Fat sensitivity is a growing part of our politically correct national conversation. As the proportion of obese and morbidly obese people swells, there are calls to quell the prejudice fat people face when they are shamed for their body size. What right do other people have to judge or define me on the basis of my body size? To try to coerce or force me to adopt behaviors I very well might not want to adopt?
Several meta-analyses—studies pulling together the results of multiple smaller studies—have demonstrated that fat discrimination decreases a person’s ability to find work, to be promoted and to be paid a fair wage. Excessive weight in women has been found to decrease their wages by as much as 9%. Toby Cosgrove, past CEO of the Cleveland Clinic, famously advocated a policy of refusing to hire obese workers.
On the other hand, employers do have a financial stake in having a healthy workforce. The Conference Board, a nonprofit business membership and research organization, estimated that obese workers cost employers in the U.S. an estimated $45 billion annually in lost workdays and medical expenditures. Employers providing health insurance for their workers have significantly higher per capita health care costs for their obese versus their non-obese workers.
So, who is right in this debate? “It’s my damn body, leave me alone!” versus “It’s our bottom line!”
From a public health perspective, obesity is an epidemic, with serious population-level health consequences. Diabetes, heart disease, stroke, cancer—the chronic diseases that are the leading causes of death in this country are all exacerbated by obesity. As a nation, we have become significantly less healthy and much of that is attributable to our excessive weight and lack of healthy behaviors.
For me, the issues come down to two questions. First, should everyone who is overweight or obese lose weight? Second, what are the most effective ways to encourage someone to lose weight?
About six months prior to starting my healthy lifestyle, I decided to stop trying to lose weight. My entire life had been spent losing weight or gaining it all back again. I felt like I was on a perpetual diet. So, I just stopped dieting. In those six months, I gained an additional twenty-five pounds. My weight was not stable and was causing several serious health issues for me. If I had not changed my lifestyle, I have no doubt that my life would have been significantly shortened.
If you have read other posts I’ve written, you know that my obesity had undermined my emotional health and self-image. In many ways, my emotional and spiritual obesity were far more caustic to me than my physical obesity.
I know that there are obese people who are stable in their weight, who have a healthy self-image, and who are physically active. For those physically fit and overweight people, there is no reason for them to lose weight.
I think emotional and physical health should be the markers for whether or not someone should be embarking on a lifestyle change. I will also note that this is just as true for underweight people who are not physically fit. I will even go farther: whether we like it or not, an exercise regime is something we should all be following.
That answers the “who” question in my mind. The “how” question is more complex. You cannot make someone lose weight and exercise. You might be able to coerce them for short periods of time. But. To change my lifestyle, the way I eat, the way I follow healthy behaviors—I have to want to do that. You can’t do it for me. I have admitted that I am a recovering food addict. Are we so naïve as to think that we can just tell addicts to quit and they will?
Obesity is a wicked problem, both at the individual and the population levels, and wicked problems don’t have any quick-fix solutions. Fat-shaming, or hanging signs at an elevator to encourage someone to take the steps instead will only increase the divide. Like other addiction treatments, real solutions are likely to be multi-modal: medications or surgery, counseling, exercise therapy, group support and education. I hope more physicians become skilled in having the “we need to talk about your weight” conversation. Perhaps re-framing that question to one that is asked of all patients—“what do you do to be physically active?”—is a place to start. And, if the answer to that question is “nothing,” perhaps that physician can help that individual find a starting point that is comfortable and achievable. Help someone help himself to take the first step.