Monday, March 2, 2009

When Fashion Meets Obesity Prevention

This weekend I saw the screening of “America the Beautiful“, a moving documentary film by Daryl Roberts that deals with how the pervasive activities of the fashion, clothing, cosmetics and entertainment industries have utterly trampled and destroyed women’s self-image for monetory gain – thereby not only providing ample fodder for the billion dollar diet and weight-loss industry, but at the same time fostering the epidemic of lethal anorexic and bulimic eating disorders. The screening was part of the Eating Disorder Education Organisation’s annual conference here in Edmonton.

The film should probably be seen by all health professionals dealing with obesity – especially those, who widely promote the general ideology that thinner is healthier (even though epidemiological studies clearly tell us that this IS NOT THE CASE!). This “thinner-is-better” ideology is by no means rare amongst health professionals (especially those active in public health) and is often promoted under the “prevention” banner.

Regular readers of these pages, may recall that we recently proposed a Clinical Staging System of Obesity, where the recommendation for Stages 0 and 1 obesity is NOT weight loss, but rather just prevention of further weight gain.

While many colleagues have agreed and supported the general notion of the Edmonton Obesity Staging System, it has drawn some criticism from prevention advocates for not recommending weight loss to everyone who meets the BMI criteria for obesity (i.e. including those, who currently have no health problems related to their excess weight). Behind this criticism, I sense the pervasive ideology that all excess weight is bad and that “healthy weights” should be the goal of anyone carrying a few extra pounds.

Women are clearly far more susceptible to this “healthy-weights” messaging and at any given time are likely to show more dissatisfaction, concern and preoccupation with their weight than men. While most of this weight obsession may well be fueled by the unachievable “ideal” of body weight promoted by the fashion and cosmetics industry, it is not unusual to hear “better health” as a justification for openly engaging in unhealthy weight-loss behaviours.

Here is my message to all health professionals and policy makers concerned with obesity: let us define obesity in terms of its actual impact on health – let us not recommend weight loss to those, who have nothing to gain.

Let us always remember that a key element of the Hippocratic Oath is to first and foremost DO NO HARM.

Let us therefore make sure that our weight-loss recommendations are based on sound evidence of benefit and are specifically targeted to those who actually have or are at clear risk of developing obesity-related health problems.

For those who may just have a few extra weight, but no health problems, let us limit our recommendations to eating healthy, being active and maintaining your current weight (whatever it may be).

Health cannot be measured on a scale!

Edmonton, Alberta

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