Caught Between Confronting Reality and Claiming Autonomy

It has long been a struggle – one of confronting the biological reality of obesity while claiming autonomy and embracing our own identity. Having our eyes wide open about obesity and health while we tell people who want to impose their judgments on us to buzz off. This is my body and my life.

Puritans and scolds in the realm of public health have made it hard.

Rejecting Medical Care

Within the movement that calls itself “Health at Every Size” (it’s a trademark) there are people who look at the advent of advanced and effective treatments for obesity with horror. Ragen Chastain, who calls herself a certified patient advocate, is unequivocal about it:

“Manipulating weight is not a path to health. The belief that fewer fat people existing is good – that’s weight stigma.”

Clinical psychologist Cheri Levinson is on board with this, saying “I don’t think there should be any form of treatment for obesity. I realize that I am at the extreme of this opinion.” Lisa Erlanger is a family medicine physician committed to practicing medicine from the perspective of “Health at Every Size.” She tells Jamie Ducharme for Time that she refuses to prescribe anything for weight management:

“I believe I have an ethical obligation not to offer a treatment with false promises.”

Caring Instead of Proselytizing

However, clinical science is making this dogmatic approach, denying the existence of obesity as a real medical condition, more difficult to defend. We already have topline results from a major study (being presented today) that show when people receive advanced medical treatment for obesity, the likelihood that they will die from heart disease, have a stroke, or have a heart attack goes down. Significantly.

Folks who are serious about caring for people with obesity have found that confronting the reality of obesity does not have to be in conflict with patients claiming autonomy for decisions about their health.

Pragmatism Versus Dogmatism

Mara Gordon is a family physician who has learned that urging patients to lose weight can cause more harm than good because, within that framework, it reinforces weight stigma. So she has tried to eliminate a preoccupation with weight in her practice. Yet, the availability of semaglutide and now tirzepatide for obesity is prompting her adapt again.

She explained to Ducharme that these drugs may truly help “If you’re facing hatred and fatphobia on a daily basis, if you can’t do the things you need to do because the chair at your office isn’t the correct size. I wish we lived in a less superficial society. But my job is to take care of the patient right in front of me.”

As medical facts about the value of obesity treatment become ever clearer, we’re betting on pragmatism to win out over dogmatism.

Click here for Ducharme’s essay about the tension between advanced obesity treatments and Health at Every Size beliefs. For outstanding perspective on the benefits and the limits of advanced obesity care, read this from Fatima Cody Stanford and Simar Bajaj.

Prometheus, painting by Jose Clemente Orozco / WikiArt

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November x, 2023