‘Fat shaming’ plays ugly role in medicine’s failing campaign to treat obesity

fatshame-300x230The medical establishment needs to take a hard, long look at its failing efforts to combat obesity and overweight, conditions that now affect just under 40 percent of American adults (93.3 million people) and 20 percent of youngsters (13.7 million) in the U.S.

That’s because doctors and medical scientists have “ignored mountains of evidence to wage a cruel and futile war on fat people, poisoning public perception and ruining millions of lives,” Michael Hobbes has reported in a long, strong story on the Huffington Post.

Hobbes has marshaled an array of available data to wag an unhappy finger at U.S. society, acting on conventional medical wisdom, for blaming and shaming those who are overweight or obese, contending that they lack self-control, discipline, and the personal fortitude to deal with what he says is clearly an uncontrolled medical and public health menace.

“Fat shaming,” including doctors’ stern but ineffective demands that patients simply eat less and exercise more, fails to address the wider and deeper dietary and nutritional mess that prevails, not only in America but also globally, Hobbes says. He notes that no nation on the planet has yet found a way to reduce among its people the growing health harms  — heart disease, cancers and others — caused by overweight and obesity.

Hobbes, who syas he never has worked on a story in which so many sources spent to much time in tears recounting their harsh and derogatory treatment, reported that doctors’ responses to the overweight and obese display a bias that would be unacceptable with any other group:

 Doctors have shorter appointments with fat patients and show less emotional rapport in the minutes they do have. Negative words— “non-compliant,” “overindulgent,” “weak willed”—pop up in their medical histories with higher frequency. In one study, researchers presented doctors with case histories of patients suffering from migraines. With everything else being equal, the doctors reported that the patients who were also classified as fat had a worse attitude and were less likely to follow their advice. And that’s when they see fat patients at all: In 2011, the Sun-Sentinel polled OB-GYNs in South Florida and discovered that 14 percent had barred all new patients weighing more than 200 pounds.

With the Huffington Post’s powerful visual display of his story, including positive photographs and the showing of hard numbers — including “.008 … chances of a woman classified as obese achieving a ‘normal’ weight — Hobbes wrote that doctors and researchers, after decades of work, know that:

[D]iets do not work. Not just paleo or Atkins or Weight Watchers or Goop, but all diets. Since 1959, research has shown that 95 to 98 percent of attempts to lose weight fail and that two-thirds of dieters gain back more than they lost. The reasons are biological and irreversible. As early as 1969, research showed that losing just 3 percent of your body weight resulted in a 17 percent slowdown in your metabolism—a body-wide starvation response that blasts you with hunger hormones and drops your internal temperature until you rise back to your highest weight. Keeping weight off means fighting your body’s energy-regulation system and battling hunger all day, every day, for the rest of your life.

Meantime, doctors lump overweight patients together with gross metrics to assess and to try to improve their health and well-being — without considering patients’ individual situations and how they might lose pounds. Caregivers can’t just look at weight or body mass index. Instead, Hobbes reported: “Habits, no matter your size, are what really matter. Dozens of indicators, from vegetable consumption to regular exercise to grip strength, provide a better snapshot of someone’s health than looking at her from across a room.”

He reported that research has found a common sense but counter-intuitive way for successful weight loss: It takes time and emphasizes positive rather than negative reinforcements in using an array of therapies with the overweight and obese — stigmatizing them less, and, golly, treating them with respect and dignity. It may best be done, not by doctors in the harried office time, but in formal, rigorous settings like specialized care facilities.

In my practice, I see the harms that patients suffer while seeking medical services, and the powerful argument for all of us to stay healthy and away from needing medical care, especially by not smoking, exercising, eating healthfully, and keeping control of alcohol consumption and our weight. Hobbes is right that shunning and shaming loved ones, friends, work mates, and even people on the street for their size is unacceptable prejudice.

Plenty of blame to share

While making the case about society’s shabby treatment of those with weight challenge, he may go light on bad actors who aren’t helping us all with weight and obesity. Big Sugar, Big Soda, Big Agriculture, and food processors deserve more criticism and regulation to reduce the many ways they harm not just the health of Americans but people around the planet. Their rise has coincided with the obesity explosion, rigorous research and fine journalistic digging has shown. They also have been abetted by industry friendly regulators and dubious “science.”

With the poor suffering disproportionately from diet and weight nightmares, it’s hard, for example to see that the U.S. Agriculture Department, one of the major supporters of national nutrition standards and programs, has top officials so determined to cozy up to rich, powerful interests in the industry they’re supposed to be our watchdogs over.

It’s also hard to understand why institutions like Cornell University allowed their academic standing and reputation to support a promoter of a popular but counter factual notion (as described by the Buzzfeed site) that, “simple environmental cues can help people lose weight and eat healthier, without the need for rigorous dieting and intense exercise.” That was a thesis of Cornell Prof. Brian Wansink, who, under pressure from watchdogs like the web site “Retraction Watch,” found his published studies come under fire.

JAMA publications, which had put out a half dozen of them, pulled them, meaning Wansink has seen 13 of his works retracted. Cornell investigated him for more than a year and found he “committed academic misconduct in his research and scholarship, including misreporting of research data, problematic statistical techniques, failure to properly document and preserve research results, and inappropriate authorship.” He since has resigned from the school. Will his widely popularized views, however, add to the toxic mess Hobbes’ described?

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