How Obesity Hides in Plain Sight

The failure to acknowledge obesity is so common in so many situations that it leads people to observe that obesity hides in plain sight. That was the conclusion of Kirsten Mueller and colleagues from the Mayo Clinic who assessed the accuracy of self-reports about weight status from a series of 508 internal medicine outpatients. Only 20% of people with obesity correctly assessed their status in that series.

Do People Recognize Their Health Risks?We took a broader look at the recognition of obesity in a representative sample of U.S. adults, asking three separate groups of respondents if they believe they might have obesity, hypertension, or weigh more than what is good for their health. We compared the rate of self-reports for each of these conditions to CDC estimates. In comparison to the known prevalence for obesity, only 61% acknowledged that they might have obesity. The number that recognized the possibility of excess weight being a problem was higher, 71%. And strikingly, the number for hypertension — a diagnosis with no visible signs — was the highest at 87%.

We shake our heads when we hear otherwise thoughtful people respond to such observations and suggest that this problem must be attacked head on by driving greater awareness of the dangers of obesity. It’s a natural response, but it’s quite naturally wrong, in our estimation.

Our culture has no shortage of reminders when body mass index strays outside of norms. Even the most casual reading of the literature on weight stigma provides abundant clarity that people with a high BMI are aware that they have a problem. Part of the problem is that the condition of obesity is so highly stigmatized that people will go to great lengths to avoid being described as having that condition.

The real problem is the pervasive, false assumption that obesity is a voluntary and reversible condition. Folks who study this disease and folks who provide evidence-based obesity care know better. It’s a chronic disease that can be managed, but not easily cured.

Perhaps these distinctions explain why hypertension is so much more readily acknowledged. It carries no comparable stigma. Treatment is straightforward and readily available. Insurance readily covers treatment. None of that is true for obesity.

If we want people to acknowledge and act upon the problem of obesity, we must act to wipe out stigma and improve access to evidence-based care. Improving the options for treatment will take more work, but that work is moving ahead in fits and starts.

Admonishing people to take obesity more seriously will have no effect until health policy reflects the seriousness that this complex, chronic disease requires.

Click here for the study by Mueller et al and here for more on the recognition of obesity in primary care. Click here for more on the pitfalls of obesity awareness campaigns.

Hidden, photograph © Nha Le Hoan / flickr

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


February 15, 2016