Kristal Hartman, 45, has struggled all her life with chronic obesity and still considers herself to have the disease even after losing over 100 lbs. “It does not even matter what the number on the scale says,” Kristal explains. “I still have obesity and will for the rest of my life.”

Kristal is the chairwoman of the Obesity Action Coalition (OAC), a group with nearly 100,000 members in the United States and a mission to educate the medical community and general population about obesity as a disease.

“We all have personal responsibility for our health and our lives,” she says, “but obesity is a chronic disease just like any other chronic disease — heart disease, high blood pressure, diabetes. It should be treated as such.”

“We all have personal responsibility for our health and our lives,” she says, “but obesity is a chronic disease just like any other chronic disease — heart disease, high blood pressure, diabetes. It should be treated as such.”

– Kristal Hartman

The weight of stigma

Kristal grew up as an active kid in Oregon. She enjoyed the outdoors. She was on the high school basketball and dance teams. But, despite a predominately healthy lifestyle, she found herself gaining more and more weight throughout high school and college. It wasn’t until after she graduated that Kristal learned she had polycystic ovary syndrome (PCOS) and that the related hormonal imbalances had been impacting her weight for years.

By the time Kristal was in her 30s, she had a job in the medical field and three young sons. But at 5’1 and about 275 pounds, her weight was starting to impact her everyday life. She developed pre-diabetes, asthma, and joint and muscle issues. She was on 14 medications to manage comorbidities of obesity and had to make frequent trips to urgent care.

Kristal tried diet after diet and exercise plan after exercise plan to improve her health, but nothing helped. Meanwhile, her primary care provider (PCP) seemed to think her inability to lose weight was due to a lack of motivation or self control.

“The only advice I got was, ‘If you could just put the fork down and go for a walk, you’d be able to lose this weight,’” Kristal says. “That only made me feel worse because I was so hard on myself and blamed myself.”

Building her toolbox 

After years of illness and much consideration, Kristal got bariatric surgery in 2014. Bariatric surgery is a type of procedure that changes your digestive system to help you lose weight.

To shed weight after the surgery, Kristal walked daily. At first, just to her mailbox. Then, she increased to walking a block, then two, then three. When Kristal had to walk in the dark during the winter, her mom drove behind her with headlights on to light the way.

By 2017, Kristal had lost 100 pounds, joined a running club, and signed up for a half marathon. “I didn’t do it to get to a number on a scale,” she notes. “I did it because I needed to be healthy for myself and my kids.”

To help maintain her weight loss, Kristal takes medication that makes her feel fuller and satiated. With this combination of hard work, support, and resources from what Kristal calls “the toolbox,” she now can eat and exercise the way her PCP always suggested.

Through her work with OAC, Kristal advocates for others with obesity to have access to the complete toolbox, from knowledgeable PCPs to nutritionists to surgery to medication to mental health support.

“Every person with obesity deserves that,” she says. “They deserve to figure out what their special toolbox formula is. They may need all of it, they may need one or two things, I don’t know, but they should have access to all of it.”

Expanding the toolbox 

According to the CDC, more than 40% of adults in the United States suffer from obesity. Obesity-related conditions include heart disease, stroke, type 2 diabetes, and certain types of cancer. And from an economic standpoint, obesity is associated with about $172 billion in excess annual health care spending. 

“Obesity is a chronic illness that increases the risk of developing other diseases,” says Ryan Esquejo, a biologist in the Internal Medicine Research Unit at Pfizer. “Patients may suffer from obesity not because of the lack of self-discipline, but rather due to a combination of factors such as genetic, environmental, and underlying illness.”

Over the last 20 years, scientists have learned more about the biological mechanisms involved in appetite regulation, which has led to a better understanding of obesity and the discovery of new treatments. New-generation obesity medicines mimic naturally occurring hormones called incretins that are secreted from the intestine upon sensing nutrients after a meal and increasing satiety (how full one feels) after eating.

Ryan and his team continue researching with the goal to develop potential treatments that are easy to use, accessible, effective, and tolerable. 

“Obesity is a complex illness,” says Ryan. “I hope that, as technology evolves and as research advances, we gain a better understanding of the disease so that we can develop effective medicines and that the patients who need breakthroughs are able to access them.”

The path to unbiased care

Recently, Kristal wrote a letter sharing her experience with obesity and stigma. In it, she expressed the impact scientists like Ryan have by recognizing people with obesity as deserving of empathetic and unbiased medical care. 

At Pfizer’s Kendall Square office, Kristal and Ryan read her letter together. 

Afterward, Ryan asks Kristal what the most important part of her treatment journey has been. 

Rather than mentioning her surgery or medication, Kristal says, “You need a health care provider who is going to be willing to be on that journey with you, keep an open mind, [and] try all the tools in the toolbox to see what works…We want to be treated as if we are an individual and have an individualized treatment plan.” Kristal asks Ryan about his work toward new medical treatments for obesity and related conditions, work that could help grow the toolbox for patients.

“I have friends and family members who also have some sort of metabolic disorder, so coming to work, to me, it’s a bit personal,” he tells her. “I’m happy to be working with a great team at Pfizer. We’re doing really good science in order to find new therapies for obesity.”

Ryan explains that the team is “deeply committed to serving the needs of people who are suffering from obesity and type 2 diabetes.”

“I love that your team is passionate,” Kristal says. “Passion about the science and passion for helping patients, that means a lot.”

“I love that your team is passionate,” Kristal says. “Passion about the science and passion for helping patients, that means a lot.”

– Kristal Hartman