Abstract
It has struck me over the past few months that, wherever you turn, someone is commenting on obesity. The term ‘obesity epidemic’ has become common parlance and I'm always noticing how ‘baddies’ in children's literature are usually fat (think of Dolores Umbridge or Dudley Dursley). The Daily Mail recently published an article urging readers to consider childhood obesity as a form of abuse, calling it a plague and suggesting that certain overweight children should be taken into care. This preoccupation is not limited to the popular press; I did a survey of my British Medical Journal (BMJ) guilt-pile (for the record, 10 copies) and found 30% had a reference to obesity on the cover alone.
My worry is that a preoccupation can so easily become prejudice. Have you ever said something along the lines of ‘she was obese, of course’? If you've ever tried to do a procedure on someone with excess adipose tissue without success it's always the factor you blame it on. The truth is, however, that lumbar punctures sometimes don't work even on slim people. And some of the fittest, thinnest people develop osteoarthritis or polycystic ovaries. While some conditions are far more common in those with a body mass index (BMI) above 30, others traditionally associated with obesity, such as fertility abnormalities and back problems, are in fact only slightly more common.
We should also remember that the causes of obesity are incredibly complex. The ‘obesogenic society’ is not a myth—we are all bombarded with opportunities and incentives to overeat and the cheapest and most appealing food is often the most fat saturated and nutritionally depleted. Socio-economic and psychological factors play a huge role but it is also estimated that genes contribute between 25 and 40% to a person's adiposity. Furthermore, we in the medical profession may exacerbate matters by missing medical conditions such as hypothyroidism or prescribing drugs, such as antipsychotics or beta-blockers, that can lead to a person gaining weight.
Demonizing overweight and obese people does nothing for society or our patients. On an individual basis, obese people should be approached with the same consideration subtlety that would be shown to anyone else. Of course, obesity may contribute to medical conditions and this should be discussed with patients. Some treatments may be inappropriate and ineffective for certain people due to their lifestyles, liver transplants for alcoholics for example, but a person's weight should not be used as a rationing tool. Sometimes, as in the case of joint replacement surgery, the illness being treated is the barrier to losing weight.
Obesity is on the increase and is more common in lower socio-economic groups and in certain areas in the country. People do make choices that lead to obesity but these decisions are based on a whole range of factors, many of which they have no control over. It is important that we are aware of these issues because our attitudes as health professionals really count. We should be fighting against the social inequalities and commercial interests that are promoting obesity while stressing simultaneously that individuals do have responsibility for their own well-being.
The idea that parents raising obese children are committing child abuse takes the prejudice to another level. It has only one merit; it recognizes that obesity is not the fault of the child. As with adult obesity, the causes are varied and complex. Feeding a child is not a form of abuse. An obese child may be loved and happy; it is just that, for whatever reason, his parents are feeding him too many calories. No parent would ever claim to be perfect, and all children are affected by their parents' faults to some degree. We should be tackling childhood obesity, but treating parents as criminals is not the answer.
So yes, obesity is a preventable and treatable condition associated with serious complications. It is not, however, a plague, or a sin, or a form of abuse.