What is it about obesity that gets under people’s skin? People who are obese are treated as pariahs on society. They’re discriminated against and are also less likely to get married, have a family and get paid less than their thinner counterparts.

newman norm

The stigma of obesity is all around us, like in the media, where people who are overweight or obese are often shown eating unhealthy food, sitting down in unflattering poses and wearing unflattering clothing. In cartoons, movies and TV shows people with obesity are portrayed in a negative light, being the villain or being dumb (or both). Remember the character Newman from Seinfeld or before that, Norm from Cheers who never left his seat? As a result, people think it’s okay to treat obese people this way, and for obese people, it creates a society where they feel unwelcome.

Stigma even occurs in health care. A recent example of ‘fat shaming’ was cited in an obituary of a woman who died of cancer saying that the health issues she was suffering were all pinned on her weight without further investigation. Years ago some physicians in our clinic discussed starting an obesity clinic. Not all were on board, citing challenges with effective treatment and some even not hiding their displeasure for seeing obese people.

Why is there all this stigma towards obesity? It’s no secret that many people believe that if you’re overweight or obese that it’s the cause of eating too much and exercising too little. As a result, people think obese people are lazy, don’t care and can’t control how much they eat. Sure, those two things do factor into it but as I’ve discussed before, it’s far more complex and includes things from a person’s biology to the environment they live in.

About 15 years ago the Canadian government announced $30 million in research funding targeted to the prevention and management of obesity. A great step forward a lot of us thought. But the public response was quite cynical and can be summed up by a letter to the editor I read that simply said: “Eat less and move more. Now give me the $30 million.”

But lifestyle factors such as diet and exercise have a role in many other risk factors as well such as high cholesterol, blood pressure or blood sugar. Why do we not hear of cholesterol shaming, or blood pressure shaming? It seems that if we know someone taking medication for their blood pressure or cholesterol we feel they’re unfortunate. We don’t make them feel like losers (nor should we). We’ll often laugh too if a person says they can eat even more fatty foods because they’re taking a pill for their cholesterol. Can you imagine what comments would arise if someone who was obese decided to eat more knowing they were taking a prescribed medication for weight loss?

Tess

The big difference is that you can see obesity, you can’t see high cholesterol and high blood pressure. Although, I’m not so sure that if we could tell if someone has high blood pressure just by looking at them, we would treat them as poorly. In our society, image is a big thing. One only has to browse the supermarket magazine rack or join Instagram to realize the promoted body type is thin. However, times are changing with attempts to put people with obesity in a more positive light, yet that still meets criticism like Tess Holliday being on the cover of Cosmopolitan.

For some people, there is an unconscious bias. For example, having chairs with arm rests makes it hard for larger people to comfortably sit in them. It may not be intentional to make those people feel uncomfortable but that is the result, and a simple fix can include chairs without arm rests or bench seating. Of course it’s difficult to see the world through another’s eyes, but that doesn’t mean we shouldn’t try.

Sometimes the bias is intentional. If, as a society (or even as an individual), we believe obesity is a thing of individual responsibility, then it absolves us of responsibility. We don’t need to spend resources in creating supports and solutions for obese people. We don’t need to consider how our food is made because it’s your fault if you eat it and get obese. We don’t need to support the creation of communities that encourage physical activity because it’s your fault if you aren’t active.

This notion of individual responsibility is even promoted in some of the most influential health organizations in the world. The American Heart Association, arguably a leader in heart disease that sets recommendations many other organizations follow has decided that weight is a health behaviour. This is unconscionable and as Chair of the AHA’ Obesity Committee, my committee is pushing back at this gross misunderstanding and are getting support from The Obesity Society.

There are definite concerns with obesity that can’t be ignored and the absence of fat shaming does not mean the promotion of obesity. Obesity is a risk factor for a myriad of diseases like diabetes, heart disease and some cancers. There are also physical consequences such as back pain and arthritis in the knee. And even mental health issues associated with obesity.

airport check in

There are other real issues with obesity that aren’t health related. One that often comes up is the issue of air travel in two ways. You don’t have to be obese to realize how small airplane seats are now. For someone who has a larger build, this is terribly uncomfortable and can affect the space of the person in the next seat. Should obese people be required to purchase two seats, or given two seats for the price of one?

What about the effect on the weight of the plane? In order to keep costs down, airlines have focused a lot of attention in this area. At the same time the average weight of the passenger has climbed. In larger planes this may not be a problem but for smaller planes, weight allowances must be adhered to for safety reasons. Some have suggested people pay for their ticket based on their weight. That might seem fair if you believe obesity is well within an individual’s sole control, but that isn’t the case. Otherwise obesity rates wouldn’t differ across countries and populations. The only real fair answer is to treat people equally.

Obesity is not new. It’s been around as long as there have been organized societies, but right now, there are a greater number of obese people than ever before and that comes with a cost to the individual and society. Therefore, we need to work together to create a society that supports health behaviours and healthy living, as well as recognize that a person’s size isn’t an indication of who they are as a person.