What a Word Like “Elephant” Reveals

A good friend pointed us to a recent commentary that carries the title of “The Elephant in the (Class) Room: Campus Obesity.” The choice of words got our attention and lurking below the surface were a number of issues: weight bias, false assumptions about obesity, and problems with peer review are at the top of the list.

The commentary, published in the Journal of Community Medicine and Health Education, laments resistance to screening university students for a high BMI and proposes that such resistance “compounds this national health crisis.” In making his case, James DeBoy compares obesity to domestic violence, date rape, DUI, sports concussions, hazing, and plagiarism. They are all, he suggests, conditions that can derail an academic career. So he believes that a university should intervene in obesity as it does in those other situations.

No doubt this man is sincere, but he is sincerely wrong in comparing obesity to date rape. That comparison just doesn’t work. He was also sincerely wrong as the leading advocate for Lincoln University’s requirement that students with a BMI over 30 lose weight or pass a special course called “Fitness for Life” before they could graduate.

After attracting international attention in 2009, this requirement was eliminated amid concerns from faculty that “the school is becoming the laughingstock of the whole world.” At the time this controversy erupted with DeBoy at the center of it, he was chairman of Lincoln’s Department of Health, Physical Education, and Recreation department. Today, he is a professor in the university’s Department of Nursing and Health Science.

False assumptions make this kind of thinking possible. One is the assumption that students with a high BMI are unaware of their weight. Another assumption is that a short course in healthy living will cure their obesity.

The use of the elephant metaphor points to another problem: the quality of peer review that allowed this insulting language to slip through. Professor David Allison, a strong advocate for high standards in peer review, offers a thoughtful explanation:

The author addresses an important question and should be commended for trying to thoughtfully consider the sometimes seemingly competing goals of acting to promote obesity reduction and physical health while at the same time promoting respect and self-esteem for all persons, regardless of size. The author wisely notes “Let us be clear: the assault must be directed upon the condition obesity, not the person with obesity,” yet the article’s title sadly betrays this sensitivity.

The title’s “Elephant” reference is a flippant, pejorative, and gratuitous turn of phrase. We would not accept similarly flippant, pejorative, and gratuitous language in an article describing students with problems around suicidality, schizophrenia, needs for wheelchairs, and so forth, and the journal editors abrogated their responsibility by letting this inappropriate title past peer review.

Such a problem with peer review in this journal is unsurprising when one considers the reputation of the publisher, the Omics Group, as a “predatory publisher” of journals which the U.S. Department of Health and Human Services asked in 2013 to cease and desist from using the names of its institutes (e.g. NIH, NLM) and employees. In the realm of obesity, one of the Omics Group journals uses a logo that is a cartoon depiction of obesity with a hamburger (shown on the right).

So the use of an elephant as a metaphor for obesity in college students reveals a lot of problems with the publication in which it appears.

Click here to read the commentary, here to read about the 2009 controversy at Lincoln University, and here to read more about the problems with Omics Group journals.

Elephants, photograph © Patrick Bouquet / flickr

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September 28, 2015