The Embrace

Rejecting Shame but Struggling with Acceptance

Medical ethicist Arthur Caplan is struggling. On one hand, he knows shaming people with obesity is clearly wrong. But while he rejects outright shame for people with obesity, he’s struggling with with the idea of acceptance.

He decided to talk about this because he was watching the Emmy Awards and Lizzo came on. “For those who don’t know, she’s an African American woman who’s overweight,” he writes. He goes on to say, “She’s a great singer, but heavy to the point where it’s clear that there is obesity.”

Then he gets to what seems to be his main point:

“Medicine, in particular, has to speak up and say that there are going to be consequences if you are morbidly obese or very heavy with high risk. You’re going to wind up with many medical problems. Society has an interest in not having that happen because of the huge costs associated with those medical problems.”

Visual Diagnosis of Obesity

There are two problems embedded in Caplan’s commentary. First and foremost is his presumption that obesity is a visual diagnosis and that he can assess her health based upon watching her perform on television. It’s not and he can’t. He’s not a physician and she is not his patient. He is a medical ethicist with a PhD, though, and thus he should be familiar with the ethical problems of armchair diagnosis.

Obesity is not purely a disease of size and well-controlled obesity does not mean that a patient of large size becomes petite. It is rather more complex than that, and as Fatima Cody Stanford recently explained, a person with obesity can have their condition under control and still be living at a high weight.

Unsolicited Advice

The second big problem is all about unsolicited advice. Caplan’s assertion that “medicine has to speak up” about someone judged to have a body that’s too large is simply wrong. This is not to say that anyone should be in denial about the reality of obesity and the risks it presents for health. But no, every doctor everywhere doesn’t need to pipe up every time they spot someone who might have obesity. Nor do random members of the public.

Unsolicited medical advice is a violation of the ethical principle of respect for autonomy.

Dehumanizing People with Obesity

This brings us to a new call to action from Australia. Blake Lawrence and colleagues have published a fine summary of harm to public health from weight stigma. They describe how public discourse about obesity often stereotypes and dehumanizes persons living with it. They write:

“The core discourse is the idea that the consequences of obesity have the potential to prompt people to take action about their weight.”

But that idea doesn’t help. In fact, it compounds the harm of obesity and makes good health outcomes less likely because of the stress and self-stigma it heaps on people.

A better starting place is to accept and embrace the humanity of all people of all sizes and shapes. Leave the medical advice to their personal doctors. Lizzo’s health is not your problem, Dr. Caplan.

Click here for Caplan’s commentary and here for the call to action from Australia. To read about an earlier swipe at this problem by Caplan, click here.

The Embrace, painting by Diego Rivera / WikiArt

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October 28, 2022

One Response to “Rejecting Shame but Struggling with Acceptance”

  1. October 28, 2022 at 11:58 am, Angela Golden said:

    YES and way to go Ted. Once again you stand up and call out those that are misplacing their time and energy. Obesity is a chronic disease that should be a diagnosis discussed between the person and their healthcare provider of choice not someone watching them from afar!