Thursday, August 9, 2012

Does Weight Bias Promote Obesity?

Over the next little while, I will be taking a few days off and so I will be reposting some of my favourite past posts. The following article was first posted on June 5, 2009:

There is now an overwhelming body of literature that documents the substantial bias and discrimination that overweight and obese people face in all important domains of living, including employment, health care and education. The well-documented negative portrayal of overweight and obese people in the media as lazy, poor-willed, over-indulgent does much to reinforce and promote this bias.

I have previously suggested, that perhaps even well-meant public health messaging, promotes simplistic (and therefore?) ineffective solutions (diet and exercise), may well reinforce the prevailing public notion that obesity is simply the self-inflicted consequence of eating too much and not moving enough.

Why is weight bias important?

From my own daily interactions with health professionals and decision makers it is often blatantly evident that weight bias is a root cause of the health system’s failure to take responsibility for and ensure equitable access to evidence-based obesity treatments.

Additionally, however, as discussed in a comprehensive review of this topic published in last month’s issue of OBESITY, Rebecca Puhl and Chelsea Heuer from Yale University’s Rudd Centre for Food Policy and Obesity (New Haven, CT, USA), point out that weight bias may have a direct negative impact on the psychological and physical health of people challenged by overweight and obesity.

As stated in their article:

“The emerging data thus far suggests that weight bias increases vulnerability to depression, low self-esteem, poor body-image, maladaptive eating behaviours and exercise avoidance.

These negative consequences challenge societal notions that stigma may serve a positive function of motivating healthy eating behaviours, and instead suggest that bias may impair efforts to engage in healthy lifestyle behaviours through negative emotional distress and unhealthy eating patterns.”

Thus, in the prevailing climate of weight-bias and stigmatization, I fear that well-meant public health efforts to promote healthy active living are likely to remain ineffective in helping people with excess weight achieve weight control.

In fact, in my own practice, I am all too keenly aware of the frustration, distress, anger, despair, and devastating sense of hopelessness that patients often report every time they encounter simplistic and naïve (and as we now know entirely ineffective and futile) suggestions to simply eat less and move more.

Unfortunately, as also pointed out in the article by Puhl and Heuer, there is virtually no research on strategies to reduce weight bias:

“Of the few studies that exist, weight bias appears to be a challenging stigma to reverse, and may be resistant to interventions that have successfully improved attitudes towards other stigmatized groups. It is likely that multiple stigma-reduction strategies will be needed to shift negative societal attitudes about obese persons.”

“This may require education about the complex causes of obesity and the harmful consequences of stigma, recognition of the difficulties of obtaining significant sustainable weight loss, efforts to challenge weight-based stereotypes, promotion of weight tolerance in multiple settings where bias is present, and legislation to prohibit inequities based on body weight”.

I fully concur with the authors’ conclusion that without sufficient attention to this issue, weight bias will remain both a social injustice and a public health issue, negatively affecting the lives of both present and future generations of people struggling with excess weight.

AMS
Edmonton, Alberta

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9 Responses to “Does Weight Bias Promote Obesity?”

  1. DHanson says:

    Eating less does work — I weighed 310 pounds when I was in my 30’s and as I learned to eat less and be more active, my weight dropped slowly over the next almost 30 years. Today, I weight 175 pounds which is still too much but it is less than what I weighed at 17 years old.

    I have followed Dr. John McDougall’s program for years. He has written about 6 books and has a great website. drmcdougall.com

    Please don’t tell people that they can’t lose weight by eating less (and eating more of the right foods — low calorie vegetables and unprocessed whole grains(.

  2. DebraSY says:

    Since this study’s publication, we have seen Georgia launch a campaign to humiliate fat children into eating less and moving more. Billboards of sullen, fat children with all capped headlines of doom and gloom:

    WARNING: STOCKY, CHUBBY, CHUNKY ARE STILL FAT

    WARNING: CHUBBY KIDS MAY NOT OUTLIVE THEIR PARENTS

    WARNING: ONLY 4% OF CHILDREN WERE CONSIDERED OBESE IN 1982. NOW, MORE THAN 30% ARE

    WARNING: CHILDREN WHO ARE OBESE ARE MORE THAN TWICE AS LIKELY TO DIE BEFORE AGE 55 THAN A CHILD WHOSE BMI IS IN THE NORMAL RANGE

    To her credit, Rebecca Puhl, this study’s author threw herself into the media frenzy saying how WRONG this approach is. I wonder, fifteen years from now, what impact we’ll see on Georgia’s obesity rates in the adults who were “educated” by this campaign. I wonder whether Puhl et. al. will “win” this battle and we will stop, already, public sanctioned bullying of fat children.

  3. Anonymous says:

    I agree with DHanson.
    In most cases – not always, I have a friend who gained weight as a side effect of medication.
    But for most people – like me – fat is a result of too much food.

    The “weight bias” idea increases obesity because it encourages people to feel like they’re not overeating, they’re unjustly and unfairly picked on.
    So they don’t learn to eat right, they learn to rationalize obesity as natural, and any comments against obesity are just discrimination.

  4. SLCCOM says:

    Just an anecdote: I have switched to a much better antidepressant, and my dessert cravings have just about disappeared. I was reading the comments on a balanced obesity article, which were full of outright hatred. I got up and got a candy bar.

    Part of me was watching with amusement. And planning to share this with you!

  5. Victor In Whitehorse says:

    Hello, I am a participant of the “Weight Wise” program here in Whitehorse Yukon. I was prescribed Cymbalta 30mg 2x Daily and discovered that it flipped the switch in my head that was preventing me from losing weight previously. The program started in April 2012 and I started the program at 440 lbs. I was a bit over 450 lbs at my “peak weight” in 2011 and it took enormous effort and many failures to lose the 10 pounds I lost between 2011 and 2012. I had steadily yo-yoed from 450 to a few pounds lower then higher then lower etc… I really FELT out of control in what I called the “Disney effect” that food had on me, I felt that each opportunity to eat was exciting like a trip to disneyland and nothing else in my life felt that exciting. I just could not resist food and even if I conciously thought, “Today I won’t have junkfood on the way home from work” I would still stop and get some, I just could not resist the urge.

    Now it is August 2012 and I weigh 395 pounds as of this morning. I am amazed that each day I am able to have the exact same foods (breakfast, snack, lunch, snack, supper) and get the right amount of water. I have not had junk food for over a month now and even when the KFC opened back up here I just didn’t care about it. I now have the same perspective on food as I do on other things in my life. Food is now a manageable choice. YAAY

    I was originally prescribed Cymbalta in April then there was a week of atrial fibrilation that I beleive was brought on by my getting too dehydrated in a weekend work party. The doctor’s were not sure if Cymbalta could cause this so for a month I was off of it, and the cravaings came back within a few days, Within a few days of being back on Cymbalta I was “fixed” again. No more “Disney Effect” of food and the atrial fibrilation has not returned either.

    I would love to be part of a study showing the effects on my brain of being on then off then on again with Cymbalta! I am absolutely convinced there is a chemical issue in my brain. I am thrilled to be losing weight and I look forward to the opportunity to explore the surgery option to add yet another tool to my toolbox of things helping me regain my life!

    I am also well aware that different medications do not work for everyone.

    Peace everyone, I know the journey is hard, do NOT give up hope!

  6. Tina (UK) says:

    I was constantly frustrated by visits to doctors which involved me being lectured about my weight; disbelieved when I told them the problems I was having; having health issues constantly being put down to weight issues; gaining weight while following their advice, but having them disagree that what I said was happening was happening and the general failure to take my issues seriously enough to investigate them properly.
    I was told to eat a low fat diet which I had been doing for some time. I was told to get exercise when I was going to the gym 3 times a week and walking 4 miles most days. I was told that the pain I experienced in my lower legs when walking was due to the female skeleton being inferior for walking purposes and that extra weight was compounding this ‘fact’. I was tired all the time and hungry too. My stress levels were very high and I believe that I may have been suffering from PTSD (never investigated despite enough information being available to indicate that this was a reasoable thing to look into.
    Then I joined sparkpeople.com and started tracking my food and exercise only to find that I was not getting anywhere near enough calories in (or protein). Now I am treated for chronic pain due to fibromyalgia and those pills add weight, along with the sleepers I rarely take due to chronic insomnia. Eat less and exercise more is NOT the be all and end all and I am so relieved to find people who actually study this issue and instead of making me feel like a weak-willed failure will enable me to find solutions instead of blame and being written off as a hopeless liar. I could kick some doctors for their ignorance, and blaming attitudes – some commenters too.

  7. Arya M. Sharma, MD says:

    Thank you Tina for sharing your experience, which reminas all too common. I always recommend that every assessment for obesity begins with a full assessment of mental health and relationship issues. PTSD, depression, anxiety, ADHD, chronic pain, complicated grief, insomnia, and many other mental health conditions can lead to overeating and otherwise affect metabolism. No diet and exercise can fix these problems, they require professional help from a psychotherapist and/or psychiatrist – not something a dietitian or exercise coach can offer.

  8. Listen to Your Patients | Dr. Sharma's Obesity Notes says:

    [...] is just one example of a comment that one reader (TinaUK) sent me in response to a post on weight bias: “I was constantly frustrated by visits to doctors which involved me being lectured about my [...]

  9. Dee says:

    What a wonderfully articulate client! 5 stars for this repost!

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