Nicolas Argy, MD, JD
I recently attended a national conference on eating disorders, held at a prestigious university, sponsored by the school of public health.
What I witnessed left me speechless and dumbfounded by the utter disregard for science, public health and patient welfare by one speaker who was as fanatical as she was wrong in denying adiposity as a health problem. There is a price to pay in a society where political correctness trumps sanity. When efforts to avoid hurt feelings and when completely fringe opinions bereft of any basis in fact are legitimized, we are on a path to self-destruction. Yes there are winners and losers. Yes there are wrong, silly and unfounded opinions which should not be respected when they deny reality or promote untruths.
The first set of speakers described research on the adverse health effects of recognizing and notifying patients of excess adiposity presumably due to the stigma, bias and prejudice to which the overweight population is subjected. The adverse effects included depression and possible worsening of eating disorders
One speaker stated the following
"Informing a teen of their weight status during a clinic visit decreases positive affect, increases negative affect and body dissatisfaction."
While being sensitive to how the message is delivered is crucial to minimize stigma, bias and poor body image, the adverse effects of not identifying an eating, exercise/activity and weight problem has even greater potential for long-term and short term adverse health effects
The conference was punctuated by one speaker who denied that being obese had adverse health effects and consistently repeated the statement “show me the data”
Based on thirty years of practicing clinical medicine and being involved in public health, I spoke with expert colleagues and reviewed the consensus statements of every major national, international and specialty group who confirmed overwhelming data showing the devastating impact of adiposity including increased mortality and untold suffering.
Social activism to accept adiposity, if it denies the science of the deleterious effects of obesity including
· premature death,
· abnormal lipid profiles
· sleep apnea,
· metabolic syndrome and
· nonalcoholic fatty infiltration of the liver
does a great disservice to public health and every individual who can make efforts to lower their risk profile.
While the problem is complex and multifactorial requiring multidisciplinary approaches to address; denying the problem is shear lunacy. The speaker went on to say that those who have diabetes should not be counseled to lose weight but should rather be treated with drugs! This recommendation is not only against the weight of scientific evidence but puts the patient at greater risk from all the adverse health effects of the drugs. Medical errors and drugs side effects including the thousands who have hypoglycemia due to drugs are put at increasing risk by this terrible advice.
There is no doubt that unwarranted discrimination, bias and prejudice should be eliminated. At the same time when someone cannot fit in one seat on public transportation why should the innocent people sitting next to them be villainized if they express their discomfort? In those rare cases where adiposity makes it impossible for a person to perform their job or perform it safely, then they should not be considered for the position (the military and police forces frequently enforce weight restrictions on their personnel) While the limits can be based on functional status and outcome this often directly correlates with weight.
The depression and stigma associated with many medical conditions is unfortunate and increased rates of depression, anxiety and stress are seen with the diagnosis of cancer (as well as many other serious conditions). This does not mean we do not share that information with patients. There are consequences, sometimes adverse, from learning that we have certain health conditions but we do not deny autonomy and pertinent information for making healthy decisions paternalistically due the possibility of hurt feelings, anxiety or depression… we as providers give the diagnostic information and then discuss the treatment options and interventions to address the underlying primary condition and provide tools and resources necessary to address secondary effects of possible depression and anxiety associated with learning the diagnosis
Using social stigma can be a powerful tool to encourage salutary activities such as quitting smoking. Public health officials have historically used stigmatizing as a strategy to minimize deleterious behaviors such as smoking , and other addictive behaviors. We as a society should promote salutary behaviors, staying physically active, eating a healthy diet and yes also maintaining our weights at a healthy range.
Denying a problem has never made it go away and to deny legitimate science, endorse fake science or recommend dangerous therapies when prevention remains our most powerful tool is foolhardy. Putting on blinders to the enormous problem posed by adiposity in our society is ill conceived and unfortunate. It denies the science that is so obviously true.
We should use all our tools to fight obesity both in terms of staying active, eating whole unprocessed foods and look at taxing foods engineered to be addictive with low nutritional value. It is time that the food industry which spends millions to create addictive highly processed food of little nutritional value be taxed heavily and those revenues used to subsidize other healthy alternatives like fresh fruits and vegetables.
Embracing being obese is not the solution, no more than embracing smoking or drinking to excess. We need a rationale compassionate not stigmatizing but honest approach to both identifying and treating adiposity
Being overweight is not a moral failing and should not be stigmatized. Ignoring adiposity though does us a great disservice as well. I hope with the help of my clinicians, family friends and colleagues that I can get back to a healthy weight having struggled with being overweight/obese my entire life.
I am always thrilled when friends say, “Nick you look great”, when I do successfully lose weight but I also deeply appreciate kind friends who ask what happened because I looked happier and healthier when I was thinner; both statements being true.
Let’s stop being politically correct to the point that we deny reality and jeopardize public welfare giving dangerous advice. The time has come to reject political correctness and safe zones. The time has come to face realities which while not ideal, offer us the opportunity to improve as individuals and as a society.
Please email me for copy of full set of references on adiposity
Nicolas Argy MD, JD copyright 2018