A recent article in the National Post about obesity tried to inform about some of the causes and contributors to obesity and goals of weight management, with some discussion of the stigma that surrounds obesity. While some of the comments posted by members of the public in response to this article were supportive, others were completely horrifying, such as:
“It never ceases to amaze me how people do not take responsibility for their own obesity. It’s about self discipline and obeying nutritional rules. Obesity is not a disease and neither is gluttony… it’s a daily choice.”
“No disease makes you ingest food. You ONLY gain weight and get fat from too much food. It all comes down to calorie intake and not enough exercise. No med, no chemical imbalances do this.”
“If people ate vegetables and meat and natural, homemade everything, with limited sugar, they would not get fat. Anyone who does not realize this is stupid, and in all likelihood, fat.”
These comments highlight some key issues around obesity that need to be made crystal clear:
1. Obesity IS a chronic disease. Who says so? How about the World Health Organization, the Canadian Medical Association, and the American Medical Association, to name a few. A chronic disease is defined as a medical condition that is persistent or otherwise long lasting in its effects, and that cannot be prevented by vaccines or cured by medication. Obesity should be treated as any other chronic medical condition, such as diabetes, arthritis, or heart disease.
2. There is a profound stigma that surrounds obesity. There are widespread, negative stereotypes out there that people with obesity must be lazy, unmotivated, and lacking in self discipline. People with obesity face this stigma not only from the public, but also within their workplace, and from friends and family. Sadly, this stigma is actually worse amongst health care professionals than in the general public.
Why is there so much stigma? I think a lot of it comes down to a total lack of understanding that obesity is NOT a lifestyle choice, but has a long list of complex pathophysiologic mechanisms that contribute to the disease, with that list being unique to each person. Contrary to the second comment quote above, medications can cause obesity (from steroids to some antidepressants, anti-seizure, and antipsychotic medications just to name a few), as can a host of ‘chemical imbalances’ contribute, from depression, to a lower production of satiety (fullness) hormones, to many, many others. Not to mention that there are over 100 genes so far identified that contribute to obesity – so there alone you have 100 reasons why one person’s ‘best weight’ can be very different from that of another.
3. We need to help people with obesity feel accepted, welcomed, and make it easier to access care. The stigma that surrounds obesity can make it feel nerve-wracking to approach your doctor for help. Here are some questions you can ask to start the conversation with your doctor:
- Do you believe that obesity is a chronic disease?
- Are you willing to work with me to treat my obesity as a chronic and complex medical condition? If not, can you recommend someone who might be better suited to help me with this?
- Can you help me to set personal goals for weight management? (this may be stopping further weight gain, or losing 5-10% of body weight to optimize health)
Disclaimer: I have received financial support from Novo Nordisk Canada to develop this blog post. Novo Nordisk has not influenced the content or the promotion of this site and is not responsible for its content.
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