COMMENTARY

Should We View Obesity as Normal and Okay?

Arthur L. Caplan, PhD

Disclosures

May 08, 2018

Hi. I'm Art Caplan and I'm at the Division of Medical Ethics at the NYU School of Medicine. About a week ago I paid a visit to the NYU hospital. I need knee surgery. It's coming up relatively soon and I had to meet with the orthopedic surgeon.

One thing that I noticed while I was in the waiting room was that the chairs were enormous. These chairs were double and triple the size of what I think of as a normal-size chair. I realized that they were there because we have an obesity epidemic in this country. What we are doing is resizing the world to accommodate people who are overweight. Those chairs are one example, but many people, particularly women, say that dress sizes have shifted and what used to be size 10 is labeled size 8, even though it is still a bigger size.

Clearly, we are trying to accommodate larger people in many areas of life. When you build a stadium or a theater today, the seats are bigger, and so on. This leads to the question of fat acceptance. We have a battle going on. In particular, some celebrities, some people in fashion, and some models are saying that fat is normal, fat is something we should accept; we shouldn't discriminate against it, we shouldn't be biased against it, and we certainly shouldn't shame someone who is overweight.

It's an interesting problem, because I think we do have to resize the world; there's no point in making chairs that large people can't sit in. The airline industry certainly knows something about that. They get complaints when they don't make more space for large people. The reality is that obesity is causing tremendous health problems in this country. It is causing the diabetes epidemic. We have all kinds of arthritis problems. We have many weight-associated health issues, and the only solution to these issues is to get us to try to lose weight. That is not something that is arguable or that the facts don't bear out. It's simply true.

Arguing that fat is normal is different from arguing that we shouldn't shame people because they're fat. I think we should not concede that being fat is normal because it is unhealthy. It is clear that doctors are going to have to address patients' weight issues when they have them, and many patients do. That doesn't mean that we should be shaming people. After all, if 40%-50% of Americans are overweight, then it's clear that a lot of us struggle to solve and cope with this problem. We don't have great behavioral strategies that let us lose weight easily.

We're still in a situation, in other words, where somebody might say, "I would like to lose weight" but it's just hard for them to do. There isn't any evidence that shaming somebody—literally calling them out and saying, "Aren't you embarrassed? Don't you have any self-respect?"—works in getting people to lose weight. We've got to manage an obesity epidemic. We've got to acknowledge that we have too many people who are too fat. We shouldn't buy the line of argument that's heard in some circles, which says fat is normal. It may be common, but it shouldn't be accepted as normal.

On the other hand, shaming people, causing them anxiety and emotional distress about it—I don't think that's going to solve the problem. That's not going to help. We're walking a fine line. I don't think we should be accepting the idea that all of us are fat and that's just the way it is, or that it's just part of being a normal human being. It isn't. That's only a recent problem, as we have too many calories that are too tempting and we struggle with that. We have to work with patients to find ways that they can diet, that they can exercise, that they can try to do something to lose some of that weight.

Shaming? No. But accepting fat as normal? I wouldn't go down that road either.

I'm Art Caplan, at NYU School of Medicine. Thanks for watching.

Talking Points: Should We View Obesity as Normal and Okay?

Issues to consider:

  1. Some physicians feel that doctors who "fat shame" patients can cause mental and physical harm to patients.

  2. It's been suggested that fat shaming by a medical professional can lead patients to postpone seeking healthcare or avoid interacting with doctors.

  3. Others believe that by normalizing obesity, we are normalizing unhealthy behaviors that could lead to serious health conditions.

  4. There are more obese and "plus-size" models and actors in movies and television than ever before, leading some health professionals to worry that obesity is being normalized and that fewer obese people will be motivated to lose weight.

  5. Some healthcare professionals say that overweight people are often not included in medical research, based on assumptions about their health status.[1]

  6. In one study of over 300 autopsy reports, obese patients were 1.65 times more likely than others to have significant undiagnosed medical conditions.[1]

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