Accepting Obesity Shouldn't Stop Us From Warning of Its Dangers

 Hi, I'm Art Caplan. I'm at the Division of Medical Ethics at New York University Grossman School of Medicine.

I'm going to enter into a topic that is really fraught with emotions, strong feelings, and worries, which is the topic of obesity. I decided to talk to you about this because I was watching the Emmy Awards on TV and I noticed two things.

One, the singer Lizzo came on — for those of you who don't know, she's an African American woman who's overweight — and she said, "What I want to see on the Emmys is people who are fat like me and Black like me." She performs with a group called The Big Girls, and they won an Emmy at the 74th Awards for their talent. She's a great singer, but heavy to the point where it's clear that there is obesity.

I think everybody knows that the price of obesity in America is huge — but sometimes we forget — due to diabetes, knee replacements, cancer, and many other diseases that follow in the wake of obesity. The cost estimate for the US due to overweight/obesity is $2 trillion per year added to our bill because of preventable disease due to overweight. People who are way overweight are costing much more in terms of their medical costs than are people who are not.

There's been much attention to this subject, too. Recently, the WHO came out and one of their leaders said that you have to listen to people with obesity and their families, but we have to treat obesity as a disease. It clearly is a chronic disease. It takes a terrible toll on people throughout their lifespan. We have to find ways to try and address it. We can't just pretend that it isn't the source of disability, death, and huge medical costs for individuals out there who are obese.

What's the controversy? It's how do we get into this subject and how do you address it with someone who's overweight? It's pretty clear that just shaming people and saying, "You should be ashamed of yourself, you're too fat," isn't necessarily going to be the road to getting people to lose weight.

There are many other people, like Lizzo, who say, "Look, I need some acceptance. I don't want to just be seen as someone who's got a chronic medical disease. I can sing, I can dance, and I'm talented. I don't want people to reject me." Lord only knows that Hollywood and the media have spent plenty of time fat shaming individuals when they gain weight or are overweight or obese.

This is one of the toughest topics I can think of, trying to walk the fine line between saying we accept difference — we accept cultural difference and what's viewed as beauty in size and shape. It's not one-size-fits-everybody. We also want to not be blaming, finger pointing, and condemning as a strategy to deal with obesity.

But we, on the other hand, can't just say that obesity is normal and something that is an individual lifestyle choice because it's going to harm you. Medicine, in particular, has to speak up and say that there are going to be consequences if you are morbidly obese or very heavy with high risk. You're going to wind up with many medical problems. Society has an interest in not having that happen because of the huge costs associated with those medical problems.

I think everybody needs to be thinking hard when they have patients and when they're talking to groups about raising the fact that obesity is a healthcare problem — it is a disease — but there are many people with diseases that we don't just see as diseases.

They are people who have other skills. They have other things they're doing in life. We can recognize that, praise that, and admire that. Shaming is not the route. I don't think there's any evidence that that does much good in trying to get people to change lifestyle or accept a treatment plan or surgery for obesity.

It's important to figure out a way to get into the topic, saying, "I discuss this with all my patients. Weight is part of a good, healthy lifestyle just like wearing a seatbelt, getting your vaccinations, and doing other things that are health-promoting." Be gentle and sympathetic while discussing the topic.

One of the things I get asked sometimes is, "Aren't there many physicians who are overweight?" I'm struggling with weight myself, and I think the way to broach that topic is to say I know about it, and we're in it together. I've seen it in my family or in my personal life. It's tough. It's hard. Over time, we want to do something about it. We don't just want to have negative health consequences.

At the same time, it doesn't mean that's the only thing that one focuses on about a person who's heavy any more than it's the only thing that one focuses on for someone who is in a wheelchair or who has a child. There are many traits, abilities, capacities, and skills that everyone has.

Lizzo, in a sense, is right. Why shouldn't she see people who look like her up on stage winning major awards? At the same time, everybody needs to understand that obesity is something that we have to get a grip on. Childhood obesity is exploding around the world, especially in the US. Adult obesity continues to take a terrible toll on disability and death.

We have to admit that it's not something that we want to ignore but it's not something that we want to make the be-all and end-all of anybody's life.

https://www.medscape.com/viewarticle/980883