Great Cormorant, Little Egret, and Gadwall Duck in Taudaha Lake, near Katmandu, Nepal

Obesity, Cancer, and Other Unmentionable Health Conditions

A new essay in the AMA Journal of Ethics raises a surprising question. Should obesity be an unmentionable health condition? Does its diagnosis do more harm than good? Kristen Hardy writes instead about healthcare for fat people. She does not like the diagnosis of obesity because, she writes, “‘excess weight’ is a myth. Fat people enrich humanity in a biological sense, through genetic and physiological diversity, not only in a sociocultural one.”

She explains that “‘overweight’ and ‘obesity’ are terms that ‘otherize’ and do harm to members of the fat community by representing fatness as an abnormal condition.”

Pathologizing People

Hardy’s essay makes some good points about the harm that weight bias does to people in healthcare. But the problem is not the diagnosis of a disease pathology. The problem is the confusion of that disease with a person’s identity. With obesity, this is especially hard because when the body fails to regulate fat tissue, the effects go beyond physiology and health. It has an effect on appearance and appearance is key to a person’s identity.

So the problem ensues – both healthcare providers and patients can have a very hard time separating the person from their disease. A consistent finding in weight bias research is that “many doctors don’t see past the fat.” This is indeed a great problem in healthcare.

People who claim fatness as their identity reject the idea that obesity is a legitimate medical diagnosis, as Hardy does in her essay. The ethical principle of medical autonomy tells us that this is a legitimate choice for an individual.

But that does not negate the fact that obesity is a real medical condition that can cause harm to every part of a person’s body. Effects on appearance are tangential. Obesity should have nothing to do with personal identity. The medical concern is the physical harm it does.

Denying that obesity is a real health concern for many people serves to deny their right to seek care for it. Hardy fails to account for this.

Unmentionable Diagnoses

For centuries, cancer was an unmentionable diagnosis. This was because of the persistent stigma that cancer equals death. So doctors did not mention it as a matter of professional ethics.

Making obesity an unmentionable diagnosis would be a mistake. While some people claim fat as their identity, many others do not. And what’s more, it is a huge mistake to equate the pathophysiology of obesity with identity or appearance. The problem with obesity is the physical harm that it does to a person’s body.

Denying this is unethical.

Click here for Hardy’s essay.

Great Cormorant, Little Egret, and Gadwall Duck in Taudaha Lake, near Katmandu, Nepal; photograph by Prasan Shrestha, licensed under CC BY-SA 4.0

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July 16, 2023