Obesity, Health, and Respect for Human Diversity

Respect for human diversity is a slippery goal. You might assume that public health policies advance that goal. But a new analysis from Ximena Ramos Salas and colleagues suggests that the opposite is true. Policies aimed at obesity can contribute to bias against people living with it.

Five Pervasive Themes

Ramos Salas found five problem themes in Canadian health policies on obesity. First is the theme of childhood obesity as an ominous threat. Dire warnings set up arguments for subtly blaming parents, especially mothers. Are they harming the health of their children?

Next is a false narrative that preventing obesity is simple. It requires only healthy eating and physical activity. Of course, the complex systems that promote obesity are not so simple to overcome. Forty years of failed efforts to stem its growing prevalence testify to that fact. But suggesting prevention is simple also suggests that people with obesity have somehow failed at a simple task.

The third narrative – obesity is an individual problem – magnifies the blame for people affected. As a result, many public health programs hammer away at the task of “educating” individuals to make better choices.

Aiming for an ideal, healthy body weight is the fourth theme. Ramos Salas points out that this divides the population into two classes. People with a healthy weight are good and fit members of a preferred class. An unhealthy weight defines the class of others. They need work. It’s not hard to see how this framework can promote bias.

Finally, the narrative of obesity as a risk factor – not a real disease – can also serve to promote bias.  It eases the way for describing people with obesity as making poor choices and effectively putting themselves at risk. The pathophysiology of obesity is not nearly so simple.

The Word That Must Not Be Said

Because of weight bias, obesity is even more difficult to address. And as we have noted here, weight bias itself is perhaps the biggest barrier to better health for people living with obesity.

In the extreme, it gets in the way of rational dialogue. Serving to illustrate this point, Jennifer Brady and Natalie Beausoleil offer a passionate commentary. They write about their adamant opposition to a medical concept of obesity. They see “complicity” and a “neoliberal, healthist” agenda to “eradicate fat people.” That word – obesity – seems to offend these authors.

Has the concept of obesity become so burdened with bias and stigma that respectful give and take is impossible? We hope not. But everyone with an interest in this subject should ask themselves. Am I contributing to the problem?

Click here for the analysis by Ramos Salas et al. Here you will find the commentary by Brady and Beausoleil. The response from Ramos Salas is here.

Diversity, photograph © Johannes Ortner / flickr

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January 29, 2018