Surveillance without Caring for Obesity

Surveillance for obesity keeps popping up in the news this week. Caring for obesity? Not so much.

The starting point was a study and commentary in Pediatrics that identified a potential problem with guidelines for universal BMI screening for childhood obesity. The problem is that once children are screened and labeled with the diagnosis of obesity, the customary brief follow-up appears to be unhelpful.

In the New York Times, Bioethicist Elizibeth Yuko describes her experiences with strangers commenting on her size and assuming she’s pregnant. It’s all very pleasant until the random stranger learns there’s no pregnancy. “OK, honey. But really, a woman of your size shouldn’t be wearing those high-waisted dresses.”

In Social Science and Medicine, researchers describe the experiences of women with obesity seeking reproductive healthcare. One patient’s physician refused to remove an IUD, telling her it would be a “disaster” if she became pregnant. Another reported hearing this advice from a specialist:

Gals your size, OK, mortality rates are higher. So I go ahead and intervene, help you get pregnant here. Then you go down to (a birthing ward). And then, boom! Pulmonary embolism.

In yet another new study, researchers found that weight-based stigma and shame predict childhood distress more than a high BMI itself does. Lead author Jaana Juvonen explained:

The widespread misconception is that anyone who is heavy is likely to feel distressed because of their weight. Yet our findings suggest that demeaning peer responses to weight is the primary social factor underlying these emotional problems. In other words, heavy weight by itself is not causing emotional problems. Weight-related peer mistreatment does.

The common thread here is that surveillance can do great harm in the absence of appropriate care. In a classic essay on the theory and ethics of health screening, David Mant and Godfrey Fowler offer advice on the prerequisites for ethical screening. Access to effective treatment and assurance for the quality of the test and follow-up care are essential.

Vigilant surveillance of obesity does more harm than good unless it comes with genuine, effective care.

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September 17, 2016

8 Responses to “Surveillance without Caring for Obesity”

September 17, 2016 at 8:56 am, Allen Browne said:

Ted, you are hurting me. This is so true. Going home from a breakthrough meeting on advanced therapies for children with obesity at University of Minnesota. Exciting work and information, but almost all “off label”. More work to do.
- September 17, 2016 at 10:05 am, Ted said:
  
  Thanks, Allen, for plugging away at this.
September 17, 2016 at 8:57 am, M Whigham said:

Reminds me of the research in education. Basically, children live up to their labels. Give a child grades of “C” in the third grade and they will be more likely to be a C student in high school. In our community, grades are not given until middle school – certainly an educationally sound practice. Call a child naughty and they live up to the label. Not my area, but label them as obese and ????.
We do know how important compliments are. Compliment your daughter more for looks than intelligence – not a good idea. We tend to become our labels.
- September 17, 2016 at 10:04 am, Ted said:
  
  Well said. Thank you!
September 17, 2016 at 12:55 pm, Nik Dhurandhar said:

Repeated publications about obesity prevalence have a purpose to an extent, but after that they have diminishing returns. Many a times, it appears to follow the following assumptions:

1) We identified who has obesity
2) Furthermore, we also scared you with bad health effects of health
3) Now that you know the above two facts, all you need to do is lose weight ( which you would not have known had we not pointed it out repeadly. )

Diagnosis does not equal to treatment and certainly not cure. Especially, for chronic diseases. Need for all of us to think things through.
September 17, 2016 at 5:03 pm, MaryJo said:

Even if the initial screening is well-done and the assessment and diagnosis accurate, if access to genuine, effective care is lacking and appropriate treatment with proper follow-up is not given, in my opinion, this is grounds for negligence malpractice.
September 18, 2016 at 1:50 pm, allen browne said:

I agree with Mary Jo. It is wrong to identify/acknowledge a problem and not help.
- September 19, 2016 at 5:06 am, Ted said:
  
  Amen.