Still Getting Ready to Rethink Obesity

The big JAMA obesity issue came out this week with a promising theme: “Reimagining Obesity in 2018.” It was full of good new data on bariatric surgery. But it was a little short on imagination. At JAMA, judging by the content of this special issue, they’re still not quite ready to rethink obesity.

Count Calories, Tax Sugar, and Go for Surgery

It’s been six years since the last JAMA theme issue on obesity. But looking at the content of the new issue, one would never know that the field of obesity medicine has flourished since then. Obesity medicine is among the fastest growing medical specialties. New fellowships in obesity medicine are emerging. And the medical options for treating obesity are multiplying.

JAMA has published many research findings that advanced obesity medicine in the last six years. But in this issue, you won’t find any substantive mention. Scan the content and you might think that an imaginative approach to obesity consists of counting calories, taxing sugar, and going for surgery if all else fails.

Acknowledging Stigma

If there’s any bright spot, it would be that at least the new issue notes that weight bias is a problem to address. In 2012, JAMA made no mention of bias and stigma. At least in the new issue, Mary Burke and Frank Heiland mention the subject.

Unfortunately, it comes in a viewpoint that frets about “normalizing” obesity. “Paradoxically,” they say, reducing weight stigma might actually yield benefits. (Imagine that!) But they go on to suggest harnessing peer pressure to promote healthy behaviors. We have doubts. Shaming seems to come along for the ride whenever peer pressure comes into play.

Ironically, throughout this issue, JAMA continues using disrespectful language about “obese people,” rather than the more respectful people-first language that AMA calls for.

Perhaps in another six years, JAMA will be ready to bring imagination and fresh thinking to the subject of obesity. This issue is quite interesting. But it falls short of reimagining obesity.

Click here for Edward Livingston’s overview of the new theme issue and here for contents of the issue. For some fresh thinking on obesity medicine, we suggest this impressive issue of Medical Clinics of North America, edited by Scott Kahan and Robert Kushner.

Getting Ready to Fly, photograph © Scott Macpherson / flickr

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January 20, 2018