Hippocrates and the Dooley Hospital

Obesity Awareness: First Do No Harm

Could it be that obesity awareness campaigns amount to public health malpractice? It’s a question worth thinking about. A number of recent studies point to the likelihood that persuading someone that they are overweight can do more harm than good. The fine line between fat shaming and obesity awareness campaigns is just about impossible to see – if it even exists.

Wasted Worry About Recognizing Excess Weight

We see a familiar bias in researchers looking for the possibility that people with obesity aren’t worried enough about their weight. For example, this 2011 study examined attitudes and behaviors of people who misperceive their weight. The researchers define misperception as thinking one’s weight is “about right” when BMI falls in the range of overweight or obesity. The study showed that people who misperceived their weight were less likely to want to lose weight.

They found mixed results in health behaviors. Weight misperception did not predict that people would eat more. Nor was it a consistent predictor for physical activity. It only predicted how much people worry about their weight. Duh!

Health Outcomes Tell a Different Story

More recent data are focusing on health outcomes associated with weight misperception. They tell a very different story. In this study, youth with a high BMI who thought of themselves as being at about the right weight were less likely to have symptoms of depression 12 years later.

In this study, young women with a high BMI had significantly lower blood pressure if they thought of their weight as being about right.

And in yet another study this year, Kelley Borton and colleagues report that adolescents who think their weight is about right are less likely to gain weight or engage in a number of unhealthy behaviors.

A Subject Fraught with Bias

No doubt, this subject is fraught with bias. Weight is a highly charged subject. Folks who advocate for body positivity have strong opinions. But folks who worry about “weight misperception” have some equally strong feelings in the opposite direction.

Those latter feelings too often take the form of weight bias and surface from healthcare providers. Rachel Wacks, a graduate of the Boston University School of Public Health, describes her experiences:

The biggest assumption physicians – and others – make is that I’m not very bright, because smart people would not choose to be fat. I’m blamed for my fatness before the health screening even begins.

People should step back from assuming that weight misperception is an urgent problem. First do no harm. Public health and healthcare practitioners must start with respect for people of all sizes and shapes. Focus on health above all else.

Click here for more from the Harvard Public Health magazine.

Hippocrates and the Dooley Hospital, photograph © Taber Andrew Bain / flickr

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June 11, 2017