Why Addressing Weight Bias is the #1 Strategic Goal of the Obesity Network
Monday, December 12, 2011
CBC Commentator, Rex Murphy
Regular readers will recall a host of previous posts on the issue of weight bias and discrimination.
Canadian Obesity Network members will hopefully also be aware that for the past four years, addressing weight bias and speaking out against weight-based discrimination has been the #1 strategic goal of the network.
Rather than listing all of the activities that the Network has undertaken to address this issues (the latest one being the launch of the image gallery “Picture Perfect at Every Size“), in today’s post I would like to share a story and explain why I continue to believe that this is the central problem at the the very heart of finding solutions to the obesity issue.
I remember this as though it was yesterday. I had just arrived with my family in Canada, having accepted a Tier 1 Canada Research Chair in Obesity at McMaster University. I was just discovering Canadian television and was quite impressed the first time I saw Peter Mansbridge on the CBC’s “The National”.
Interestingly, that evening one of the news items that caught my attention was an announcement by then Health Minister Anne McLellan, that the Government would spend $15 million to support obesity research – certainly good news for an obesity researcher just arriving in Canada.
This brief sense of having arrived in the right place at the right time, however, was shaken by what followed – a scathing, derisive, and contemptuous commentary by Rex Murphy, Canada’s premier TV commentator – not known to mince words.
In brief, as far as I can recall, the gist of his commentary was that this funding for obesity research was another perfect example of wasteful spending of tax-payer dollars.
To paraphrase his words, “so now the Government of Canada is spending millions of dollars to show that Canadians get fat by eating fast food and lounging in front of their TVs“.
I don’t remember the exact wording or the many ‘humorous’ angles that Rex Murphy took in this typical meandering monologue but I do recall the immediate effect it had on me. In my mind I could see Canadians across the country nodding and agreeing with Murphy, that spending any money on obesity research was indeed a complete waste – we already know the reasons: ‘gluttony and sloth’ – what’s there to research?
It became blindingly obvious that Rex Murphy was simply stating aloud what most people think – no wonder governments would be hesitant to support obesity research, or worse still, actually consider providing obesity treatments to Canadians.
I admit that prior to hearing this commentary, I had not given much thought to the issue of how weight bias ultimately stands in the way of finding solutions to the obesity epidemic.
Unfortunately, while Rex Murphy could perhaps be forgiven for failing to recognize the true psychosocial and biological complexity of this problem, I continue to be baffled that so many of my professional colleagues continue to trumpet simplistic notions of “eat-less-move-more” as a solution to the problem.
Frankly, I do not believe that they fully appreciate how, by reducing the entire problem of obesity to simply a matter of diet and exercise, they do little more than reinforce what most people already believe – obesity is simply a matter of ‘gluttony and sloth’.
No talk of food insecurity, abuse, depression, stress, time-pressures, addiction, genes, incretins, adipokines, hypothalamic pathways, adipostats, mitochondrial inflexibility, medications, or any of the other countless ‘scientific’ intricacies that may indeed result in the ‘symptoms’ of overeating or undermoving.
By reducing obesity simply to a matter of ‘lifestyle’, they provide the perfect excuse for funding agencies to rather fund research on ‘real’ health problems, for regulators to tighten the criteria for obesity medications, for payers to deny or limit the access to obesity treatments, and for health professionals to not see obesity management as part of their job.
This is why there will be no solution to obesity without first solving the issue of weight bias and discrimination.
This is why, addressing this issue remains the #1 strategic priority of the obesity network.
To anyone unhappy about how much funding is going towards supporting obesity research, unhappy about availability or access to obesity treatments, unhappy about lack of obesity training for health professionals, unhappy about reimbursements to health professionals for obesity counselling, unhappy about integrations and accommodation of people struggling with severe obesity, or even just unhappy about the surprising fact that Canada’s only national obesity organisation receives virtually no government funding to sustain its efforts – I have one simple suggestion: begin by showing zero-tolerance for ‘fat jokes’ or ‘fat talk’, do not use language, images, or messages in your presentations and writings that further promote stereotypes or reduce this complex problem to simply a matter of ‘lifestyle’, and please do stand up and speak out on the issue of weight bias and discrimination.
If the Canadian Obesity Network does nothing else but bring awareness to this aspect of the obesity problem – it will have well been worth the ride.
AMS
Edmonton, Alberta
Monday, December 12, 2011
What a wonderful post! I would love to say just this to a number of doctors in my life– is there a paper or publication that you could point me to that describes the various complex factors which may lead to obesity in a more detailed and technical manner? Thank you for posting!
Monday, December 12, 2011
I agree it’s a good start, eliminating the obvious derogatory comments, but the values around weight bias are pretty insidious. There’s a million ways to maintain the stereotypes without saying something obviously discriminatory. “Wow, you are so strong willed, the way you said no to dessert” translation: “if you eat dessert you are weak-willed”. “Wow you look fantastic, so fit and healthy, how much weight have you lost?” Translation: “you were fat before and obviously unhealthy and unfit” etc.
Monday, December 12, 2011
No talk of food insecurity, abuse, depression, stress, time-pressures, addiction, genes, incretins, adipokines, hypothalamic pathways, adipostats, mitochondrial inflexibility, medications, or any of the other countless ’scientific’ intricacies that may indeed result in the ’symptoms’ of overeating or undermoving.
Of wow. You go through this whole rigamarole, and then you casually say that you think it all comes down to “overeating or undermoving.” (It’s just that fat people have complex reasons for being lazy gluttens! It’s not all their fault, poor dears!)
Can you cite studies that support the idea that people with higher BMIs consistently eat more and move less than smaller people? Because if they exist, I haven’t seen them.
Monday, December 12, 2011
@ DeeLeigh: well spotted! Indeed, the data on overeating and undermoving are indeed pretty sketchy (see previous posts on this e.g. https://www.drsharma.ca/inactivity-does-not-explain-canadas-obesity-epidemic.html)
Monday, December 12, 2011
This is the twenty-first century we have changed from calling mentally retarted to mentally handicapped and insane or crazy to mental health consumer. Now, if we could get the obose (between the ears media people like Rex Murphy) to a word other than obese or over weight it would be grnad–because when obese and over weight goes out of style then so will the mindset of ‘move more eat less’. Til then we will have to put up with the media fat heads. Very good post.
Monday, December 12, 2011
A well-articulated post! It’s just too bad that few MDs are likely to be visiting your site and even fewer will be impacted by your valuable perspective.
Tuesday, December 13, 2011
Recently I went to pick up a friend of mine at a restaurant. For some reason he said ( I was wearing 2 sets of pants because it was cold outside) he said , LOOK at you, you are so fat, stop eating, you are killing yourself. I started crying. We’re just telling you this because WE LOVE YOU ! My boyfriend chimed in.. (Really in the middle of a bunch of strangers in a restaurant?)
Tuesday, December 13, 2011
I’m unhappy about getting a weight-loss diet from a hospital based doctor recommended dietitian that did not lead to my losing weight.
After months of no weight loss, I cut down food to way below what she said was “necessary for health”, I lost weight, and I got an excellent report at my next physical exam with my family doctor. My “inadequate” diet was just fine. A couple of years later, my maintenance diet now is less than what she said I “needed” to eat while trying to lose weight.
The dietitian was obviously misinformed on what an effective weight loss diet is.
She was like a surgeon who didn’t want to use a scalpel.
If I had kept with her plan I’d still be looking for all sorts of other reasons why I couldn’t lose weight – my doctor and I would be going through that whole list of problems you mention, with utter futility.
I’d add another cause of failure to lose or control weight:
iatrogenic overweight – caused or worsened by inadequate medical treatment itself (no matter how well intentioned)
Tuesday, December 13, 2011
What a great post. I see my patients getting discriminated against every day because of their weight. It really highlights the lack of understanding of this problem not only by the public but even by physicians as well.