Friday, April 25, 2014

Obesity Left, Right, and Centre

sharma-obesity-right-way-wrong-wayMuch of the obesity debate – its causes and solutions – is heavily tainted by conflicts of interest – the most important one perhaps lurking among those, who put their beliefs and ideologies before scientific fact.

An essay by Kathleen Kendall-Tackett, published in (of all places) Clinical Lactation, nicely summarizes how conventional political ideologies and belief systems colour this discourse.

Apart from commenting on the often “moralistic” nature of the obesity debate (thin = good, fat = bad), Kendall-Tackett also reflects on the racist, gender and class overtones of this discussion.

With regard to political ideologies, she notes that,

“For some on the right, the obesity epidemic merely reinforces their beliefs about the cause of the ever-widening gap between the rich and poor or between whites and minorities. After all if African Americans, Latinos, or the poor are becoming fatter than America’s predominantly white elite, it is only more proof that they lack responsibility to take care of themselves…if middle-class Americans, particularly middle-class children, are getting fat, it surely indicates the frailty of their own class status.”

“And for those on the left, the growth of obesity is further proof that large, multinational corporations are running amok, fattening a hapless public with their billion-dollar advertising campaigns and super-size value meals. The American people, particularly the poor and minorities who have the highest obesity rates, they argue, need to be protected from these corporate behemoths.”

Both positions reek of,

“…paternalistic condescension towards fatness and fat people—not only do people with this view assume that fatness is inherently bad, but they also presuppose that fat people (that is, minorities and the poor) are too ignorant to know that they should be thin.”

Or, in words of Paul Campos,

“And what is it with these skinny uptight Anglos, anyway? Who exactly deputized them to be the fat police at their local fast-food emporium?”

Indeed, it is easy to see these ideologies reflected in the political discourse around obesity.

In  prevention,  policies run the gamut from de-regulation (“consumer choice” and “free market forces”) on the right to “shame, blame, tax and ban” policies on the left.

Never mind that neither one of these approaches is supported by hard evidence – indeed, most of the evidence is so poor that it may as well be ignored when it comes to deciding who is right and who is wrong.

While the anti-sugar witch hunt is nearing its climax (the same folks were shouting for anti-fat bans just a few decades ago), those who ignore the mass of data showing the rather modest (if any) effectiveness of “lifestyle change” as a means to tackle excess body weight, continue to propagate “eat-less-move-more” solutions to this epidemic.

Caught in the centre (with nowhere to go) are those who actually bear the weight of the problem (pun intended).

While those calling for better access to and greater investments into pharmacological and surgical obesity treatments are called out by the left for “medicalizing” the issue, those on the right cry out against “coddling” people living with obesity – after all, they are only getting what they deserve given the “poor choices” they have made (you made your bed – now sleep in it!).

Again, both sides of the argument are heavily influenced by the firm belief that everyone can (and should) be a master of their own weight (after all, its just calories and calories out, right?).

No wonder I am wary of ideologies and beliefs as a source of conflict of interest – particularly as these are seldom declared or disclosed.

@DrSharma,
Edmonton

Hat tip to Noreen Willows for pointing me to this article.

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5 Responses to “Obesity Left, Right, and Centre”

  1. David Brown says:

    The big problem is lack of understanding. Academics are just beginning to understand how fats and carbohydrates affect gut health.
    https://us-mg5.mail.yahoo.com/neo/launch?.rand=cvu8jbl2jm34o#4423091903

  2. David Brown says:

    Oops. I meant to past this hyperlink. http://www.marksdailyapple.com/gut-flora-healthy-immune-system/#axzz2zu4txCye

  3. Sukie Crandall says:

    There may well be political overtones to some of this bigotry, but I think that a large portion of the attitudinal problems are rooted the very same deficits that affect so very many aspects of medicine:
    1. The general public tends to be very poorly educated in sciences and simply does not know how to weigh evidence and postualtions, how to consider alternative explanations, how to compare actual studies, even where to find abstracts (ex. looking in PubMed).
    2. Fables tend to be extremely embraced, and health perceptions are rife with those.
    3. Personal experience does not necessary translate to other people but many do not realize that.
    4. Many of the press and PR people, by dint of having the same educational backgrounds actually reinforce myths and misconceptions in their reports. (Kudos to the ones who do their homework and actually speak w the researchers before presenting their reports! I wish all were like them because they are exceptional.)

    Still, not having hard data I am not about to discount that there may be political, racial, and economic overtones which affect many of the misconceptions about weight.

    Nor are such misconceptions only about overweight. A friend of ours has to put up with people accosting her in public for what they assume is anorexia, and even people trying to take work from her because of their biases about her weight, even though there is a lack of hard numerical evidence compared to alternative explanations that models built like thin 15 year olds draw anyone to anorexia. Many models actually are thin 14 and 15 year olds who grow out of the profession in a year or two, but about a quarter of models, including the long lasting models, tend to be people from genetically very thin, small framed families who eat large meals and are active. Another misconception is that being so thin means they are naturally more healthy. Actually, just like anyone else they can have genetic vulnerabilities just like anyone else, and being very thin means that any infection places some of them at increased risk. A third misconception is that life is easier for them with more jobs and more dates, when in reality many of the very thin, even ones who are beautiful in print, find that employers worry about them not having fat reserves if they become ill so do not hire them for other types of work, and a number of people do not date the very thin.

    Being bulky myself but having been underweight during much of my teens, and having both family (skinny on Dad’s side and fat on Mom’s) and friends on both extreme sides of the weight spectrum, it seems to me like weight bigotry happens to anyone who is not in the middle range, and I think that the skinny and the heavy should join forces on pointing this out, and should support each other.

  4. C says:

    Thank you for this post.

    I have to disagree with the previous commenter. Unfortunately, I don’t believe that people with more science knowledge are less likely to have negative attitudes toward obese people.

    I agree with much of the article. I also think that a lot of discrimination toward fat people stems from fear: people want to believe that they (and their spouses, their children, etc.) will never be fat, or can stop being fat, so they have to believe that people can control whether they are fat or not. There’s also disgust — people feel disgust toward fat people and want to justify it by believing bad things about them.

    Dr. Sharma, I think the paragraphs you quoted above as being written by Kathleen Kendall-Tackett were actually part of an extended quote she used from the book “Fat Politics” by Eric J. Oliver. It is confusing because the quote is so long and because it begins in a new column, so you can’t see that it is indented. But on the second page you can see where her own words start again.

  5. Arya M. Sharma, MD says:

    Regarding the quote you may be right – whoever said it – it is an interesting notion.

    a

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