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Although HIV and obesity are not mirror images, lessons from the HIV response could accelerate fairer and more effective care for people living with obesity.

These were the findings in the paper titled "Weight management in people with HIV" published as part of The Lancet HIV series on Nov. 8.

This series highlights how HIV and weight stigma can intersect, and how community-led, integrated services can help address both.

By adapting HIV's activist-built tools, i.e., community leadership, stigma measurement, legal protection and integrated treatment access, weight-stigma reduction can move beyond blame and toward care that treats obesity as a health issue, not a moral failing.

"Obesity and HIV are shaped by stigma that extends beyond public prejudice. In HIV, moral judgments about sex, loss of autonomy and enduring associations with death based on widespread images of HIV as a wasting disease have delayed care-seeking and sustained discrimination," says Dr. Simiso Sokhela of Ezintsha at Wits University, South Africa, and a series author. "Effective treatment has reduced some enacted stigma, but anticipated and internalized stigma often persist, even among people with an undetectable viral load."

Weight stigma shares important features with HIV stigma: Body size is immediately visible, allowing judgment before any clinical or workplace interaction. It is also commonly framed as a failure of personal willpower, despite the roles of genetics, metabolic differences, medications, food environments and structural poverty.

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