Fat shaming to solve the obesity problem?
Why didn’t the doctors think of that? Because it doesn’t work.
Bill Maher recently addressed obesity rates in a segment on his talk show. His call for fat shaming to make a comeback has started a national conversation about weight bias. Late night host James Corden responded with an accurate and entertaining rebuttal on his own show. While I cannot match Corden’s eloquence and humor, I can add the perspective of a physician specializing in obesity medicine.
The majority of Americans are either overweight or obese. My state of West Virginia has the highest obesity rate in the nation. This epidemic is a major threat to public health. Excess weight significantly increases risk for conditions including type two diabetes, heart disease, high blood pressure, arthritis and even cancer.
While these facts are widely known, treatment is far less clear. For years, we have been told that we should be able to easily control weight with diet and exercise. This advice has failed to improve the problem, but many people continue recommending this strategy without providing additional support. This approach ignores other risk factors, including genetics, stress, sleep and even prescribed medications that may promote weight gain.
Relying on personal responsibility alone for weight regulation does not address the food environment. We are surrounded by highly processed, high-sugar foods that are nearly impossible to consistently resist. This is great for food companies’ profits, but is dangerous to our health. Almost all of us, even when well-intentioned, have personally experienced difficulty eating just one cookie or chip. This is not limited to certain people who “lack willpower.” It is normal for processed foods and the sight and smell of them to trigger a desire to eat. Yet we blame individuals rather than recognizing that the environment and our bodies’ natural tendencies are setting us up to fail.
Obesity is a complex problem requiring treatment that addresses all of the factors involved in regulating weight. Major medical organizations, including the American Medical Association and The Obesity Society, now officially recognize obesity as a disease that requires lifelong treatment.
Health insurance companies often deny coverage for effective treatments, claiming obesity is a cosmetic issue resulting from personal choice. Nobody chooses this problem. Blaming the person with this disease is a form of weight bias, and it leads to denials of care and higher costs later.
There has never been a shortage of fat shaming. Discrimination related to weight is common in school, in the workplace and even in medical settings. Studies show that fat shaming does not result in weight loss. Such practices are not only unhelpful, but actually harmful to health. Some people avoid health care because they fear judgment, which can lead to inadequate treatment of obesity and related conditions. Contrary to what Maher believes, there is actually an association between perceived weight discrimination experiences and higher weights.
Everyone should be treated with respect and have access to appropriate care, regardless of size. At West Virginia University School of Medicine, an obesity medicine curriculum teaches the harms of weight bias and trains medical students to effectively and non-judgmentally counsel patients on weight management. WVU Medicine treats obesity as the complex disease that it is, utilizing a team of various types of health professionals to provide non-surgical and surgical options. Such comprehensive approaches that are supported by evidence should become the standard.
Corden got it right. Fat shaming never left, and it does not help. The science is clear that obesity is more than a lack of willpower, so we should not tolerate the practice of blaming people for their weight. Although fat-shaming is not the answer, Maher was right about one thing: Something needs to be done because this is a public health crisis. We should demand options for unprocessed, whole foods. We should require health insurance companies to cover effective treatments. Let’s stop using a failed approach, and embrace effective strategies and policies to treat obesity and improve the health of our nation.