The Fear of Medicalizing Obesity
The fear of “medicalizing obesity” repeatedly surfaces in writing about obesity and never fails to impress. It surfaces in discussions with health plans worried about about “opening the floodgates” to evidence-based access to care for obesity. It surfaces even in scholarly publications.
The latest example is a remarkably naive publication in health: an interdisciplinary journal. In a paper that contains surprising factual errors, Selena Ortiz and colleagues propose that surgical obesity treatment is “diverting attention away from the ultimate drivers” of obesity and “generating disparities” by improving the health of some, but not all people with obesity.
Though the authors write about the “drivers of obesity,” they give no hint of understanding the biological basis for the condition they are discussing. The “fundamental drivers” that they specify are socioeconomic inequality, low educational attainment, residential segregation, and “producers of the obesity epidemic (e.g. the food, marketing and advertising, and automobile industries).”
Commenting on this publication, Harvard obesity medicine physician Fatima Cody Stanford said:
I was surprised to find a publication in a scholarly health journal that is so completely free of objective facts about the condition being considered. To suggest that treating obesity might “create health disparities” is simply irresponsible. Likewise, Dr. Ortiz writes about addressing the “root causes” of obesity without acknowledging that the root causes of obesity have yet to be fully determined.
Ortiz seems to fear an imagined epidemic of obesity surgery. She claims that “bariatric surgery is expanding exponentially.” In fact, the number of procedures plateaued in 2010 and have grown only slightly since then. While advancing these false claims, she expresses little concern about the very real consequences of untreated obesity for substantial and growing numbers of people who are severely affected.
Perhaps the most offensive suggestion in the Ortiz paper is the suggestion that providing access to evidence-based obesity care is like parking an “ambulance at the bottom of the cliff.” Obesity is not a simple problem like falling off a cliff. It has neither simple causes nor simple solutions. Providing care to individuals is not a threat to population health. Both strategies are essential. Both strategies must be grounded in good evidence for real benefits.
Obesity causes profound harm to the people who are living with it. Encountering ignorance and indifference about this human suffering never ceases to be shocking.
Click here for the paper by Ortiz et al.
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August 23, 2016