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Does Normalizing Obesity Do More Harm Than Good?

It is estimated that 44% of Americans will be obese by the year 2030. The AMA warns that increasing obesity rates will lead “to millions of additional cases of type 2 diabetes, stroke and coronary heart disease, as well as arthritis and hypertension. Billions of dollars will be wasted through lost economic productivity and skyrocketing medical costs.”

And yet, a funny thing is happening in consumer land – efforts to normalize obesity are gaining momentum via social media platforms. Take the “beauty comes in all sizes” ad for example. This was shared with me by an old grade school friend on Facebook. And while I can appreciate the sentiment that women of various genetic predispositions are beautiful, I stopped short at the idea that obesity itself was attractive. There is a growing movement among obese men and women to promote acceptance of their size, and if they win this argument they could substantially undermine efforts to help Americans become healthy and avoid disease. I know this sounds harsh, but to me, promoting beauty of all sizes – when that includes obesity- is tantamount to promoting a “smoking is cool” campaign.

Smoking rates in the United States have dropped from 42.4% in 1965 to 19% in 2010. Although one-in-five people still smoke, we have successfully reduced the smoking burden by more than half. The reasons for this reduction are complex, but they include public awareness campaigns regarding the harmfulness of cigarette smoking, increasing taxes on cigarettes, and public policy regarding where and when people can smoke in public.

The same exact approach can’t work for obesity because while people can simply quit smoking, we can’t quit eating. And what we eat is less important than how much we eat. I personally do not favor “fat taxes” on specific food items because almost any food could cause weight gain if consumed in large enough quantities. I also don’t favor singling out obese people for portion reduction at restaurants (this has actually been proposed), or other policies that are similar to what we’ve done with smoking in public spaces. Promoting prejudice against the obese is not constructive.

So that leaves us with public perception/education and peer pressure as our primary national strategy for reducing obesity rates.  (Of course smaller initiatives can help: employers can incentivize weight loss and wellness, policy makers can encourage new housing developments that promote active lifestyles, and local groups and non-profits can promote fitness initiatives and healthy eating behaviors.)

My concern is that if too many people decide that normalizing obesity is better than fighting it, America will lose this battle. Obesity-related disease is already costing us about twice as much as smoking-related illnesses. And both smoking and obesity are nearly 100% avoidable.

Obesity is not beautiful, and we must redouble our efforts to win the hearts and minds of the public on this subject without resorting to the other extreme (idolizing anorexia). Good health lies somewhere in the middle – and keeping our middles within a reasonable range is the most important health goal we have.


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3 Responses to “Does Normalizing Obesity Do More Harm Than Good?”

  1. Ben says:

    Nice article, and I totally agree that normalizing obesity might lead some people to give up a weight-loss regimen more easily, but I think the effect is likely to be pretty trivial. I think most of these campaigns are really more about anti-bullying than actually getting anyone to embrace obesity. Regardless, despite their efforts, obesity is (and will continue to be) heavily stigmatized… unlike the anti-smoking campaign, which was taking something “cool” and trying to make it “uncool”, the this obesity campaign is trying to take something “uncool” and make it “cool”… a much harder task in my opinion, and I just can’t imagine it will really do much to make people think that being fat is OK.

    Also, I’d like to correct the commonly repeated notion that obesity is driving a healthcare cost crisis. While annual costs for the obese are substantially greater than for the public at large, the average lifespans of obese individuals are so dramatically shorter that the net cost of a fat person to the healthcare system is, on average, less than for “healthy” individuals. It’s not a pleasant or desirable outcome, but we shouldn’t pretend that curbing obesity will somehow free up healthcare dollars in the long-run.

  2. Weasel says:

    I am horrified and completely offended by this article. ALL people are beautiful whether obese, skinny, tall, short, handicapped, etc. The fact that people think otherwise is one of the main causes of bullying in America. The last thing we need is for “medical professionals” to use a possible link between obesity and health concerns to fortify this line of thinking.

  3. Ben says:

    @ Weasel – You’re just playing a semantic game. Beauty is necessarily exclusionary (“attractive” people are attractive relative to less attractive people). Humans are built to size up others in large part by physical features to decide who they should mate with, who they should hunt with, who to war with, etc etc, and attempting to rebrand “beautiful” as “everybody” or “worthy” just forces us to switch to another word for beautiful that actually means something (“attractive”,”desirable”, “alluring”,”good-looking”… take your pick). Your larger point – that unattractive people have redeeming value, and that we shouldn’t use the heuristic of physical beauty to define someone’s worth – is well taken, but just calling unattractive people “beautiful” won’t help with bullying. Likewise, declaring that fat people are beautiful shouldn’t affect a physician’s obligation to encourage patients to lose weight… because the “possible link between obesity and health concerns” isn’t just “possible”, it’s “almost certain”.

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Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

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