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Is Not Medicalizing Obesity Discrimination?

Here is a brief excerpt from a recent talk, in which I discuss why I believe that not medicalizing obesity is a form of discrimination: Appreciate your comments. AMS Edmonton, AB

Does Not ‘Medicalizing’ Obesity Promote Weight Bias and Discrimination?

Yesterday, in Ottawa, I participated in a Café Scientifique discussion about whether or not obesity is a disease, which naturally also touched on the issue of whether or not obesity needs to be medicalised. My co-discussant was Jacqui Gingras, Associate Professor at Ryerson University’s School of Nutrition in Toronto. The discussion was elegantly moderated by Mark Tremblay, Director of the Active Healthy Living and Obesity Research Group, at the Children’s Hospital of Eastern Ontario. While there was no disagreement that excess body fat can indeed pose a health problem as well as no disagreement that the current definition of obesity, based on simple measures of height and weight, is clinically meaningless (as it does not discriminate between those for whom ‘excess’ body fat is indeed a health problem from those for whom it is not), there were nevertheless differences of opinion on whether or not ‘medicalising’ obesity would be helpful. Although I am the first to agree that health cannot be determined by simply stepping on a scale, it is exactly because things are not that simple, that it does take a trained and knowledgeable health professional to determine for whom excess body fat is a disease and for whom it is not. Indeed, I am fully aware that it often takes extensive medical knowledge and understanding of the rather complex socio-psycho-biology of weight gain as well as clinical skills, experience, and judgement in its assessment, to decide, when the accumulation of body fat poses a health risk and when it does not. This, interestingly, is no different from the many clinical decisions that health professionals deal with every day. Indeed, figuring out exactly in which cases a symptom, a clinical sign, or the result of a diagnostic test is an indicator of ill-health and in which cases it is merely a harmless ‘norm-variant’, is what makes the practice of medicine so interesting (and complicated). If diagnosing a ‘disease’ was as easy as taking out a measuring tape or ticking off lab values, then anyone could do it. Indeed, to take specific examples, deciding when a wave on your ECG is a sign of underlying heart disease and when it is not, or when a mole on your skin is a precancerous growth and when it is not, is exactly what doctors go to medical school to learn. It is exactly because we do not exclusively leave the diagnosis of… Read More »

Say ‘No’ To Weight-Based Bullying and Discrimination

Yesterday, the Canadian Obesity Network hosted the First Canadian Summit on Weight Bias and Discrimination. Judging by the tremendous media interest in this summit (which was completely sold out), it seems that this topic has struck a nerve. In the many media interviews that were given by panelists and myself, it appears that there was a particular interest in weight-based bullying and discrimination at the workplace. This is one of the issues addressed in a very useful policy brief published by the Rudd Centre for Food Policy and Obesity titled, “Weight Bias – a Social Justice Issue“. With regard to obesity and employment, the document points out that compared to job applicants with the same qualifications, obese applicants are rated more negatively and are less likely to be hired. Obese applicants are also perceived to be unfit for jobs involving face-to-face interactions. In addition, overweight and obese applicants are viewed as having ■ poor self-discipline; ■ low supervisory potential; ■ poor personal hygiene; ■ less ambition and productivity. Apart from not being hired because of their excess weight, obese employees are offered lower wages, are less likely to be promoted, and are often the first to be fired irrespective of their actual job performance. Other examples of discrimination in the work setting include: ■ becoming the target of derogatory comments and jokes by employers and coworkers; ■ being fired for failure to lose weight; ■ being penalized for weight, through company benefits programs. As blogged before, this issue is not just important because of the economic consequences but also has some very real psychological and physiological implications for the victims of such decisions and behaviours. A detailed conference report, Council recommendations, and videos of the presentations will be posted on the website of the Canadian Obesity Network in the next couple of days. In the meantime, I’d certainly love to hear from my readers about any weight-based discrimination that they have experienced or witnessed and any suggestions anyone may have on how best to address this issue. AMS Toronto, Ontario Videos of the presentations at the Weight Bias Summit are available here

Register Now for the Canadian Summit on Weight Bias and Discrimination

On January 17th, 2011, the Canadian Obesity Network is hosting the first National Summit on Weight Bias and Discrimination, at St. Lawrence Hall, Toronto. This summit should be of interest to all health professionals, policy makers, legislators, educators, media and anyone with an interest in understanding and ending the stigma against excess weight. The meeting is open to anyone who has experienced or is concerned about weight bias and discrimination. As regular readers of these pages are well aware, weight bias and discrimination is widespread among the public, health professionals, media, policy makers and employers. Overweight and obesity are often viewed as the result of simply making poor choices or a lack of willpower and self control, and not as the complex conditions they are. The direct implications for the health of those struggling with excess weight are profound. The Canadian Obesity Network seeks to address this important issue by engaging influential thought leaders representing media, education, employers, healthcare systems, law and decision makers to review the evidence on the extent and consequences of weight bias on Canadians. The meeting will be moderated by André Picard, one of Canada’s top health and public policy observers and commentators and columnist for the Globe and Mail. The Council members include: Hon. A. Anne McLellan, Officer of the Order of Canada, who has formerly served as Canada’s Minister of Health, Minister of Justice and Attorney General of Canada Ben Barry, CEO of the Ben Barry Agency, the first modeling agency in the world to challenge the status-quo beauty ideal by representing models of all ages, sizes, backgrounds, and abilities. Merryl Bear, Executive Director of the National Eating Disorder Information Centre Chris Burton, Chief Commissioner at Girl Guides of Canada Bruce Ferguson, Director of the Community Health Services Resource Group at The Hospital for Sick Children, Toronto David Sculthorpe, business leader and Chair of PREVNet, a national research network committed to stopping bullying in Canada. Hugh O’Reilly, head of the Pension Benefits and Insolvency Practice at Cavalluzzo Hayes Shilton McIntyre and Cornish, who has also successfully represented patient advocacy groups on human rights issues. Louise Forand-Samson, Artistic Director of the Club musical de Québec and Chair of the Board of the Laval University Research Chair on Obesity. Myles Ellis, director with the Canadian Association for the Practical Study of Law in Education (CAPSLE) and Co-Director of the Research and Information Division at Canadian Teachers’ Federation.… Read More »

Does Weight Discrimination Affect Glucose Control?

Regular readers will recall previous posts on the very real negative health impacts of the weight-bias and discrimination that people with excess weight face everyday. Now, a paper by Vera Tsenkova and colleagues from the University of Wisconsin-Madison, just published in the Annals of Behavioral Medicine, suggests that perceived weight discrimination may directly affect glycemic control. The study included over 900 non-diabetic participants of the Midlife in the United States (MIDUS II) survey and found a clear relationship between measures of adiposity (BMI, waist circumference) and HbA1c levels (a marker of glycemic control). Participants were also asked “how often on a day-to-day basis do you experience each of the following types of discrimination?”: (1) “you are treated with less courtesy than other people”, (2) “you are treated with less respect than other people”, (3) “you receive poorer service than other people at restaurants or stores”, (4) “people act as if they think you are not smart”, (5) “people act as if they are afraid of you”, (6) “people act as if they think you are dishonest”, (7) “people act as if they think you are not as good as they are”, (8) “you are called names or insulted”, (9) “you are threatened or harassed.” Respondents who indicated that they had ever experienced any such mistreatment were then asked “what was the main reason for the discrimination you experienced?” A dichotomous indicator was created based on whether one had ever (at least once) experienced due to weight or height. Interestingly, the highest HbA1c levels were seen in people with high waist circumference levels who also reported having experienced weight discrimination. These negative effects of weight discrimination appeared independent of health behaviors, such as smoking, exercise, and fast-food consumption. As the authors discuss, “Previous studies have documented that obese individuals might not seek timely healthcare or comply with proper healthcare regimens due to fear of mistreatment, teasing, and the demoralization that results from this mistreatment. Thus, perceptions of persistent mistreatment may exacerbate the already harmful consequences of central adiposity for a range of physical outcomes, including glycemic control.“ In addition there may be physiological mechanisms that may account for this relationship. Thus, chronic psychosocial stress such as perceived discrimination might introduce the major stress hormones (norepinephrine, epinephrine, and cortisol), which may have adverse effects on lipid and glucose metabolism. As the authors note, “Understanding how biological and psychosocial factors interact to increase… Read More »