Shame for Having Obesity, Shame for Reversing It

A new research letter in JAMA Surgery spells it out. After facing bias and stigma for having obesity, people who seek out the most effective treatment available – bariatric surgery – face public scorn for it. Patrick Dolan and colleagues found that 39 percent of American adults believe that bariatric surgery is “an easy way out.”

It’s a story of shame for having obesity. And then shame for doing something about it.

A Speck of Good News

However, you’ll find a tiny bit of good news buried in this research. As a matter of fact, fully 92 percent of respondents believe health insurance should cover medical procedures to help people lose weight.

On top of that, women were especially likely to believe that insurance should cover weight management. Also, women were less likely to see surgery as “an easy way out.” 

The Gap of Ignorance and Bias

So it seems that people understand obesity is a health problem. They even believe health insurance should cover medical procedures to help with it. But they simply don’t understand what it takes to provide real medical help.

You’ll find this ignorance even in most primary care providers. The form on the right is what passes for “counseling” about a healthy weight. A provider typically hands it to a patient on the way out of a “preventive care” visit.

The impact of such brief interventions has been well-studied. It’s zero. No effect. It’s not helpful.

But the popular thinking holds that all you need to overcome obesity is healthy eating and an active lifestyle. Follow that nostrum and you’ll have no problem. Have a problem? You’re not following the golden path. Obviously.

So this is why so many people assume that bariatric surgery is “an easy way out.” Thus it often takes a lot of courage and determination to run the gauntlet and get the surgery that many people need in order to overcome obesity. But the fact remains that it’s the best, most effective tool we’ve got.

Dolan concludes regretfully and correctly:

There is no simple way to fix this problem, and it may take years of public and physician education regarding the health benefits of weight loss surgery to improve its perception and increase its utilization.

Click here for the study and here for more from JAMA. For additional reporting, click here.

Shame, etching by Max Klinger / WikiArt

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December 14, 2018

2 Responses to “Shame for Having Obesity, Shame for Reversing It”

  1. December 14, 2018 at 8:55 am, Michelle Cardel said:

    Interesting that the form on the right indicates a BMI of 23 or less as “underweight.” Generally, we consider a BMI below 18.5 to be underweight. Regardless, their “counselling” suggestions on the form will be of no help to patients struggling with their weight.

  2. December 14, 2018 at 11:06 am, Allen Browne said:

    I disagree with Dr. Dolan. People and health care providers do recognize the health consequences. They do not understand the physiology of the disease of obesity. Bariatric surgery is the strongest, most reliable changer of the abnormal physiology of the disease. As we understand the disease better, we will develop more strong, reliable changers of the physiology and be able to determine which tool for which person. The future is coming.