Tale of a Girl and a Peacock

Caught Between Denial and Hyperbole on Obesity

It seems like an endless struggle. On one hand we face strident voices from some corners of public health who want to catastrophize obesity. These are the voices of moral panic. But on the other hand, we have to contend with voices who seemingly deny that obesity is a health problem. That the only problems linked to obesity comes from the adverse effects of this moral panic and stigma that results. Of course, neither denial nor hyperbole are helpful for dealing with obesity.

If you want a good understanding of how this plays out in popular media, listen with a critical ear to the current episode of On the Media – “The F-Word.”

Hyperbole and Denial About Obesity and COVID

The program starts with Yoni Freedhoff explaining the merits of going beyond BMI for diagnosis and evaluation of obesity. Anytime you can get a general audience into an accessible conversation about the Edmonton Obesity Staging System (EOSS), it’s a notable accomplishment.

Unfortunately, the conversation did not stop there. It moved on to discuss weaknesses of studies that made overstated conclusions about the very real risk poor outcomes with COVID-19 for people living with obesity. There was a good point to be made about catastrophizing the problem. But unfortunately, this segment does not offer clarity that, if you set aside the hyperbole, it’s still clear that obesity brings a higher risk of poor outcomes.

If you want a good analysis of this, it’s worth reading a recent study by Marcela Rodríguez-Flores and colleagues. Their paper offers data on the predictive value of the EOSS for COVID-19 outcomes. In short, they found that it does a better job than BMI in identifying the risks of obesity for poor outcomes with COVID. It also leaves no doubt that clinically significant obesity puts a person at risk for worse outcomes if they develop a case of COVID.

Moral Panic

One way to describe hyperbolic reporting about obesity is the framework of a moral panic. Again, On the Media does a fine job of this. They talk with Katie LeBesco about the nature of moral panics – both in regard to obesity and in other contexts. They talk to Katherine Flegal about her analysis of data that showed the mortality effects of overweight and perhaps mild obesity have been exaggerated by some researchers.

But unfortunately, they also present some iffier suggestions that BMI is a contrivance of a scheming pharmaceutical industry and the moral panic about fat has its roots in racism. These points are interesting if you want to look for conspiracies, but they might be a little overstated.

Sticking with Facts

Between the extremes of hyperbole and denial about obesity, we land on some facts to take home. In the short run, moral panic and stigma probably do more harm that obesity itself. But for the long run, there’s really no denying that this complex chronic disease can bring a great deal of harm to a person’s health and quality of life. The best strategy is simply to deal with it objectively and set aside all the hype.

Hype doesn’t help. Neither does denial.

Click here for the “The F-Word” from On the Media and here for further perspective on catastrophizing obesity. For the Rodríguez-Flores of obesity and COVID outcomes, click here.

Tale of a Girl and a Peacock, painting by Petro Kholodny / WikiArt

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July 11, 2022