Yesterday, on the first day of the 1st Caribbean Obesity Forum, I presented various talks on obesity - its economic implications, its assessment and the need for firmly anchoring obesity treatment in primary care.
Interestingly, several family doctors in the audience raised the interesting issue that here on Barbados (as probably on other islands) many patients are actually quite happy with their weights.
One family physician noted in his presentation the case of an overweight woman, who presented in his practice with diabetes. A few weeks after starting her on metformin, she came back considerably distressed about the fact, that she had now lost a few kilos. He noted that despite explaining out that her diabetes was now under control and her blood pressure had improved, she remained unconvinced about the benefits of being on this treatment. To her, losing weight equated directly with being unhealthy and ‘less sexy’ to her husband.
This topic came up several times during the day, where the issue of how to address obesity related health problems in a culture, where excess weight is considered both physically attractive and a sign of good health - never mind that the Caribbean (as pointed out by other speakers) now has some of the highest diabetes rates in world - I have heard Jamaica referred to as the world capital of foot amputations.
The notion of obesity as a sign of good health of course is not that surprising - especially in countries where malnutrition, infectious diseases, gut parasites, and other ‘wasting’ conditions, are endemic. Being skinny is a sure sign of sickness and weight loss is most alarming.
One discussant reminded me of the African practice of fattening rooms, where brides-to-be would be sequestered and overfed in order to be their ‘best weight’ on their wedding day - the exact opposite of Western societies, where brides wanting to lose weight provide healthy profits for the weight-loss industry.
Obviously, in such a setting, the very idea that excess weight may adversely affect pregnancy outcomes, is clearly a hard sell - as noted by the colleague speaking on the issue of epigenetic programming in utero.
In the discussions, I did point out that while we certainly did not have an issue with women not wanting to lose weight (in fact our challenge is perhaps the opposite - convincing many women that the few extra pounds they would so desperately like to shave off their butts and thighs may actually protect them from diabetes and other health problems), we do have a problem with men trivialising or denying the problem.
These learnings are nevertheless important to me, especially when practicing in a country like Canada, where we see patients with a wide range of ethnic and cultural backgrounds.
As clinicians, let us be aware that when some of our patients appear unconcerned about their weight-realated health problems, they may not simply be unmotivated to consider obesity treatments - they (and their family and friends) may actively oppose and resist them.
AMS
Bridgetown, Barbados
In The News
January 13th, 2012 at 9:50 am
Dr. Sharma, you mentioned the colleague who was addressing epigenetic programming in utero at the conference in Barbados. I wondered whether this colleague was speaking at all to the possible correlation between exposure to environmental toxins during pregnancy and the development of childhood obesity. Did you see the program on CBCs, The Nature of Things, called “Programmed to be Fat”? It aired last night (Jan 12). I would be most interested in your observations and opinions of this type of research and its findings.
January 13th, 2012 at 2:10 pm
@Ann Marie: the environmental toxin angle is actually not all that new. Haven’t seen last night’s documentary, but here is a link to an earlier post on this topic: http://www.drsharma.ca/do-environmental-toxins-promote-obesity.html
January 17th, 2012 at 4:05 am
The idea that being fat can be healthy is actually not entirely wrong. When you say ‘The notion of obesity as a sign of good health of course is not that surprising - especially in countries where malnutrition, infectious diseases, gut parasites, and other ‘wasting’ conditions, are endemic. Being skinny is a sure sign of sickness and weight loss is most alarming.,’ you don’t mention the fact that having nutrition reserves helps people survive those conditions. However, it’s true.
Heavy people also have better outcomes with diseases that are correlated to higher weights such as heart disease, and with cancer. It’s known as “the obesity paradox” in the medical literature. However, it’s only a paradox if you view being heavy as a disease. If you see it as a physical characteristic that has both positive and negative impacts on health risks, then it can simply be interpreted as resilience.
The populations in so-called third world countries would be better served if doctors and leaders addressed the problems with malnutrition, infectious diseases, gut parasites, etc. The issue of weight, for them, is even more of a mixed bag than it is in wealthy countries.