016018, 10.1002/14651858.CD015092.pub2, 10.1002/14651858.CD016017). https://www.aerzteblatt.de/news/fast-alle-studien-zu-abnehmspritzen-von-herstellern-finanziert-a4c0435a-b30e-4d18-92f3-4ccdf5087d1c

Note on sourcing: The STAT article is behind a paywall. Every detail attributed to STAT in this piece is taken from AJMC’s fact-checked summary of it or from Reuters, both of which cite STAT explicitly. No quotation is reproduced here that we could not find in an accessible source. The identity of the April patient is not known and is not speculated about here beyond the White House denial that has been reported.