Obesity Medicine: Time for a Paradigm Shift?

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Overweight and obese individuals often experience hostility in public as well as from the medical community.
Overweight and obese individuals often experience hostility in public as well as from the medical community.

I am often struck by the strong bias from the medical community against people with obesity. I've seen it up close as someone who has struggled with weight control for most of my life. A recent article published in the Huffington Post about this issue caught the attention of my long-time medical director, who then shared it with the medical staff where I practice. Reading this story struck a nerve as it evoked a lifetime of not-so-good memories of my own.

The piece, titled “Everything You Know About Obesity Is Wrong,” points out the folly of our failed medical efforts to address weight, size, and obesity. As the author writes, “I have never written a story where so many of my sources cried during interviews, where they shook with anger describing their interactions with doctors and strangers and their own families.” As a profession, we've responded to obesity almost entirely incorrectly, blaming big people for being big and convincing our patients that obesity is a personal shortcoming. The author notes that in doing so, we've created a society where almost half of 3- to 6-year-old girls already have concerns about their weight.

One of the points of the piece that captivated me and my colleagues was the author's assertion that overwhelming medical evidence has been ignored for decades by us in the medical community. The 2 key pieces of strong and consistently ignored evidence are as follows: 1) diets don't work, and 2) weight and health are not always linked.

The piece evoked a sadness in me that I rarely allow to surface. I've been ashamed of my body to some extent for as long as I can remember. Trips to the municipal swimming pool as a child led me to ambivalence about taking my shirt off while in the pool area.  If I did, I felt different from all the other kids, and if I didn't, I'd do everything I could to cover my torso with my arms, towels, or anything I could get my hands on. My parents were very kind people, but they didn't know how to support my struggle, other than to try bizarrely contradictory tactics. One year it was, “First boy awake gets a candy bar!” The next year it was, “If on your birthday you are over X pounds, then you'll need to skip lunches and drink Metrocal.” For those too young to know, this was an unappetizing 1960s diet shake, and I recall tossing a can of it into the trash during school lunch. I might as well have worn a flashing sign saying, “I'm fat!” I know my parents felt bad, and they soon stopped with the public-shaming Metrocal plan.

My interactions with the medical world have also been occasionally painful. As the Huffington Post article described, people with weight problems feel shamed by numerous events in the medical process. For me, a recent moment of embarrassment occurred while reading the report of my knee radiograph, which began “…a XX-year-old obese male…” Another moment in the medical process that I have come to completely avoid is the weigh-in at the front end of medical appointments. I dreaded getting on the scale only to hear the medical assistant announce my weight, sometimes with a sound of surprise, in an area with numerous other patients and staff within earshot. Now I decline having my vitals measured, which usually prompts confusion and resistance from the medical assistant charged with weighing me. I just smile and say, “Just put in the chart that the patient declined. It'll be OK.”

Overweight people face hostility in public as well as in medicine. I can recall a few years ago pulling my car up next to an exit door of a local supermarket to load some heavy groceries. I wasn't blocking anyone or anything, yet a woman pulled up next to my car, rolled down her window, and spat out, “Why don't you lose some weight?” I'm sure these stories aren't unfamiliar to many readers who have faced similar situations.  

In the end, humiliation and embarrassment as well as denigrating remarks drive overweight patients away from medical care. I know that there have been times when I've almost avoided making a necessary appointment because of anxiety about the weigh-in and the dread of the poundage announcement. Data cited in the Huffington Post article show that higher-weight patients are more likely to avoid medical care: “Three separate studies have found that fat women are more likely to die from breast and cervical cancers than non-fat women, a result partially attributed to their reluctance to see doctors and get screenings.”

A quote in the article by a counselor who specializes in obesity brings to light the sadness and futility that many of our higher-weight patients (and colleagues) face: “A lot of my job is helping people heal from the trauma of interacting with the medical system,” says Ginette Lenham, a counselor who specializes in obesity. “The rest of it,” she says, “is helping them heal from the trauma of interacting with everyone else.”

Reference

Hobbes M. Everything you know about obesity is wrong. Huffington Post website. https://highline.huffingtonpost.com/articles/en/everything-you-know-about-obesity-is-wrong/. Published September 19, 2018. Accessed December 3, 2018.

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