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How Will Obesity Affect the Sustainability of the Health Care System?

Yesterday, I presented a brief talk on obesity at the Summit on Sustainable Health and Health Care, organised by the Conference Board of Canada.

While the two-day conference deals with a number of issues relevant to sustainable health, it was my task to discuss some of the implications of the obesity epidemic.

As I pointed out, obesity no doubt presents important challenges for any health care system, especially if we continue to pretend that this is a problem that will simply disappear if we step up preventive measures (e.g. impose higher taxes on junk food, bring back phys-ed classes to schools, etc.). While such measures may or may not help prevent a further advance of the epidemic, they will hardly help solve the problems of the 20,000,000 Canadians, who are already overweight or obese.

In fact, there is no hope for a sustainable system unless we begin accepting the fact that obesity, at least for the foreseeable future, is here to stay and that unless we begin providing treatments for those, whose health is being affected by increased adiposity, in the same manner as we would for any other chronic progressive condition, we can only expect that our spending on obesity related health problems will continue to increase.

Irrespective of any measures that we may or may not be able to implement to prevent obesity, not offering evidence based help to those who already have this condition is simply disrespectful and discriminatory.

Halifax, NS


  1. And, as you outline in the Staging System, it could be more sustainable if we quit treating people who really didn’t need to be treated with the counterproductive ELMM “cure.” My concern with your post a few days ago about the medicalization of obesity, per the endocrinologists, is that it is going to lead to more of the same. The comments seemed to promote that. I hope they start to differentiate where body size might pose an actual risk, much like those same endos differentiate between harmless thyroid nodules and thyroid cancer — you don’t rip out a thyroid for the former, but you do for the latter.

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  2. Good point ksol – I do hope that recognising their role in addressing obesity also means that they will need to get the education and information they need to actually help and not make the problem worse.

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  3. Dear Dr. Sharma,

    Recently, after reading Raymond Downing’s book, “Biohealth,” and after reflecting for several months on the dearth of critical medical studies, I have concluded that Health Care Systems inevitably sustain themselves (and continue to expand in power), yet–over the long run–these systems are capable of providing neither improved health (as I now understand that concept) nor authentic (compassionate) care.

    Critical medical studies (if widely adopted as a serious movement towards greater emancipatory construction of knowledge and practice within medicine as a culture) could offer our currently dysfunctional and broken (yet ever growing) systems the necessary hope to establish ethical foundations which could transform health care professionals into honorable servants of our fellow human beings (and their most profound health challenges) rather than servants of social injustice and staunch supporters of bureaucratic and capitalist power structures.

    Critical medical studies adopts critical social theories for the purpose of constructing new lenses of analysis, new ways to reveal the hidden forms of oppression and social control which lurk within the dominant medical discourses and which prevent most of us from recognizing the many ethical blind spots we have come to ignore or to rationalize as necessary evils.

    According to Raymond Downing, “The principle critique of medicalization by social scientists is that it ‘desocializes’ disease, that it ignores social factors in the etiologies of diseases, and consequently in their management.” p. 52

    Downing’s brief speculative discussion of anorexia nervosa as a potentially symbolic response to “intolerable” kinds of social organization provided me with innovative ways to consider the former behaviors I had habitually practiced, which resulted in a most burdensome, painful, and oppressively heavy load that I was compelled to carry with me at all times, day and night, like a huge unavoidable billboard illustrating the severity of the oppressive conditions I was still carrying inside—announcing to the world that I had suffered ENORMOUS pain and had endured repeated and MASSIVE assaults to my sense of self as a human being. Symbolically, over decades, I had transformed my body like a work of art, so that it reflected accurately my distorted perceptions of the machine-like object, or thing, I believed myself to be.

    To this day, I still find the social institutions and the cultural norms, with which I must coexist and sometimes participate, mostly morally repugnant and highly intolerable. The social injustices all around me come close at times to making me want to simply get the hell out of this ugly world. I see pain in the faces of many children and adults. I observe suffering disguised as anger, or deep sadness turned into self-certain convictions about the way our world harbors evil spirits.

    Personally, I needed to become extremely fat for many reasons. Some days, my size was a perfect way to say to a sick society: eff you! I reject your values. I reject your immoral and ignorant demands for my body to look like you say it should look. I reject your values. I reject your standards of beauty.

    There is a strange kind of power to be wielded while living as a lovely woman who weighs over 300 lbs, and who proudly hides her private rage inside–like a terrorist hiding a bomb. The world was allowed to see my weight, my size, but by god they could never see ME. They saw only their stereotypes and their false assumptions.

    I, in fact, was nowhere to be seen.

    Eventually, I needed to become thin—for myself—but even that transformation has had to be a kind of protest art…a type of rejection of cultural values which I find abhorrent.

    Oh, it’s all far too complicated to explain my former obesity in terms of oppressive social conditions and my never ending hatred for social control as a pretense for caring. It’s all much more complicated than any one person can begin to understand.

    But I agree 100% with Dr. Sharma’s assessment: “…obesity…is here to stay…”

    And I do not believe that obesity is a disease that exists “inside people” but reflects a profound rejection of social dysfunction and injustice; it demonstrates complex power struggles, chronic grief, loss, and rage.

    Sometimes, it is a protest that speaks louder than any words.

    Sometimes, it becomes an explosion that shatters your sense of self and demands that you make your life over.

    Sincerely Yours,

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  4. Dear Dr. Sharma,

    Please allow (and please forgive my request if it seems inappropriate) an addendum to my previous comment (above).

    When discussing my own experiences with weight loss, I sometimes forget to include (or intentionally neglect to mention) information that is (to me) critical for others to hear (to avoid advancing misunderstandings and false perceptions about my weight-loss-related experiences). Sometimes I omit this part of the discussion because it simply does not fit neatly (or clearly) within socially approved and dominant discourses about weight loss.

    My remarks (about my former weight and size, current weight and size, and the process that has happened and is still happening in relation to this change in body size) often become distorted very easily and quickly, given the dominant discourses (for discussing weight loss and/or dieting) popularized and legitimated by media sources, corporate interests, political policies, and professional health care providers.

    I do NOT want to suggest that my own significant reduction in size resulted from personal choices I made as an individual, for example, to improve my “lifestyle” or to decrease my “health risks.” Those particular ways of conceptualizing the changes I’ve experienced are grossly simplistic to the point of being FALSE.

    Actually, I have no adequate explanations or reasons to offer which could be interpreted as valid or scientific evidence regarding how and why my body mass changed (and continues to slowly change.)

    To attribute the reduction in body size to my own choices, efforts, or changed behaviors (as an individual) merely forces my unique personal experiences to appear as if they can and should magically fit within the linguistic boundaries and limits constructed by dominant discourses.

    Thus, these forms of language use (although very common) distort reality and result in dishonest (unethical) exchanges of ideas between innocent human beings who may have no desire to participate in the perpetration (spreading) of blatant lies–and who may feel angry and deeply hurt–even victimized–by these ongoing forces of domination and social control which continuously apply social pressure and coercion, and which typically results in unethical (dishonest) behavior unless resistance and solidarity are, instead, advanced.

    For me, this issue is the HERD of elephants in the room. It is a constant reminder to me of the forces of domination surrounding us and distorting our perceptions of reality without our consent and without our awareness. I believe, also, it is a vivid illustration of that which Habermas has named “the colonization of our lifeworlds.”

    Thank you.

    RNegade (hopefulandfree)

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