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Does the Focus on Obesity Prevention Promote Bias and Discrimination?



While I am taking a brief break from clinics and other obligations (including daily blog posts), I will be reposting past articles, which I still believe to be relevant but may have escaped the attention of the 100s of new readers who have signed up in the past months.

The following was first posted on 02/02/08

Imagine walking into an emergency room with chest pain and simply being sent away with a leaflet advising you to quit smoking.

Imagine arriving at a hospital with signs of stroke and simply being referred to a lecture on reducing sodium intake.

Imagine being diagnosed of colon cancer and just receiving well-meanining advise on the virtue of eating more fibre.

What is fundamentally wrong with the above scenarios? The simple fact that they are confusing prevention with treatment.

While giving up smoking, excessive salt and eating more fibre may be valuable in preventing heart disease, stroke and cancer, as treatments (at least in the short term) they are near to useless.

Once patients present with the disease, they need treatment.

This is not to say that lifestyle changes are not as important for secondary prevention – but they are rarely enough.

While many may agree with the above, they seem to have a hard time applying this knowledge to obesity.

While every politician, non-government organization and legions of health workers are campaigning for more efforts on preventing obesity, rarely do I hear the cry for more treatments – this is blatant discrimination!

When a quarter of the population or around 11,000,000 Canadians already have the “disease” focussing all available resources solely on prevention is a joke.

Not that efforts at prevention are not important – of course they are. Yet, even the most optimistic experts do not think that the current epidemic can be reversed in the forseeable future. It will take time to rebuild our cities, force people to abandon their cars, regulate our food chain, focus on calories and change our culture of overconsumption and sedentariness.

Even if any of these measures worked, no one expects them to have an immediate impact on those struggling with obesity today.

A 200 lb 17 year-old does not have 10 years to wait for “prevention” to kick in – he/she needs help today.

Even if treatment focussed only on providing minimal obesity treatments to those who most need them, i.e. those already experiencing the complications of diabetes, knee pain, sleep apnea, fatty livers, infertility – we would still need to provide obesity treatments for millions of Canadians.

Ignoring their plight and focussing all resources on “prevention” is not only demeaning and in-human, it also perpetuates the wide-held notion that obesity is entirely preventable and that anyone who has obesity has obviously “failed” at doing the right thing and therefore simply deserves no better.

The more we promote the idea that all it takes to prevent obesity is simply for individuals to eat less and move more – the more we can rest in our armchairs and blame people with obesity for just eating too much and not moving enough.

What message could be more powerful in cementing the already widespread bias and discrimination against individuals struggling with this condition?

Perhaps only worse is the message that anyone can become masters of their own weight if they only tried hard enough (as in Biggest Loser?). This idea is even more discriminating, because it implies that anyone who is too heavy is simply not making the effort.

All of this flies in the face of the fact that recidivism of obesity in our current obesogenic environment is almost 100%.

No matter how much weight people lose and irrespective of the weight-loss method (perhaps short of surgery) weight sooner or later comes back. In the exceptional few who do manage to keep the weight off, it remains nothing short of a daily obsession, where the slightest slip-up is punished with immediate weight re-gain.

Simply losing weight is not treatment for obesity – keeping it off is!

Continuing to channel all our efforts solely into prevention and ignoring the plight of the millions who have no where to turn for help except to commercial weight-loss scams is a direct reflection of and only promotes the bias and discrimination against people with obesity.

Fortunately, treating obesity is not more difficult or even more expensive than dealing with other chronic conditions – but it does require at least the same attention and commitment of resources as we devote to other chronic diseases. Not providing treatment is perhaps only a reflection of the bias and discrimination towards people struggling with this condition (they deserve no better!).

We cannot afford to simply write off a quarter of all Canadians. Health ministers, health authorities, NGOs and health professionals now have to step up to the plate!

AMS

3 Comments

  1. Obese people feel a great amount of guilt and shame for not being able to lose weight. Dr. Sharma points out that the obese are given information for prevention of obesity… not actual treatment models. No wonder they can’t lose weight. Without the tools they need, the obese don’t have a chance of losing the weight. It’s a conundrum.

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  2. The attitude by medical professionals and casual observers is even worse because nobody seems to understand the difference between association and causation. Sure, sleep apnea is associated with obesity. Maybe this is because when the apnea starts, and it has been found in infants, you wake up so tired that you are exhausted. Gee, I wonder why you don’t exercise and overeat to stay awake?

    Rather than blame the person, why not try to figure out what is wrong in the body that leads to the loss of energy, rather than ordering a sick person to start exercising. There is an epidemic of autoimmune disease that is being carefully ignored by the CDC and NIH.

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  3. Bariatic surgery cures obesity.

    Don’t like surgery, try the suggestions of the national weight loss registry:

    “We found that in the National Weight Control Registry, successful long-term weight loss maintainers (average weight loss of 30 kg for an average of 5.5 years) share common behavioral strategies, including eating a diet low in fat, frequent self-monitoring of body weight and food intake, and high levels of regular physical activity. ”

    from: Annu Rev Nutr. 2001;21:323-41.
    Successful weight loss maintenance.
    Wing RR, Hill JO.

    If anyone deserves blame it is the M.D’s who fail to provide their patients with the known treatment to best cure obesity.

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