Search Results for "discrimination"

Is Not Calling Obesity A Disease Discrimination?

In the many discussions I have had about calling obesity a disease, I have often heard the argument that calling obesity a disease somehow discriminates against larger people. Indeed, there are people who consider “obesity” to be largely a “social construct” invented by the “medical establishment” to “medicalize” something that is simply a natural part of the spectrum of human shape and size. Funnily enough, some of the most passionate opposition to calling obesity a disease, comes from that very same “medical establishment” – doctors who don’t want to see providing obesity care as part of their job, hospital administrators who think providing obesity treatments takes resources away from dealing with “real” diseases, and payers who fear having to shell out millions of dollars for expensive obesity treatments. Indeed, if I had to point to one single factor that has in fact stopped the “medical establishment” from finding better treatments and providing access to effective and compassionate care for people struggling with excess weight, it is their refusal to consider obesity a disease. The paradox in all this would be funny if it were not so sad – it turns out that many in the very same “medical establishment” that is being sharply criticized by social scientists and the size-acceptance crowd for “medicalizing” obesity, are in fact fighting as hard as they possibly can to NOT have obesity declared a disease. So oddly, the people who appear so concerned that labeling obesity a disease could somehow discriminate against people of size,  are widely supported by the general public, many of who would think the notion of obesity as a disease ridiculous, given that in their view, being large is simply a matter of poor choices.  Sounds to me, like a rather uncanny alliance between the far left and the far right. While I fully understand that for some people, being “labeled” as having a disease may be traumatic, I see this as no more or less traumatic than being “labeled” as having hypertension, diabetes, arthritis, sleep apnea, or for that matter, cancer. Does this mean some people for who their excess weight poses no medical risk will get mislabeled? Sure it does. But there are also many otherwise healthy folks “labeled” as having hypertension, diabetes or even cancer, who will live to a ripe old age – good for them! I am also the first to celebrate size and shape diversity and readers may recall that I invented the Edmonton Obesity Staging System to deal with the issue of “healthy”… Read More »

Are Cost-Saving Arguments For Treating Obesity Another Form of Discrimination?

Yes, health care costs consume an increasing proportion of taxes (in countries with public healthcare systems) or personal income. Yes, there is also considerable waste in healthcare systems and not every dollar spent is necessary or provides any meaningful benefit. Indeed, even where health benefits are achieved, these may perhaps be had at a lower cost than in our current systems. Thus, there is no argument against reducing waste and improving cost-effectiveness of treatments (or for that matter, prevention). However, arguing in favour of cost-effectiveness should not be confused with arguments for cost-savings, as is often put forward in discussions about obesity treatment. Indeed, authors often bend over backwards to demonstrate the potential cost-savings that may come from treating obesity. Case in point is a study by Oleg Borisenko and colleagues, who in a paper published in Obesity Surgery, suggest that (based on the Scandinavian Bariatric Surgery Registry), surgical treatment of severe obesity led to savings of €8408 per patient, which translates into lifetime savings savings of €66 million for the cohort, operated in 2012. Be that as it may, I feel that savings cannot be the sole argument in favour of providing treatments for a disease. Given the tremendous impact that obesity has on the health and lives of people living with obesity, I would argue for treatments even if they increase healthcare costs. Let us remind ourselves that we do not argue about whether or not treating people with heart attacks, osteoarthritis, kidney failure or cancer saves money for the health care system – it rarely does, and is besides the point. The reason we spend money treating these conditions is because the people presenting with these conditions deserve treatment – period! Thus, I would argue that the primary reason that health care systems should be spending money on treating obesity is because people with obesity deserve treatment – not because it saves money for the system. Thus, even if there was a net cost to treating obesity, people with obesity deserve treatment as much as people with diabetes, heart disease or chronic kidney disease. If this means a greater cost to the health care system, so be it – raise taxes or increase payers contributions – don’t try to save money by simply refusing to pay for obesity treatment (or rationing it by making it difficult for patients to access). Using cost-savings as the prime argument for treating obesity… Read More »

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