Search Results for "discrimination"

Are Lifestyle Zealots Promoting Weight Bias and Discrimination?

There are no doubt important benefits to be had from following a healthy lifestyle. A healthy diet, plenty of physical activity, restorative sleep, meditation, mindfulness, healthy relationships all contribute to maintaining good health and well-being.  And yes, all of the above can and probably should be part of any management regimen for any chronic disease.  However, the notion that these measures alone can constitute an effective and feasible treatment approach to obesity is neither supported by long-term randomised controlled studies nor by real-world experience of most individuals living with obesity, who have attempted controlling their weight with such measures.  Obviously, there are some anecdotal cases of individuals who have apparently “conquered” their obesity by drastically changing their lifestyle, mostly following rather restrictive dietary regimens (of which there are many) together with a punishing dose of daily exercise – but these rather exceptional cases in fact constitute fine examples of just what it takes to lose and sustain significant weight loss and should readily explain why this approach will simply not appeal to or prove feasible for the vast majority of people living with obesity.  Harping on about how lifestyle change is the real answer to obesity is simply promoting “fake news” and clearly implies that anyone who has tried lifestyle measures and failed, has simply not tried hard enough.  Such a message can only lead to even greater internalised weight bias and does little more than to reinforce the notion with the rest of us, that people with obesity are simply too lazy, lack motivation or willpower and are perhaps just not smart enough to get it.  Thus, every time another health zealot feels called upon to voice their opinion on how they may have personally conquered their obesity or have helped clients conquer theirs, I can only cringe at how my patients living with obesity perceive such messages.  Rather than freely acknowledging that trying to manage your obesity with lifestyle measures alone means a lifetime of restrictions and ongoing efforts, healthy living enthusiasts promote notions that do little more than to promote weight bias and ultimately reinforce stigma and discrimination.  Perhaps, even more importantly, now that we have effective medical treatments, their messages imply that anyone turning to these treatments is simply taking the “easy way out”, not willing to do the work and should probably be ashamed of themselves for failing to stick to the righteous path of… Read More »

The 3Ds of Obesity: Discrimination, Disinformation, & Disinterest

Last week I gave a Keynote presentation to dignitaries and attendees at the 5-Year Anniversary of the Helmholtz Institute for Metabolism, Obesity and Vascular Research (HI-MAG) in Leipzig. Tasked with summarising where we stand in obesity prevention and management for attendees who were not obesity experts, I boiled down the message to three points. We are where we are in addressing obesity both in terms of prevention and management because of the 3Ds: Discrimination, Disinformation, and Disinterest! Not much needs to be said about discrimination, as it is well documented that people living with obesity experience discrimination on a daily basis, be it in educational settings, workplaces, or when moving about in public. In my talk I zeroed in on the discrimination people with obesity face in health care settings: doctors spend less time with them, order fewer tests, prescribe fewer treatments, and generally have little advice to offer beyond “Eat Less Move More”. No wonder, people with obesity turn to doctors as a last resort after all their do-it-yourself approaches have failed.  Much of this weight-bias and discrimination is directly fueled by a barrage of disinformation by a multi-billion weight loss industry that has little to offer beyond useless dietary supplements, fad diets, exercise machines, and loads of other stuff that they can happily unload on desperate victims under a barrage of nonsense or half-truths (all those weight-loss secrets your cardiologist does not want you to know!). Unfortunately, governments and policy makers are complicit in this by announcing successive unachievable population goals, that focus largely on food and activity policies, none of which have yet made a dent in the obesity epidemic but do serve as a fine excuse to not provide treatments to those who already have the problem.  Finally, it is hard to fathom the amount of disinterest and lack of knowledge that the vast majority of healthcare providers show in the management of obesity. This is particularly true for most of academic medicine, which has bemoaned but otherwise largely ignored the problem. By any metric, be it in the number of academic chairs, PhD theses, research projects, research funding or publications, obesity ranks aeons behind any other major health problem of our time. We are still licensing doctors and other medical personnel that have never managed a single patient for their obesity (not just with obesity).  Fortunately, we are now finally seeing some movement in all… Read More »

Canadians Widely Support Policies and Legal Protection Agains Weight Discrimination

According to a four-country survey published by Rebecca Puhl and colleagues in the Milbank Quarterly,  a representative proportion of the public in Canada, USA, Iceland and Australia, where weight-based discrimination is widely documented would support policies and legal protections against this practice. The survey assessed public support for potential laws to prohibit weight-based discrimination, such as adding body weight to existing civil rights statutes, extending disability protections to persons with obesity, and instituting legal measures to prohibit employers from discriminating against employees because of body weight. At least two-thirds of the participants in all 4 countries expressed support for policies that would make it illegal for employers to refuse to hire, assign lower wages, deny promotions, or terminate qualified employees because of body weight. Women and participants with higher body weight expressed more support for antidiscrimination measures. Here is what Canadians had to say about these issues: Canadians expressed more support for all the proposed laws against weight-based discrimination than did the participants in both Iceland and the United States. 70% to 91% of participants in Canada, US, and Iceland supported laws that would make it illegal for employers to refuse to hire, assign lower wages, deny promotion, or terminate qualified employees because of their body weight. Support was highest for laws that would prohibit employers from assigning lower wages to qualified employees because of their weight. The majority of participants (both adult and student samples) in the United States, Canada, and Australia agreed that their government should have specific laws prohibiting weight discrimination, and they supported laws that would include body weight in existing human rights statutes. 71% to 87% of adults and 69% to 93% of students in all the countries in our study were in favour of passing laws to address bullying in the workplace. laws that would consider obesity as a disability or would provide people with obesity the same legal protections afforded to individuals with physical disabilities received the least support of all laws women were significantly more likely to support antidiscrimination measures than men were support for laws across countries was higher among participants in the obese BMI range than among thinner individuals Beliefs that obesity is caused by factors outside of personal control, such as physiological and environmental factors, were particularly related to increased support for laws In Canada only, beliefs in psychological causes of obesity were positively associated with greater support for laws Certainly enough… Read More »

Information On The Genetic Nature of Obesity Can Reduce Perceived Weight Discrimination and Increase Willingness to Eat Healthier

Continuing the theme of harmful effects of weight bias, a paper by Janine Beekman and colleagues published in Psychology & Health, suggests that providing patients information on the strong genetic nature of obesity may not only reduce perceived weight bias but also increase willingness to eat a healthier diet. In this study 201 women with overweight or obesity aged 20-50 were allowed to interact with a virtual physician in a simulated clinical primary care environment, which included physician-delivered information that emphasized either genomic or behavioral underpinnings of weight and weight loss. This research builds on previous evidence that provision of genomic information in a primary care context can reduce patients’ perceived stigma because they feel less blamed for their weight. As the authors note, “This relates to attribution theory, which posits that causal attributions play an important role in determining reactions to stigmatizing information. The more overweight is attributed to controllable causes (like diet and exercise), the more negative one’s reactions are to it.” All aspects of the virtual encounter were identical except for the type of information given: Participants who received genomic information were told that body weight has a sizeable heritable component, and this may be relevant to their personal situation. Participants who received behavioral information were given a parallel message that it may be harder for those who are already overweight to lose weight (but with no mention of the role of genomics). Both groups were reminded of the importance of health-promoting behaviours related to physical activity and nutrition. After controlling for BMI and race, participants who received genomic information stated that they perceived less blame from the doctor than participants who received behavioral information. In a serial multiple mediation model, reduced perceived blame was significantly associated with less perceived discrimination, and in turn, lower willingness to eat unhealthy foods. Thus, “Providing patients with information about genomics and weight management reduced the extent to which they felt blamed for their weight, when compared to more traditional behavior-based information. Women who felt less blamed for their weight also felt less discriminated against based on their weight, and this reduced perceived discrimination was related to healthier eating and drinking cognitions” These findings may not just have implications for clinical practice but also for public health messages about obesity: “The proliferation of the “war on obesity” and social messages targeted at combating obesity are an attempt to tackle a public health problem… Read More »

Does Weight Discrimination Kill?

The Canadian Obesity Network’s new supportive logo, tagline (respect.knowledge.action) and strategic objective (to remove the stigma from obesity and bring positivity and respect to those who are affected by it) is based on the accumulating evidence that weight bias and discrimination have significant detrimental physical, emotional and social consequences for Canadians living with obesity. Now a paper by Angelina Sutin and colleagues, published in Psychological Science shows a positive association between weight discrimination and the risk of all-cause mortality. The researchers studied almost 20,000 Participants in the Health and Retirement Study (HRS) and the Midlife in the United States Study (MIDUS). In both studies, perceived weight discrimination was associated with an almost 60% increase in mortality risk. This increased risk was not accounted for by common physical and psychological risk factors including BMI, subjective health, disease burden, depressive symptoms, smoking history, and physical activity. The association between mortality and weight discrimination was generally stronger than that between mortality and other attributions for discrimination (e.g. gender, age, sexual orientation, physical disability or “ancestry or national origin” ). Thus, although such studies cannot prove causality, they do suggest that experiencing weight-based discrimination may not only have negative physical, emotional and social consequences for people living with obesity, but may also shorten life. @DrSharma Berlin, Germany