Is Awareness of Excess Weight a Problem?

Are we all sufficiently aware of our weight? Many answers might come to mind for such a broad question. Health professionals offer honest accounts of patients with severe obesity and no idea that it might have an effect on their health. Patients tell of health professionals who suggest all their symptoms are due to obesity – even with a gaping head wound. Awareness of excess weight envelopes us. But does it help?

A new systematic review and meta-analysis suggests that it’s probably not helping with mental health.

Linking Awareness to Mental Health

Ashleigh Haynes and colleagues published their analysis in Clinical Psychology Review. After examining data from 32 studies, they found that the negative effects of excess weight on mental health mostly depend upon whether people think of themselves as overweight or not. Both depression and suicide risks were higher. It didn’t matter whether a person was overweight or not. Nor did the person’s age or gender matter. Awareness was the critical link.

Of course, these data are observational. They can neither prove nor disprove that screening for excess weight will cause harm to mental health. But they are a signal for caution. The elevated risk of depression and suicide is nothing to dismiss.

A Therapeutic Model

At the core of competent obesity care, a solid therapeutic relationship between patient and provider is essential. Elizabeth Sturgiss and Chris van Weel explain that it depends upon mutual respect and shared decision making. Obesity is not off limits for a healthcare provider, but the first step in dealing with the subject is to ask permission. An unwelcome discussion will do more harm than good.

Furthermore, it goes without saying that if you’re not part of a therapeutic relationship, then someone else’s weight is none of your business. Just as people don’t need advice on heart disease or cancer from random others, your opinions on weight and health are not helpful.

These data on depression and suicide make it clear. Well-intended efforts to promote awareness of excess weight can do more harm than good. It doesn’t matter if it’s a workplace wellness program or a health screening at school. The possibility for real harm is great. Unintended consequences can easily overwhelm any benefits. What you don’t know can indeed hurt.

Click here for the review and meta-analysis in Clinical Psychology Review.

Still Life with Mirror, painting by Kuzma Petrov-Vodkin / WikiArt

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July 20, 2019