Mother and Child

Intolerance of Diversity and Medical Autonomy

“I weep.” So says a fat acceptance and eating disorder advocate who is agitated because of the guideline that emerged when the American Academy of Pediatrics spent five years analyzing reams of research on pediatric obesity, options for care, and the outcomes from that care. “Come on,” says one dietitian to another. “If you want to advocate for the medical amputation of a pre-teen’s stomach, just say that.” This kind of heated rhetoric reflects an intolerance of diversity and medical autonomy – and that is a genuine cause for weeping.

Have we become so addicted to outrage that even health professionals cannot respect the medical needs of youth and families that need care for obesity?

The Medical Ethics of Autonomy

To be clear, this kind of coercive rhetoric is unethical if used in interactions with patients. One of the most fundamental principles of medical ethics is respect for patient autonomy – the right to make medical decisions for oneself. In fact, it is a pillar of medical ethics.

So when we hear a health professional telling people that bariatric surgery is “medical amputation,” that is a cause for weeping. Because some patients can benefit greatly from these procedures. The procedures can produce durable remissions in diabetes and prevent death. Quality of life can improve greatly for people who have bariatric surgery.

No, it is not for everyone. Not by a long shot. This is one of the reasons why 99 percent of the people who are medically eligible for this procedure do not elect to have it. But the decision should not be driven by coercive rhetoric from health professionals. Not from people promoting it, nor from people seeking to stigmatize it.

Stigmatizing Medical Care for Obesity

There is great irony when someone who recognizes the harm of stigma attached to a high body weight and obesity is using heated rhetoric to stigmatize medical care for obesity. This irony is especially great when they promote stigma for both parent and child. It seems that an addiction to outrage permits even advocates against stigma to promote stigma for the sake of their fat acceptance agenda. This is a mistake.

Michelle Vicari explains why this kind of intolerance for sound medical guidance is so pernicious:

“I’m seeing lots of misinformation and bias surrounding the American Academy of Pediatrics Childhood Obesity Guideline. Comments on threads make it obvious that many have not read or understand the guidelines before posting their thoughts. Read the guideline.

“As an adolescent with obesity and without real care, I resorted to dangerous, ineffective weight loss methods. The delay in real care and treatment worsened my obesity and my related conditions. Why would we want this for our kids and teens?”

Attaching stigma to medical care for obesity is simply wrong. People who are pumping out overheated rhetoric need to look in the mirror and get a grip.

Click here to read the guideline. It helps to start with facts.

Mother and Child, painting by Egon Schiele / WikiArt

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January 13, 2023

6 Responses to “Intolerance of Diversity and Medical Autonomy”

  1. January 13, 2023 at 9:06 am, Pam Charney said:

    Bravo! Thanks for saying this. As an RD I was shocked to see such intolerance and ignorance coming from my own profession. I worked in pediatrics in the past – in a clinic that treated children who had severe obesity. I wish we had the options that are now available. The guidelines don’t say “everyone gets the same treatment”. They simply give clinicians another tool to improve care.

  2. January 13, 2023 at 3:59 pm, Neva Cochran said:

    I agree with you, Ted. I am baffled by my colleagues who seem to paint all people who live with obesity with one broad (or maybe narrow brush). It seems that do not want them to do anything that could help them lose weight whether it be through changes in eating habits, exercise, surgery or drugs. It’s their way or the highway even if the patient wants to try these and is eligible and an appropriate candidate. All those many years ago when I was “trained” as a dietitian, the emphasis was on individualizing the treatment for the patient. Where did that get lost? Okay, I’m donning my body armor and ready for the assaults and insults to begin!

  3. January 13, 2023 at 5:41 pm, John Dixon said:


    Thanks for calling this issue out with such clarity. I see this issue as the most harmful in managing those living with obesity. The issue crosses all stages of human life and includes all effective therapies and health service providers. Medical autonomy is simply ignored.

    Myths and beliefs dominate biology and science. Those seeking effective care suffer discrimination, stigma, and loss of medical autonomy. We should all look in that mirror and carefully examine how we can respect patient autonomy and work together ethically to improve the lives of those who seek help for their damaging complex condition.

  4. January 14, 2023 at 11:21 am, Michael Jones said:

    This is indeed a grievous issue that hinders efforts to provide needed help to youth (and adults) with obesity. This has been made worse by the steep decline in trust in healthcare, healthcare providers, and indeed science in general the past few years.

  5. January 14, 2023 at 1:22 pm, Joanna Strober said:

    Clearly none of this surprises me, as one of the founders of Kurbo. I still cannot get over all the hatred directed at us for creating a program that enabled children to lose weight safely. I think it’s incredibly sad that so many people want to deny access to any program that helps kids reach a healthy weight and immediately believe that it’s dangerous to teach kids to eat healthier, or quite honestly, give them tools to lose weight after they develop overweight or obesity. It’s really unfair to the children.

  6. January 17, 2023 at 12:41 pm, Asheley Skinner said:

    God bless you. That’s really all I have to say.