A number of academics and researchers have come together to advise that obesity should be recognised as complex, progressive, chronic, multifactorial disease. It is a disease for which there is no effective treatment other than strategies that could make it worse, such as changes to diet and lifestyle. All the names one gives obesity – “disease”, “weakness”, “moral failure” etc, cause stigma, and stigma makes the problem worse. Because of this, it is proposed by some people that the word “obesity” should be banned and fatness should be celebrated.
At the moment, whatever you feel about it, the word “obesity” simply refers to an arbitrary and often inaccurate measure of the amount of fat on a human body. There is a certain level of fatness that is associated with better health, but not in everyone. I get that. Thin may also mean sick. Unexercised also means sick and smoking also means sick. But not in all.
There are levels of fatness which – with or without stigma – are associated with poor health. And it for this reason that I am conflicted. Because, removing the effects of stigma will not remove the effects of obesity.
There is an inconvenient truth that the fatter a person is, the more they are at risk of diabetes, some endocrinal cancers, inflammation, cognitive impairment, liver disease. There is a lie at the heart of ‘Health At Every Size’. Yes, I do know that stigma increases the health effects of a fatter body. And the more I list the effects of obesity, the more defensive I feel.
It was proposed by my erstwhile colleagues that we can reduce stigma by calling obesity a metabolic disease rather than a moral issue. But how are these academics planning to create this change in the short-term, when most people in the community really don’t share this definition of obesity and would prefer not to live in a larger body? I think that it is important to throw off the shackles of stigma and celebrate any human shape, but, despite the body-positive movement, we aren’t there yet. Children asked to say what they most worry about STILL put weight gain near the top of their list. We are also still getting fat stigma in micro-doses everywhere.
Last month for example, I went to see Back To The Future. I couldn’t help but notice that the villain was fat, the hero was slim and the love interest was not plus size. Even if “disease labelling” makes health professionals take treatment more seriously, I am uncertain whether feeling diseased will help anyone feel happier or more at peace with themselves.
As an obesity trainer, I have pondered how to help health professionals manage the overweight client without bringing stigma into the room and without agreeing or disagreeing about whether a person “needs” to lose weight. I think that we need to respect the client, while also doing a proper assessment to understand their motives and outcomes and to make sure that nothing else is wrong. If they are overweight because they have a seriously disturbed relationship with food, this needs to be dealt with first and there is no quick-fix for a longstanding eating disorder.
It has been argued that eating disorder professionals shouldn’t touch the client wishing to lose weight, because weight-loss efforts are associated with compulsive eating. This frankly is simply an opinion I disagree with. The eating disorder specialist is schooled in neuroscience, nutrition, physiology, and psychology. With this knowledge we know enough to do a holistic assessment of the person wanting weight loss. A relationship with food is by nature complex; and it evolves in the crucible of the client’s life events and relationships. By getting the client’s story, their health, the history of their weight loss efforts, their lifestyle and aspirations, we are better able to guide him or her on what to do next.
The latest thinking on weight-loss therapy does not involve dieting, deprivation or going to the gym. But here I end my blog because, that is another story for another time.