Earlier this year I participated in a two-day workshop on weight bias hosted by researchers at the University of Calgary. The over 40 participants included researchers, clinicians, health administrators and a number of other stakeholders, who discussed all aspects of weight bias and discrimination.
A particular focus of the workshop, supported by the Canadian Institutes of Health Research (INMD) and co-hosted by the Canadian Obesity Network was to explore a research agenda towards finding effective ways to reduce weight bias and its negative consequences for the health and well-being of those living with obesity.
Indeed, there are people who consider “obesity” to be largely a “social construct” invented by the “medical establishment” to “medicalize” something that is simply a natural part of the spectrum of human shape and size.
Funnily enough, some of the most passionate opposition to calling obesity a disease, comes from that very same “medical establishment” – doctors who don’t want to see providing obesity care as part of their job, hospital administrators who think providing obesity treatments takes resources away from dealing with “real” diseases, and payers who fear having to shell out millions of dollars for expensive obesity treatments.
Indeed, if I had to point to one single factor that has in fact stopped the “medical establishment” from finding better treatments and providing access to effective and compassionate care for people struggling with excess weight, it is their refusal to consider obesity a disease.
The paradox in all this would be funny if it were not so sad – it turns out that many in the very same “medical establishment” that is being sharply criticized by social scientists and the size-acceptance crowd for “medicalizing” obesity, are in fact fighting as hard as they possibly can to NOT have obesity declared a disease.
So oddly, the people who appear so concerned that labeling obesity a disease could somehow discriminate against people of size, are widely supported by the general public, many of who would think the notion of obesity as a disease ridiculous, given that in their view, being large is simply a matter of poor choices. Sounds to me, like a rather uncanny alliance between the far left and the far right.
While I fully understand that for some people, being “labeled” as having a disease may be traumatic, I see this as no more or less traumatic than being “labeled” as having hypertension, diabetes, arthritis, sleep apnea, or for that matter, cancer.
Does this mean some people for who their excess weight poses no medical risk will get mislabeled? Sure it does. But there are also many otherwise healthy folks “labeled” as having hypertension, diabetes or even cancer, who will live to a ripe old age – good for them!
I am also the first to celebrate size and shape diversity and readers may recall that I invented the Edmonton Obesity Staging System to deal with the issue of “healthy” obesity.
However for those, struggling with the health consequences of excess weight, if calling obesity a disease gets them better access to treatments – so be it!
Case in point – the American Medical Association‘s declaration of obesity as a chronic disease has been one of the key drivers of policy decisions to include obesity treatment in various care plans across the US.
So before we accuse anyone of discriminating against larger people by calling obesity a “disease”, let’s dare ask the question – who do we harm by refusing to do so?
Yesterday, I suggested that using a cost-saving argument to justify treatments for obesity reeks of discrimination. I argued that even if obesity treatment costs the system money, it needs to be delivered in the same way that we deliver treatments for other conditions – not because they save money, but because that’s what people living with those conditions deserve.
But the “cost-saving” argument is not just used to justify treatment for obesity – it is also regularly and widely used to justify spending money on obesity prevention. The usual line of argumentation is that x dollars spent on obesity prevention will save y times x dollars in healthcare spending, which is why we need to prevent obesity.
This is nonsense. We should be preventing obesity whether or not it saves money for the healthcare system, simply because obesity (defined here as excess weight that actually causes health problems) negatively impacts health and well-being. If this costs money, so be it.
Obviously, no one is asking anyone to simply pay for everything (prevention or treatment) just because it is the right thing to do, no matter the cost.
In real life cost does matter and there is a fiscal responsibility to spend money on things that are effective and deliver real benefits – but let us not wander into weighing one disease against another in making that decision.
And most certainly the question of “fault and responsibility” leads to a very slippery slope, given that so much of what affects our health (from infections to cancer, from accidents to chronic diseases) is often avoidable.
The question really boils down to whether or not there are effective ways to prevent obesity – if there are, they need to be funded, whether they save money or not.
If you are older than 18 years and live in the USA, you may be interested in the American Society for Metabolic and Bariatric Surgery (ASMBS)’s “It Starts Now,” contest that will award winners up to $5,000 and a trip to Los Angeles, where winning entries will premiere during ObesityWeek 2015 (Nov. 2 to Nov. 7, 2015). The second-place winner will receive $3,500, and two third-place winners will receive $1,500 each.
According to the ASMBs release, anyone with a video camera or smartphone can submit their stories in videos of five minutes or less that creatively inspire, motivate and educate people to think differently about obesity.
Videos or films should address the topic of obesity and can be of any genre including drama, documentary, animation, journalism, public service announcements, experimental or music videos. There is no fee for submission.
Some ideas for video and filmmakers to consider include:
- What makes obesity a disease like cancer or heart disease
- Treating Obesity as a Disease with counseling, medications, surgery
- Obesity in America
- The Health and Economic Consequences of Obesity
- Obesity Affects Everyone
- Obesity: Balancing Prevention and Treatment Strategies
- Combatting weight stigma and discrimination
- Life transformations and personal struggles and triumphs
- Solutions to the obesity epidemic
Submissions will be judged on originality, creativity, direction, content and thoughtfulness.
It Starts Now judges include Emmy Award-winning writer and producer, Perry Rein; journalist Dan Childs, managing editor, medical coverage, ABC News; screenplay writer of Remember the Titans, Gregory Allen Howard; Jamie Dukes, NFL Network commentator and former NFL player; and Dr. Morton.
A previous ASMBS motivational video that tells three stories from the perspectives of a nurse, military veteran and former NFL player, may serve as an example.
Entries must be received by October 23, 2015. Visit itstartsnow.asmbs.org for instructions on how to enter.
According to a report in JAMA, A bipartisan group of US lawmakers has introduced House and Senate versions of the same bill, the Treat and Reduce Obesity Act of 2015, intended to help reduce health care costs and decrease the incidence of chronic disease associated with obesity, including high blood pressure, heart disease, and type 2 diabetes.
The bill calls for not only giving Medicare beneficiaries access to obesity treatments provided by health care practitioners other than primary care physicians, including nurse practitioners, clinical psychologists, and registered dietitians (if referred by a primary care physician) but also to expand drug coverage for obesity treatment under Medicare.
Meanwhile in Canada, accessing evidence-based treatment for obesity, including services offered by dietitians or psychologists as well as access to anti-obesity medications or surgery remains largely elusive to most Canadians living with obesity.
With upcoming federal elections in Canada, I wonder if any political party would step up to declare that continued discrimination against Canadians living with obesity with denial of access to evidence-based treatments is unacceptable (for e.g. obesity treatments are specifically excluded in most third party drug plans in Canada).